127 results on '"Eric Lamarre"'
Search Results
2. Utilizing Dynamic Risk Stratification in Patients With Tall Cell Variant Papillary Thyroid Cancer
- Author
-
David Zimmer, Gilman Plitt, Brandon Prendes, Jamie Ku, Natalie Silver, Eric Lamarre, Emrullah Yilmaz, Jessica Geiger, Christian Nasr, Lea El Hage, Mario Skugor, Shauna Cambpell, Shlomo Koyfman, Jacob Miller, Neil Woody, Katherine Heiden, Nikhil Joshi, Tarik Elsheikh, Hong Li, and Joseph Scharpf
- Subjects
Otorhinolaryngology - Published
- 2023
3. Prognostic value of computed tomography scan detection of cartilage invasion in advanced laryngeal cancer treated with primary total laryngectomy
- Author
-
Maxwell Y. Lee, Jonathan Lee, Sarah Stock, Mario Belfiglio, Brian Matia, Shlomo Koyfman, Nikhil P. Joshi, Brian B. Burkey, Eric Lamarre, Brandon Prendes, Joseph Scharpf, Robert R. Lorenz, Neil M. Woody, David J. Adelstein, Jessica L. Geiger, Deborah J. Chute, and Jamie A. Ku
- Subjects
Cartilage ,Otorhinolaryngology ,Carcinoma, Squamous Cell ,Humans ,Laryngectomy ,Neoplasm Invasiveness ,Prognosis ,Tomography, X-Ray Computed ,Laryngeal Neoplasms ,Neoplasm Staging ,Retrospective Studies - Abstract
We sought to determine whether detection of cartilage invasion (CI) by computed tomography predicts oncologic outcomes after primary total laryngectomy.Retrospective cohort study comparing oncologic outcomes between radiologic versus pathologic diagnosis.Assessment of clear CI versus gestalt CI resulted in 84% versus 48% specificity, 90.9% versus 80.3% positive predictive value (PPV), 60.6% versus 80.3% sensitivity, 44.7% versus 48% negative predictive value (NPV), respectively. Disease-free survival (DFS) was similar between cT4a and cT3/cT2 patients (p = 0.87). DFS trended towards superiority among pT3/pT2 versus pT4a patients (p = 0.18). DFS was similar among patients with CI on radiologist gestalt versus no CI (p = 0.94). Histologically confirmed CI was associated with a hazard ratio (HR) of 1.46 (p = 0.27), gestalt CI 1.13 (p = 0.70), and clear CI 1.61 (p = 0.10) for DFS.Gestalt determination of CI results in high sensitivity but low specificity, while clear determination of CI results in moderate sensitivity and high specificity.
- Published
- 2022
4. Association between hypertension requiring medication and <scp>30‐day</scp> outcomes in head and neck microvascular surgery
- Author
-
Brandon Prendes, Xuefei Jia, Eric Lamarre, Patrick J. Byrne, Philip R. Brauer, Peter J. Ciolek, and Jamie A. Ku
- Subjects
medicine.medical_specialty ,Reconstructive surgery ,business.industry ,Protective factor ,Free flap ,Plastic Surgery Procedures ,medicine.disease ,Free Tissue Flaps ,Surgery ,Patient safety ,Pneumonia ,Postoperative Complications ,Otorhinolaryngology ,Head and Neck Neoplasms ,Hypertension ,medicine ,Humans ,Risk factor ,Prospective cohort study ,business ,Retrospective Studies - Abstract
Hypertension has been shown to be both a protective factor and a risk factor for complications in head and neck reconstructive surgery.Retrospective analysis of microvascular free tissue transfer patients using the National Surgical Quality Improvement Program database.Hypertensive patients (n = 1598; 46.9%) had a significantly higher rate of complications, including pneumonia (p 0.001), myocardial infarction (p = 0.003), and intra/post-operative transfusion (p 0.001). In a multivariable model, hypertension was associated with returning to the operating room (OR = 1.45 [95% CI 1.20, 1.76], p 0.001), post-operative medical complications (OR = 1.53 [95% CI 1.24, 1.90], p 0.001), and surgical complications (OR = 1.17 [95% CI 1.00, 1.37], p = 0.047). However, no difference in 30-day readmission was found (p 0.05).Hypertension is a modifiable risk factor for post-operative complications in head and neck free tissue transfer, in which prospective studies are required to establish causation. This study may serve as an impetus for proactive recommendations to manage hypertension before undergoing head and neck microvascular surgery.
- Published
- 2021
5. Factors Leading to Gastrostomy Tube and Tracheostomy Requirements in Patients Treated Initially With Radiotherapy and Salvaged With Surgery and Free Flap Reconstruction
- Author
-
Patrick Tassone, Margaret Wieser, Alyssa Givens, Zachary Elliott, Ramez Philips, Joseph Curry, Louis‐Xavier Barrette, Steven Cannady, Chenge Mahomva, Eric Lamarre, Brandon Prendes, Katelyn Robillard, and Larissa Sweeny
- Subjects
Otorhinolaryngology - Abstract
Patients with recurrent oropharyngeal cancer can achieve survival benefits from surgical salvage, and often require simultaneous free-flap reconstruction. Resection and reconstruction can impact function, leading to tube dependence.describe rates of tracheostomy and gastrostomy tube dependence after oropharyngeal resection and free flap after prior radiation.evaluate patient, tumor, and treatment factors associated with tube dependence.Retrospective, multi-institutional cohort study. Patients treated from 2003 to 2020. Average follow-up 21.4 months.Five tertiary care centers.Consecutive cohort of patients undergoing resection and simultaneous free-flap reconstruction for oropharyngeal squamous cell carcinoma after head and neck radiation.gastrostomy tube dependence and tracheostomy or tracheostoma 1 year after surgery. Univariable and multivariable logistic regression were performed to identify factors associated with dependence.89 patients underwent oropharyngectomy and free-flap reconstruction; 18 (20%) underwent total laryngectomy as part of tumor extirpation. After surgery, 51 patients (57%) lived 12 months. Among patients alive at 12 months, 22 (43%) were at least partially-dependent on gastrostomy tube, and 15 (29%) had either tracheostomy or tracheostoma. On multivariable analysis, extensive glossectomy (OR 16.6, 95% CI 1.83-389, p = 0.026) and total laryngectomy (OR 11.2, 95% CI 1.71-105, p = 0.018) were associated with long-term gastrostomy tube. No factors were associated with long-term tracheostomy on multivariable analysis.Even among long-term survivors after salvage resection and free-flap reconstruction, rates of tube dependence are significant. This multi-institutional review is the largest such study to the date and may help inform shared decision-making.IV Laryngoscope, 2022.
- Published
- 2022
6. Management of Salivary Gland Malignancy: ASCO Guideline
- Author
-
Lisa Licitra, Michael G. Moore, Anna Roshal, Raja R. Seethala, Christine M. Glastonbury, Cristina P. Rodriguez, Nofisat Ismaila, Jessica L. Geiger, Harold Lau, Nicole G. Chau, Marnie Kaufman, Daniel G. Deschler, Patrick K. Ha, Beth M. Beadle, Jimmy J. Caudell, Eric Lamarre, and Paul L. Swiecicki
- Subjects
Cancer Research ,medicine.medical_specialty ,Salivary gland ,business.industry ,MEDLINE ,Guideline ,Salivary Gland Neoplasms ,Malignancy ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Humans ,Medicine ,030223 otorhinolaryngology ,business ,Intensive care medicine ,Healthcare providers - Abstract
PURPOSE To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy. METHODS ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations. RECOMMENDATIONS When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies. Additional information is available at www.asco.org/head-neck-cancer-guidelines .
- Published
- 2021
7. Outcomes of Post-Operative Treatment with Concurrent Chemoradiotherapy (CRT) in High-Risk Resected Oral Cavity Squamous Cell Carcinoma (OCSCC): A Multi-Institutional Collaboration
- Author
-
Eric Lamarre, Howard Liu, Matthew Schymick, Farzan Siddiqui, Sandro V. Porceddu, Jimmy J. Caudell, Shlomo A. Koyfman, Ahmed I Ghanem, Nikhil P. Joshi, Jamie A. Ku, David J. Adelstein, Joseph Scharpf, Neal Dunlap, Brian B. Burkey, Nancy Y. Lee, Jillian Tsai, Neil M. Woody, Brandon Prendes, L. Schwartzman, Arslan Babar, and Jessica L. Geiger
- Subjects
0301 basic medicine ,Oncology ,medicine.medical_specialty ,Perineural invasion ,cisplatin ,Article ,03 medical and health sciences ,0302 clinical medicine ,cumulative cisplatin dose ,Internal medicine ,Carcinoma ,medicine ,Adjuvant therapy ,Humans ,Oral Cavity Squamous Cell Carcinoma ,Stage (cooking) ,chemoradiation ,RC254-282 ,Neoplasm Staging ,Cisplatin ,cisplatin schedule ,business.industry ,Squamous Cell Carcinoma of Head and Neck ,Standard treatment ,oral cavity squamous cell cancer ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,high risk oral cavity cancer ,Chemoradiotherapy ,medicine.disease ,030104 developmental biology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,business ,medicine.drug - Abstract
Adjuvant chemoradiation (CRT), with high-dose cisplatin remains standard treatment for oral cavity squamous cell carcinoma (OCSCC) with high-risk pathologic features. We evaluated outcomes associated with different cisplatin dosing and schedules, concurrent with radiation (RT), and the effect of cumulative dosing of cisplatin. An IRB-approved collaborative database of patients (pts) with primary OCSCC (Stage I–IVB AJCC 7th edition) treated with primary surgical resection between January 2005 and January 2015, with or without adjuvant therapy, was established from six academic institutions. Patients were categorized by cisplatin dose and schedule, and resultant groups compared for demographic data, pathologic features, and outcomes by statistical analysis to determine disease free survival (DFS) and freedom from metastatic disease (DM). From a total sample size of 1282 pts, 196 pts were identified with high-risk features who were treated with adjuvant CRT. Administration schedule of cisplatin was not significantly associated with DFS. On multivariate (MVA), DFS was significantly better in patients without perineural invasion (PNI) and in those receiving ≥200 mg/m2 cisplatin dose (p <, 0.001 and 0.007). Median DFS, by cisplatin dose, was 10.5 (<, 200 mg/m2) vs. 20.8 months (≥200 mg/m2). Our analysis demonstrated cumulative cisplatin dose ≥200 mg/m2 was associated with improved DFS in high-risk resected OCSCC pts.
- Published
- 2021
8. Sebaceous Differentiation as Another Feature of Metatypical Adenoid Cystic Carcinoma
- Author
-
Kaitlyn D W, Ooms, Simion, Chiosea, Eric, Lamarre, and Akeesha A, Shah
- Subjects
Surgery ,Anatomy ,Pathology and Forensic Medicine - Published
- 2022
9. Primary Total Laryngectomy versus Organ Preservation for Locally Advanced T3/T4a Laryngeal Cancer
- Author
-
Maxwell Y. Lee, Mario Belfiglio, Johnathan Zeng, Christopher W. Fleming, Shlomo Koyfman, Nikhil P. Joshi, Eric Lamarre, Brandon Prendes, Joseph Scharpf, Robert R. Lorenz, Neil M. Woody, David J. Adelstein, Jessica L. Geiger, Deborah J. Chute, and Jamie A. Ku
- Subjects
Otorhinolaryngology - Abstract
Organ preservation (OP) treatment for advanced laryngeal cancer has increased compared to primary total laryngectomy. Our study compares oncologic and functional outcomes between these approaches.Retrospective cohort study.Single tertiary care institution.Retrospective review of patients receiving primary total laryngectomy or OP for laryngeal cancer between 1/1/2000 and 12/31/2018.A total of 118 patients received primary total laryngectomy and 119 received OP. Overall survival was similar between total laryngectomy and OP. When stratified by T stage, disease-free survival was worse among T3 patients receiving OP versus total laryngectomy. In T3 patients, 28 OP patients experienced local recurrence (28.9%) compared to 3 total laryngectomy patients (7.1%; p 0.01). In total, 20 OP patients with local recurrence received salvage surgery. These patients had similar overall survival to patients who underwent initial total laryngectomy (TL). About 14 OP patients with local recurrence did not receive salvage surgery. About 89 (75.4%) TL patients achieved normal diet as compared to 64 (53.8%) OP patients (p 0.001). In TL patients, 106 (89.8%) received primary or secondary tracheoesophageal-prosthesis, 82 (77.4%) of whom achieved completely understandable speech.There was no difference in survival by treatment in T4 patients, possibly because of strict patient selection. However, disease-free survival was worse in T3 patients receiving OP, likely due to a high local recurrence rate. Approximately 40% of patients with local recurrence were not eligible for salvage laryngectomy. TL patients had comparable swallowing and speech outcomes with OP patients.3 Laryngoscope, 2022.
- Published
- 2022
10. Performance of the Neck Imaging Reporting and Data System as applied by general neuroradiologists to predict recurrence of head and neck cancers
- Author
-
Jonathan Lee, Dagan Kaht, Syed Ali, Scott Johnson, Jennifer Bullen, Christopher Karakasis, Eric Lamarre, Jessica Geiger, Shlomo Koyfman, and Sarah Stock
- Subjects
Otorhinolaryngology ,Head and Neck Neoplasms ,Positron-Emission Tomography ,Humans ,Tomography, X-Ray Computed ,Magnetic Resonance Imaging ,Neck ,Retrospective Studies - Abstract
The Neck Imaging Reporting and Data System (NI-RADS) is used to assess imaging after head and neck cancer treatment. We evaluated NI-RADS with general neuroradiologists rather than with head and neck subspecialists.Computed tomography and magnetic resonance imaging examinations with/without positron emission tomography from May 2018 to September 2020 were retrospectively identified. NI-RADS scores at the primary site and lymph nodes were provided by 21 neuroradiologists. Recurrence status was based on clinical and imaging findings. Area under the curve (AUC) was used to assess accuracy.We assessed 608 scans from 464 patients. For NI-RADS categories 1, 2, and 3, primary site recurrence rates were 5%, 29%, and 65% with AUC of 0.765, while lymph node recurrence rates were 3%, 10%, and 80% with AUC of 0.820.NI-RADS as used by general neuroradiologists is effective in separating head and neck cancers into discrete categories for predicting recurrent disease.
- Published
- 2022
11. Risk Assessment in Thyroid Lobectomy and Total Thyroidectomy using Over 100 Thousand Cases
- Author
-
Eric Lamarre, Brian B. Burkey, Chandana A. Reddy, and Philip R. Brauer
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Thyroid Gland ,Thyroid Lobectomy ,Risk Assessment ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Thyroid Neoplasms ,030212 general & internal medicine ,Thyroid cancer ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Incidence ,Thyroid ,Thyroidectomy ,General Medicine ,Middle Aged ,medicine.disease ,Quality Improvement ,Surgery ,Survival Rate ,Cross-Sectional Studies ,medicine.anatomical_structure ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Cohort ,Female ,Risk assessment ,business ,Body mass index - Abstract
Objectives: To assess risk factors and non-thyroid specific postoperative complications for thyroid lobectomy compared to total thyroidectomy. Methods: A retrospective, cross-sectional study of adults undergoing a lobectomy or total thyroidectomy using the National Surgical Quality Improvement Program database between 2005 and 2017. Patients not treated by otolaryngologists or general surgeons and with unknown demographic variables were excluded. Results: A total of 106 915 patients were analyzed, 64 763 total thyroidectomies and 42 152 lobectomies. Multivariable analysis demonstrated that total thyroidectomy patients were half as likely to return to the operating room (OR = 0.491 (95%CI 0.445-0.542), P Conclusions: Our multi-institutional study indicates specific risk factors for returning to the operating room that may warrant closer follow up after surgery for total thyroidectomy or thyroid lobectomy. We also identified the most common post-operative complications. During pre-operative planning, these findings should be considered by thyroid surgeons to help mitigate risk to patients.
- Published
- 2021
12. Incidence of squamous cell carcinomas of the head and neck following prolonged pegylated liposomal doxorubicin
- Author
-
Laura M. Chambers, Lin Mei, Robert De Bernardo, Eric Lamarre, Frances Fu, Brandon Prendes, and Peter G. Rose
- Subjects
Adult ,Male ,0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,Polyethylene Glycols ,Pegylated Liposomal Doxorubicin ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Electronic Health Records ,Fallopian Tube Neoplasms ,Humans ,Pharmacology (medical) ,Head and neck ,Aged ,Retrospective Studies ,Ovarian Neoplasms ,Pharmacology ,Antibiotics, Antineoplastic ,Squamous Cell Carcinoma of Head and Neck ,Cumulative dose ,business.industry ,Incidence ,Medical record ,Incidence (epidemiology) ,Cancer ,Neoplasms, Second Primary ,Middle Aged ,medicine.disease ,Head and neck squamous-cell carcinoma ,030104 developmental biology ,Increased risk ,Doxorubicin ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Female ,lipids (amino acids, peptides, and proteins) ,business - Abstract
Despite numerous case reports, the incidence of a secondary diagnosis of head and neck squamous cell carcinoma (HNC) following pegylated liposomal doxorubicin (PLD) treatment is unknown. Computerized pharmacy records were searched at a large, multi-center healthcare system for patients who received PLD. Electronic medical records were searched to identify the patient's age at treatment initiation of PLD, diagnosis for which they were treated with PLD, number of courses and total cumulative dose of PLD (TCDPLD) and secondary malignancies. Published PLD associated HNC was utilized to determine the lowest and median TCDPLD doses associated with HNC. One thousand two hundred ninety eligible patients who had been treated with PLD were identified. The lowest TCDPLD associated HNC in the literature is 405 mg/m2. In our healthcare system, 275 patients received more than 400 mg/m2 yielding a risk of 0.004%. One hundred fifty-one patients received the lowest TCDPLD associated with HNC cancer in our series which was 640 mg/m2 yielding a risk of 0.007%. Four of 30 patients (13.3%) developed HNC who received the median TCDPLD associated with HNC in the literature of 1440 mg/m2. Five of 20 patients (25%) receiving 1650 mg/m2 developed HNC in our healthcare system. Prolonged therapy with PLD is associated with an increased risk of HNC. This risk appears to be related to the cumulative dose varying from 0.004 to 13.3% at the lowest and median TCDPLD of reported cases in the literature, respectively. Oncologists need to be aware of this risk and to screen patients appropriately.
- Published
- 2020
13. Rethinking the 10‐pack‐year rule for favorable human papillomavirus–associated oropharynx carcinoma: A multi‐institution analysis
- Author
-
Brian B. Burkey, David J. Adelstein, David D. Xiong, Daniel R. Carrizosa, Jamie A. Ku, John F. Greskovich, Brandon Prendes, Zvonimir L. Milas, Neil M. Woody, James R. Broughman, Shlomo A. Koyfman, Nikhil P. Joshi, Ashley Sumrall, Benjamin J. Moeller, Jessica L. Geiger, Eric Lamarre, Daniel Brickman, Matthew C. Ward, Kevin J. Contrera, and Catherine H. Frenkel
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Recursive partitioning ,Kaplan-Meier Estimate ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Pack-year ,Papillomaviridae ,Aged ,Aged, 80 and over ,Squamous Cell Carcinoma of Head and Neck ,Proportional hazards model ,business.industry ,Papillomavirus Infections ,Smoking ,Head and neck cancer ,Cancer ,Middle Aged ,Prognosis ,medicine.disease ,Former Smoker ,Squamous carcinoma ,Oropharyngeal Neoplasms ,Oncology ,030220 oncology & carcinogenesis ,Smoking cessation ,Female ,Smoking Cessation ,business - Abstract
Background De-intensified treatment strategies for early human papillomavirus-positive (HPV+) oropharynx cancer (OPC) rely on selecting patients with an excellent prognosis. The criterion for enrollment in current de-intensification trials is ≤10 pack-years. More nuance to the pack-year criteria may expand enrollment, improve patient outcomes, and prevent overtreatment. It was hypothesized that patients with more than 10 pack-years may experience favorable outcomes if smoking cessation has been achieved. Methods From an institutional review board-approved database, patients with HPV+ oropharyngeal squamous carcinoma treated definitively with radiation with or without chemotherapy were retrospectively identified. Patients with a history of smoking who were eligible for national de-intensification trials were included (cT1-2N1-2b or T3N0-2b [American Joint Committee on Cancer, seventh edition]). Cox regression with penalized smoothing splines was used to evaluate nonlinear effects of cessation. Recursive partitioning analysis (RPA) was used to objectively search for relationships between the 2 colinear variables (pack-years and time since cessation). Results Among 330 patients meeting the inclusion criteria, 130 (40%) were never smokers, 139 (42%) were former smokers, and 61 (18%) were current smokers. With standard therapy, all former smokers achieved a progression-free survival (PFS) rate higher than 91%, regardless of pack-year exposure. Nonlinear Cox regression demonstrated that more recent cessation was associated with significantly worse PFS even among those with ≤20 pack-years. RPA demonstrated that only current smokers experienced a 2-year PFS rate lower than 91%; former smokers, regardless of pack-years, experienced a 2-year PFS rate higher than 91%. Conclusions The 10-pack-year rule may not apply to all early HPV+ OPCs, particularly for former smokers. Future randomized de-intensification trials should consider a broader and more nuanced approach until the predictive role of smoking status is established.
- Published
- 2020
14. Poorly Differentiated Thyroid Carcinoma: Single Institution Series of Outcomes
- Author
-
SIDDHARTH KUNTE, JONATHAN SHARETT, WEI WEI, CHRISTIAN NASR, BRANDON PRENDES, ERIC LAMARRE, JAMIE KU, ROBERT R. LORENZ, JOSEPH SCHARPF, BRIAN B. BURKEY, AKEESHA SHAH, NIKHIL JOSHI, and JESSICA L. GEIGER
- Subjects
Iodine Radioisotopes ,Cancer Research ,Treatment Outcome ,Oncology ,Thyroidectomy ,Humans ,General Medicine ,Thyroid Neoplasms ,Adenocarcinoma ,Retrospective Studies - Abstract
Poorly differentiated thyroid cancer (PDTC) is a rare but aggressive subtype of thyroid cancer that portends a poor prognosis. There remains a paucity of literature on PDTC outcomes. The aim of our study was to evaluate outcomes of PDTC in our tertiary care facility.We identified all histologically confirmed PDTC cases from 1997-2018 treated at our Institution and collected data points in an IRB-approved registry. We then conducted a retrospective study to assess outcomes and identified factors associated with inferior outcomes.Twenty-three patients were identified with a median age at diagnosis of 60 years (range=39-89 years). Nineteen (83%) underwent total thyroidectomy. Eight (42%) patients had lymph node dissections and 2 (11%) underwent adjuvant radiation. Thirteen (68%) patients were treated with radioactive iodine (RAI). Those who underwent total thyroidectomy had a median overall survival (mOS) of 88 months, 5 year-OS of 56%, 5 year-local recurrence-free survival (LRFS) of 45%, and 5 year-distant recurrence-free survival (DRFS) of 36%. T4 disease had worse mOS (14 vs. 87 m, p=0.0082), and 5 year-LRFS rate (12 vs. 74%, p=0.0312) compared to T1-3. N0 disease had an improved mOS (172 vs. 32 m, p=0.0013), 5 year-LRFS rate (63 vs. 17%, p=0.0033), and 5 year-DRFS (57 vs. 0%, p=0.0252). Eight out of 23 patients (35%) were alive at last follow-up, with a median of 68 months (range=20-214). The most common cause of death was distant recurrence (73%). Six patients received systemic therapy with various tyrosine kinase inhibitors with a median duration on treatment of 7 months (range=1-30 months).Advanced T and N stage were factors associated with significantly inferior outcomes. While select patients benefited with systemic treatment, it remains unclear if intensified locoregional therapy should be considered in patients with PDTC.
- Published
- 2022
15. Tumor Volume Useful Beyond Classic Criteria in Selecting Larynx Cancers For Preservation Therapy
- Author
-
Robert R. Lorenz, Nikhil P. Joshi, Brian B. Burkey, Shlomo A. Koyfman, John F. Greskovich, Eric Murray, Eric Lamarre, J.M. Sharrett, David J. Adelstein, Joseph Scharpf, Jessica L. Geiger, Matthew C. Ward, Brandon Prendes, and Neil M. Woody
- Subjects
Male ,Larynx ,medicine.medical_specialty ,03 medical and health sciences ,0302 clinical medicine ,Larynx preservation ,Humans ,Medicine ,Registries ,030223 otorhinolaryngology ,Laryngeal Neoplasms ,Feeding tube ,Neoplasm Staging ,Retrospective Studies ,Locoregional failure ,business.industry ,Patient Selection ,Cancer ,Retrospective cohort study ,Chemoradiotherapy ,Concurrent chemoradiation ,Middle Aged ,medicine.disease ,Tumor Burden ,medicine.anatomical_structure ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Larynx Cancers ,Carcinoma, Squamous Cell ,Female ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
To investigate the association between tumor volume and locoregional failure (LRF) after concurrent chemoradiation (CCRT) for locally advanced larynx cancer (LC).This is a retrospective cohort study from 2009 to 2014 identified from an institutional review board-approved registry. Fifty-nine of 68 patients with locally advanced larynx cancer treated with definitive CCRT who had available imaging for review were identified. The main endpoint to be assessed was the association between gross tumor volumes (GTV; T = total, P = primary, N = nodal) and LRF. Receiver operative characteristic (ROC) curves were used to investigate diagnostic accuracy.Twenty LRFs were observed, resulting in a 2-year LRF rate of 39% (95% CI, 23-52%). On UVA, the GTV-T (P = .01), GTV-P (P = .05), and GTV-N (P = .04) were statistically significant predictors of LRF. Furthermore, age, smoking status, N-stage, larynx subsite, and tracheostomy/feeding tube dependence were potentially associated with LRF (P .3), whereas T-stage (T3-4 vs. T2) was not (HR 1.05, 95% CI, 0.38-2.91, P = .92). In the multivariable model, GTV-P (HR 1.022, 95% CI, 0.999-1.046, P = .07) and GTV-N (HR 1.053, 95% CI, 1.0004-1.108, P = .05) were the two most impactful covariates on the model's RGTV is associated with LRF after definitive CCRT for LC. Patients with bulky primary and/or nodal tumors may be better served with upfront surgical resection regardless of T-stage. Further investigation into the safety of larynx preservation for low-volume T4 tumors can be considered.4 Laryngoscope, 130:2372-2377, 2020.
- Published
- 2019
16. Updated Outcomes of Split Course Radiotherapy in Elderly or Infirm Patients With Advanced Cancers of the Head and Neck
- Author
-
Robert R. Lorenz, Joycelin F. Canavan, L. Schwartzman, Timothy D. Smile, Chaim Domb, Shauna R. Campbell, Shlomo A. Koyfman, Brandon Prendes, Eric Lamarre, John F. Greskovich, Nikhil Joshi, Lamie A. Ku, Chandana A. Reddy, Brian B. Burkey, Jessica L. Geiger, Deborah J. Chute, Neil M. Woody, Joseph Scharpf, and C.W. Fleming
- Subjects
Male ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Treatment intensity ,medicine ,Split course ,Humans ,Cumulative incidence ,Head and neck ,Aged ,Radiotherapy ,Cumulative dose ,business.industry ,Head and neck cancer ,General Medicine ,medicine.disease ,Prognosis ,Radiation therapy ,Survival Rate ,Oncology ,Head and Neck Neoplasms ,Female ,Radiology ,Dose Fractionation, Radiation ,Neoplasm Recurrence, Local ,business ,Split course radiotherapy ,Follow-Up Studies - Abstract
BACKGROUND/AIM Head and neck cancers are often treated with extended courses of radiotherapy (RT), which may prove excessively toxic for frail patients. Split course RT (SCRT) delivers two courses of RT separated by 4-6 weeks, personalizing treatment intensity based on response. In this study, we present our updated experience using this technique. PATIENTS AND METHODS From a single institution database, we identified patients considered for SCRT. For patients undergoing a second course of RT, cumulative incidence of locoregional recurrence (LRR) and overall survival (OS) are reported. RESULTS A total of 98 patients were included, of whom seventy-five percent underwent a second course of RT. The most common fractionation was 30 Gy in 10 fractions for each course, with a median cumulative dose of 60 Gy. In those undergoing a second course of RT, median OS was 9.7 months and cumulative incidence of LRR at 6, 12, and 24 months was 17.0%, 23.1%, and 29.4%, respectively. CONCLUSION SCRT offers an attractive treatment paradigm to personalize radiation intensity based on patient tolerance, while maintaining reasonable safety and efficacy in those unfit for standard full course RT.
- Published
- 2021
17. Predictive value of the ACS NSQIP calculator for head and neck reconstruction free tissue transfer
- Author
-
Maxwell Y. Lee, Eric Lamarre, Kate Clancy, Peter J. Ciolek, Janki Shah, Michael A. Fritz, and William S. Tierney
- Subjects
Male ,medicine.medical_specialty ,Free flap ,Free Tissue Flaps ,Risk Assessment ,law.invention ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,law ,Clinical Decision Rules ,medicine ,Humans ,030223 otorhinolaryngology ,Head and neck ,Aged ,Retrospective Studies ,business.industry ,Incidence ,Length of Stay ,Middle Aged ,Plastic Surgery Procedures ,Quality Improvement ,Predictive value ,United States ,Otorhinolaryngologic Surgical Procedures ,Surgery ,Tissue transfer ,Acs nsqip ,ROC Curve ,Otorhinolaryngology ,Brier score ,Calculator ,030220 oncology & carcinogenesis ,Current Procedural Terminology ,Female ,business ,Forecasting - Abstract
BACKGROUND Predictive models to forecast the likelihood of specific outcomes after surgical intervention allow informed shared decision-making by surgeons and patients. Previous studies have suggested that existing general surgical risk calculators poorly forecast head and neck surgical outcomes. However, no large study has addressed this question while subdividing subjects by surgery performed. OBJECTIVES To determine the accuracy of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator in estimating length of hospital stay and risk of postoperative complications after free tissue transfer surgery. STUDY DESIGN A retrospective chart review of patients at one institution was performed using Current Procedural Terminology codes for anterolateral thigh (ALT) flap, fibula free flap (FFF), and radial forearm free flap (RFFF) reconstruction. Output data from the ACS NSQIP surgical risk calculator were compared with the observed rates in our patients. METHODS Incidences of cardiac complications, pneumonia, venous thromboembolism, return to the operating room, and discharge to skilled nursing facility (SNF) were compared to predicted incidences. Length of stay was also compared to the predicted length of stay. RESULTS Three hundred thirty-six free flap reconstructions with 197 ALT flaps, 85 RFFFs, and 54 FFFFs were included. Brier scores were calculated using ACS NSQIP forecast and actual incidences. No Brier score was
- Published
- 2019
18. Second Primary Head and Neck Malignancies in Patients With Prior Human Papilloma Virus (HPV) Associated Oropharyngeal Squamous Cell Carcinoma (OPSCC) Treated With Radiation
- Author
-
Shauna R. Campbell, L. Schwartzman, E. Ilori, Joseph Scharpf, Brandon Prendes, Joycelin F. Canavan, B. Matia, Eric Lamarre, Jessica L. Geiger, David J. Adelstein, Brian B. Burkey, J. Ku, Shlomo A. Koyfman, Chandana A. Reddy, Neil M. Woody, and Robert R. Lorenz
- Subjects
Cancer Research ,medicine.medical_specialty ,Radiation ,business.industry ,Adenosquamous carcinoma ,Incidence (epidemiology) ,Cancer ,Salvage therapy ,Retrospective cohort study ,medicine.disease ,Malignancy ,Squamous carcinoma ,Oncology ,Median follow-up ,Internal medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,business - Abstract
Purpose/Objective(s) The outcomes of second primary head and neck malignancies in survivors of HPV associated OPSCC treated with radiation have not been well documented. The purpose of this study was to review the rate, management, and outcomes of non-metastatic second head and neck malignancies in patients with a history of HPV positive OPSCC treated with definitive or postoperative radiation (RT). Materials/Methods This is a single institution IRB approved retrospective study of patients with HPV positive OPSCC treated from 2001-2017 with definitive radiation and at least 3 years of follow up. Diagnoses were considered to be a second head and neck malignancy if they were distinct from index OPSCC with the exclusion of a primary or regional recurrence, primary site > 2 cm from the index OPSCC, and occurred at least 2 years from prior RT. Patients with second malignancies involving the thyroid were excluded. Actuarial analysis was used to calculate overall survival and disease control rates. Results There were a total of 418 patients who met inclusion criteria with a median follow up of 88.5 months (50.9-150.9 months). A total of 11 patients (2.6%) developed a second primary malignancy in the head and neck (2 larynx, 1 nasal cavity, 6 oral cavity and 2 oropharynx) and all were treated with definitive surgery. Median time between first and second cancers was 73 months (25-123 months). Median follow up for these patients was 25.4 months (7.7-69 months) and the median age at second malignancy was 65 years (range 54-73 years). 64% of patients were former smokers (quit > 3 months) and 36% were never smokers. Pathological tumor stage of the second cancer was T1 in 36%, T2 in 27%, T4a in 36%. The histology was squamous cell carcinoma in 9 patients, spindle cell squamous carcinoma in 1 patient, and adenosquamous carcinoma 1 patient. HPV status was negative in 45.5%, positive in 18.2% and unknown in 36.4%. Post-operative re-irradiation was given in 55%, of which 50% received concurrent chemotherapy. Locoregional control rates at 12 and 24 months were 100% and 62.5% (95% CI: 28.9-96.1%), respectively. Of the 2 patients with local failure, which occurred at 18 and 33 months after diagnosis, salvage therapy with surgery was successful. Regional failure was diagnosed in 2 patients at 13 and 16 months after diagnosis, and both of these patients ultimately died as a result of regional failure. There were no distant failures. One additional patient had died at last follow up which was unrelated to cancer. Estimated 2-year overall survival from the second head and neck malignancy was 78.9% (95% CI: 53.0-100%). Conclusion The risk of a second head and neck malignancy in survivors of HPV associated OPSCC is low, but as the incidence of HPV related OPSCC remains elevated and the likelihood of cure is excellent, secondary malignancy is an important long-term risk. Despite prior RT, consideration of post-operative re-irradiation is important as regional failure may carry a poor prognosis.
- Published
- 2021
19. Evaluating the impact of the degree of extranodal extension on outcomes in locally advanced oral cavity cancer
- Author
-
Anirudh Yalamanchali, Christopher Griffith, Chandana A. Reddy, Shlomo A. Koyfman, Neil McIver Woody, Shauna Campbell, Natalie L. Silver, Joseph Scharpf, Robert R Lorenz, Brandon Prendes, Jamie Ku, Eric Lamarre, and Jessica Lyn Geiger
- Subjects
Cancer Research ,Oncology - Abstract
e18058 Background: The presence of extranodal extension (ENE) in oral cavity cancer is associated with a higher risk of distant metastasis and worse overall survival (OS). Trials show that patients with locally advanced head and neck cancer and ENE benefit from concurrent chemoradiation over radiation therapy alone.We explored whether degree of ENE impacts survival outcomes in individuals with oral cavity cancer. Methods: From an IRB-approved database of 303 pts with locally advanced oral cavity cancer treated with surgical resection between 2001-2020, patients with pathologic ENE who received adjuvant treatment were included. Patient demographics, tumor staging, treatment information, disease recurrence, and survival were collected. Surgical slides were reviewed to confirm the extent of ENE. All staging was updated to AJCC 8th edition. Cox proportional hazards regression was used to relate patient, tumor, or treatment characteristics with either disease-free survival (DFS, composite of disease recurrence and death) or OS, from the time of radiation therapy completion. ENE was analyzed as both a dichotomous variable (major if > 2 mm, minor if ≤2 mm) and as a continuous variable in the subset of patients for whom exact ENE extent could be confirmed. Results: A total of 113 patients were identified who underwent surgery and adjuvant therapy for advanced oral cavity cancer with ENE, with 35 having major ENE and 78 having minor ENE. Forty-one patients had T1-T2 disease while 72 had T3-T4 disease. Additionally, 24 had N2a disease and 89 had N3b disease. Of these, 78 received concurrent chemoradiation while 35 received radiation therapy alone. Ninety-nine patients had pathologic slides available for review to determine exact ENE extent. Median ENE distance was 1 mm (IQR 1-2, range 0.1-10). With a median follow up time of 22.3 months, there were 48 recurrences and 67 deaths. Median DFS was 21.3 months (95%CI 11.1-33.2) and median OS was 29.9 months (95%CI 20.6-66.6). Between major vs minor ENE, there was no statistically significant difference in DFS (HR 1.18, 95%CI 0.72-1.92, p = 0.51) or OS (HR 1.17, 95%CI 0.70-1.96, p = 0.55). Furthermore, there was no statistically significant association between ENE as a continuous variable and DFS (HR 0.97 per mm, 95%CI 0.87-1.4, p = 0.96) or OS (HR 0.96 per mm, 95%CI 0.83-1.11, p = 0.58). The benefit of concurrent chemotherapy on OS was not seen (HR 0.74, 95%CI 0.44-1.22, p = 0.24), though those patients on average had more advanced nodal disease (85% N3b vs 66%). Conclusions: No significant relationship was seen between extent of ENE and DFS or OS in individuals with locally advanced oral cavity cancer. This analysis was limited by the small number of patients, that most patients had ≤2 mm of ENE, and the presence of confounding risk factors such as nodal stage and receipt of chemotherapy. Overall, the effect of the degree of ENE on outcomes in advanced oral cavity cancer remains unclear.
- Published
- 2022
20. Post-treatment sequelae and management of primary laryngeal NK/T-cell lymphoma: A case report
- Author
-
Eric Lamarre, Andrea Hanick, Paul C. Bryson, and Joseph B. Meleca
- Subjects
Adult ,Larynx ,medicine.medical_specialty ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Sore throat ,Humans ,Medicine ,T-cell lymphoma ,Airway Management ,030223 otorhinolaryngology ,Laryngeal Neoplasms ,Laryngoscopy ,business.industry ,Chemoradiotherapy ,respiratory system ,medicine.disease ,Tracheal Stenosis ,Lymphoma, Extranodal NK-T-Cell ,Stenosis ,medicine.anatomical_structure ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Female ,Airway management ,Radiology ,medicine.symptom ,business ,Laryngeal Stenosis ,Airway - Abstract
Outcome objectives 1. Describe the presentation and treatment options of laryngeal NK/T-Cell lymphoma 2. Discuss post-chemoradiotherapy sequelae and airway management Methods Case Report, April 2016. Results A 27-year-old female presented with a three-week history of flu-like symptoms including sore throat, myalgia and insidious nasal congestion. Her hospital course was complicated by pancytopenia, extensive GI bleed of unknown origin and fever. Radiographic studies revealed multifocal centrilobular ground-glass lung nodules, splenomegaly, frontal and paranasal sinus opacification and mucosal thickening and inflammatory process of false and true vocal cords with concentric multi-level narrowing. Extensive rheumatologic, hematologic and infectious workup failed to demonstrate an etiology. Flexible laryngoscopic and bronchoscopic examinations with biopsies exhibited a diffuse supraglottic and glottic exophytic, “heaped-up” infiltration; limited vocal cord motion; and airway narrowing to 3 mm. Pathology yielded NK/T-Cell lymphoma with PET/CT confirming nasopharyngeal and laryngeal involvement sparing the brain and other distant structures. During treatment, the patient's airway became increasingly compromised requiring tracheostomy. Flexible laryngoscopic examination after four rounds of SMILE (dexamethasone, methotrexate, ifosfamide, l-asparaginase, and etoposide) chemotherapy and subsequent radiotherapy with 50 Gy in 25 fractions revealed complete glottic stenosis with alteration of the laryngeal anatomy and a pin-hole aperture seen posteriorly through the tracheostomy. Two dilation procedures performed one month apart, improved her airway considerably which allowed for successful decannulation. She continues to be disease-free post treatment but has persistent supraglottic and glottic scar and has developed tracheal stenosis at her tracheostomal site. Conclusions NK/T-Cell lymphoma of the larynx has been rarely described. Herein, we describe the sequalae of treatment and the requisite airway management.
- Published
- 2018
21. Free-Tissue Transfer in the Endoscopic Era: Evolving Role of the Top Tier of Skull Base Reconstruction
- Author
-
Michael A. Fritz, Satyan B Sreenath, Eric Lamarre, Varun R. Kshettry, Dennis Tang, Raj Sindwani, Pablo F. Recinos, Troy D. Woodard, and Scott Roof
- Subjects
Skull ,medicine.anatomical_structure ,business.industry ,medicine ,Anatomy ,Base (topology) ,business ,Tissue transfer - Published
- 2021
22. Failure rate in the untreated contralateral node negative neck of small lateralized oral cavity cancers: A multi-institutional collaborative study
- Author
-
Sandro V. Porceddu, Chandana A. Reddy, David J. Adelstein, Brian B. Burkey, Neil M. Woody, Jimmy J. Caudell, Howard Liu, Eric Lamarre, Farzan Siddiqui, Jessica L. Geiger, Nikhil P. Joshi, Matthew Schymick, Neal Dunlap, Ahmed I Ghanem, Laura Tam, and Shlomo A. Koyfman
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Multivariate analysis ,medicine.medical_treatment ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Medicine ,Humans ,Cumulative incidence ,Oral Cavity Squamous Cell Carcinoma ,030223 otorhinolaryngology ,Aged ,Retrospective Studies ,Aged, 80 and over ,Adjuvant radiotherapy ,business.industry ,Incidence (epidemiology) ,Retrospective cohort study ,Middle Aged ,Node negative ,Radiation therapy ,Oncology ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Female ,Mouth Neoplasms ,Radiology ,Lymph Nodes ,Oral Surgery ,business - Abstract
Objectives The importance of treating the bilateral neck in lateralized small oral cavity squamous cell carcinoma (OCC) is unclear. We sought to define the incidence and predictors of contralateral neck failure (CLF) in patients who underwent unilateral treatment. Materials and methods We performed a multi-institutional retrospective study of patients with pathologic T1-T2 (AJCC 7th edition) OCC with clinically node negative contralateral neck who underwent unilateral treatment with primary surgical resection ± adjuvant radiotherapy between 2005 and 2015. Incidence of CLF was estimated using the cumulative incidence method. Clinicopathological factors were analyzed by univariate (UVA) and multivariate analysis (MVA) for possible association with CLF. Kaplan-Meier analysis was used to estimate overall survival (OS). Results 176 patients were evaluated with a median of 65.9 months of follow-up. Predominant pathologic T-stage was T1 (68%), 8.5% of patients were N1, 2.8% were N2b. Adjuvant radiotherapy was delivered to 17% of patients. 5-year incidence of CLF was 4.3% (95% CI 1.2–7.4%). Depth of invasion (DOI) > 10 mm and positive ipsilateral neck node were significant predictors for CLF on UVA. DOI > 10 mm remained significant on MVA (HR = 6.7, 95% CI 1.4–32.3, p = 0.02). The 2- and 5-year OS was 90.6% (95% CI 86.2–95.0%) and 80.6% (95% CI 74.5–86.8%), respectively. Conclusion Observation of the clinically node negative contralateral neck in small lateralized OCC can be a suitable management approach in well selected patients, however caution should be applied when DOI upstages small but deeply invasive tumors to T3 on 8th edition AJCC staging.
- Published
- 2020
23. Characteristics and Outcomes in Head and Neck Sarcomatoid Squamous Cell Carcinoma: The Cleveland Clinic Experience
- Author
-
Eric Lamarre, Neelab Abdullah, Brian B. Burkey, Adeeb Derakhshan, Shlomo A. Koyfman, Deborah J. Chute, and Katie Mingo
- Subjects
Adult ,Male ,medicine.medical_specialty ,Head (linguistics) ,Treatment outcome ,03 medical and health sciences ,0302 clinical medicine ,Chart ,Medicine ,Humans ,Basal cell ,030223 otorhinolaryngology ,Head and neck ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Squamous Cell Carcinoma of Head and Neck ,Head and neck cancer ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Treatment Outcome ,Otorhinolaryngology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Female ,Radiology ,business - Abstract
Objectives: To analyze characteristics, treatment outcomes, and prognostic factors of sarcomatoid squamous cell carcinoma of the head and neck. Study Design: Retrospective chart review. Setting: Tertiary care center. Subjects and Methods: Fifty-five patients were treated for sarcomatoid squamous cell carcinoma of the head and neck between 1996 and 2018. Data collection included clinical history, tumor characteristics, pathology, treatment modality, and outcomes. Mean follow up was 17.1 months. Cox univariate analysis was used to evaluate for associations with locoregional recurrence, distant metastasis, and overall survival. Results: Most patients were white males with a smoking history and median age 66 years (range 41-92) at diagnosis. Twenty-two percent had prior head and neck radiation. Tumor site was most frequently oral cavity (41.8%), followed by larynx (29.1%), and oropharynx (16.4%). Half presented with early T stage disease (15.5% T0, 12.7% T1, 30.9% T2) and the remainder with late stage disease (16.4% T3, 34.5% T4). Locoregional recurrence rate was 60.0%, metastatic recurrence was rate 21.8%, with median time to recurrence of 4 months and mean overall survival of 20 months. Presence of lymphovascular space invasion was statistically associated with locoregional recurrence ( P = .018, HR 3.55 [95% CI 1.24, 10.14]) and poorer overall survival ( P = .015, HR 2.92 [95% CI 1.23, 4.80]). Treatment with multimodality therapy was associated with decreased locoregional recurrence ( P = .039, HR 0.39 [95% CI 0.16, 0.95]) but did not impact overall survival. Conclusion: Sarcomatoid squamous cell carcinoma remains a rare and aggressive disease variant with high recurrence rates and high mortality. High risk features such as lymphovascular space may indicate the need for more aggressive therapy.
- Published
- 2020
24. The 'bowtie' reconstruction flap: A unique solution to cervical esophageal discontinuity repair
- Author
-
Joseph B. Meleca, Eric Lamarre, Usman Ahmad, and Brandon Prendes
- Subjects
medicine.medical_specialty ,Colon ,medicine.medical_treatment ,Fistula ,Jejunostomy ,Fundoplication ,Anastomotic Leak ,Anastomosis ,Nissen fundoplication ,Surgical Flaps ,Esophageal Fistula ,Necrosis ,Esophagus ,Postoperative Complications ,Gastrectomy ,medicine ,Humans ,Herniorrhaphy ,Aged ,business.industry ,Stomach ,Stent ,Plastic Surgery Procedures ,Thoracic Surgical Procedures ,medicine.disease ,Surgery ,Esophagectomy ,Hernia, Hiatal ,Treatment Outcome ,Otorhinolaryngology ,Cardiothoracic surgery ,Female ,business ,Neck - Abstract
Objectives Describe a novel technique for repair of cervical esophageal discontinuity. Study design A 66-year-old female underwent hiatal hernia repair with a Nissen fundoplication. This was complicated by ischemic necrosis of the proximal stomach requiring urgent return to the operative suite for partial gastrectomy, esophageal diversion and subsequent esophagectomy repaired with a colonic interposition graft by Thoracic Surgery. This was further complicated by a cervical esophageal colonic anastomotic leak maturing to a cervical esophageal fistula and necessitating jejunostomy tube placement and consultation to Head and Neck Surgery. Methods Case report. Results In a team approach with Otolaryngology and Thoracic Surgery, she underwent a unique, multilevel repair with a salivary bypass stent bridging the gap between the proximal esophagus and distal colonic conduit. Bilateral local advancement flaps were elevated using the skin lateral to the fistula on each side with a random blood supply pedicled medially. Each flap was rotated medially over the stent and imbricated at midline. Next, a left myogenous pectoralis flap was raised and rotated over the site of imbrication. Lastly, a split thickness skin graft from the thigh was harvested and sutured over the pectoralis flap. Three months postoperatively, the salivary bypass stent was removed and by five months, the fistula was completely closed. With cervical esophageal dilations bimonthly, the patient has graduated to an oral diet without need of her jejunostomy tube for nearly four months. Conclusion This case report describes a novel and efficacious solution to cervical esophageal discontinuity.
- Published
- 2020
25. A National Comparison of Postoperative Outcomes in Completion Thyroidectomy and Total Thyroidectomy
- Author
-
Philip R. Brauer, Chandana A. Reddy, Brian B. Burkey, and Eric Lamarre
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Postoperative Complications ,medicine ,Humans ,Thyroid Neoplasms ,030223 otorhinolaryngology ,Thyroid cancer ,Aged ,Retrospective Studies ,Completion thyroidectomy ,Total thyroidectomy ,Aged, 80 and over ,business.industry ,General surgery ,Thyroidectomy ,Middle Aged ,medicine.disease ,United States ,Treatment Outcome ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Surgery ,Female ,business - Abstract
To characterize and assess the non-thyroid-specific postoperative complications of completion thyroidectomy as compared with total thyroidectomy.Retrospective analysis: 2005 to 2017.National Surgical Quality Improvement Program database.Patients aged18 years receiving a completion or total thyroidectomy were eligible for inclusion. Patients not treated by otolaryngologists or general surgeons and with unknown demographic variables were excluded.A total of 70,638 patients were analyzed, representing 64,763 total thyroidectomies and 5875 completion thyroidectomies. The 30-day mortality rate was 0.1% for both procedures (National data suggest that total and completion thyroidectomies are relatively safe procedures but that completion thyroidectomies are associated with lower rates of postoperative complications. These findings may play a role in determining treatment plans for patients and optimizing risk reduction.
- Published
- 2020
26. Locoregional and distant recurrence for HPV-associated oropharyngeal cancer using AJCC 8 staging
- Author
-
Nikhil P. Joshi, Robert R. Lorenz, Brian B. Burkey, Neil M. Woody, L. Schwartzman, Timothy D. Smile, Joseph Scharpf, Jessica L. Geiger, James R. Broughman, Eric Lamarre, Brandon Prendes, Chengetai Mahomva, David J. Adelstein, Shlomo A. Koyfman, Jamie A. Ku, Kevin J. Contrera, David Xiong, and Wei Wei
- Subjects
Oncology ,Adult ,Male ,Risk ,Cancer Research ,medicine.medical_specialty ,Alcohol Drinking ,medicine.medical_treatment ,Recursive partitioning ,Antineoplastic Agents ,Platinum Compounds ,Kaplan-Meier Estimate ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Stage (cooking) ,030223 otorhinolaryngology ,Papillomaviridae ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,Chemotherapy ,Smokers ,Proportional hazards model ,business.industry ,Squamous Cell Carcinoma of Head and Neck ,Head and neck cancer ,Smoking ,Cancer ,Retrospective cohort study ,Chemoradiotherapy ,Middle Aged ,medicine.disease ,Oropharyngeal Neoplasms ,030220 oncology & carcinogenesis ,Female ,Oral Surgery ,Neoplasm Recurrence, Local ,business ,Ex-Smokers - Abstract
The objective of this study is to evaluate locoregional and distant failure for human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) using American Joint Committee on Cancer eighth edition (AJCC 8) staging.Retrospective cohort study of 457 patients with HPV + OPSCC, treated with platinum-based chemoradiation from 2002 to 2018, followed for a median of 4.3 years. Time to locoregional failure (TTLRF) and distant failure (TTDF) were estimated by Kaplan-Meier method. Log-rank, recursive partitioning analysis (RPA), and multivariable Cox proportional hazards were used to evaluate associated factors and stratify risk.Rates of five-year locoregional control (LRC) and distant control (DC) were 92% (95% CI, 90-95%) and 89% (95% CI, 85-92%), respectively. Smoking, T4, N3, and stage III were associated with significantly worse TTLRF. RPA identified three distinct locoregional failure groups: cT1-3 and 19 pack-years vs. cT1-3 with ≥19 pack-years vs. cT4 (five-year LRC: 97% vs. 90% vs. 82%, P .0001). The only factor associated with significantly worse TTDF was smoking status, while stage was not correlated. RPA identified two prognostic groups: former or never smokers vs. current smokers (five-year DC: 92% vs. 77%, P = .0003).In the largest evaluation of HPV + OPSCC after platinum-based chemoradiation using AJCC 8, risk for locoregional recurrence was stratified by smoking, T category, N category, and overall stage. Risk of distant recurrence was only stratified by smoking status and not related to stage. This has implications for surveillance and clinical trial design.
- Published
- 2020
27. Identifying an oligometastatic phenotype in HPV-associated oropharyngeal squamous cell cancer: Implications for clinical trial design
- Author
-
Shlomo A. Koyfman, Deborah J. Chute, Robert R. Lorenz, C.W. Fleming, Lisa Rybicki, J. Ku, Brandon Prendes, Kevin J. Contrera, Zvonimir L. Milas, L. Schwartzman, Eric Lamarre, Neil M. Woody, Catherine H. Frenkel, David D. Xiong, Daniel Brickman, Daniel R. Carrizosa, John F. Greskovich, Jessica L. Geiger, David J. Adelstein, Nikhil P. Joshi, Brian B. Burkey, Joseph Scharpf, and Matthew C. Ward
- Subjects
Oncology ,Male ,Cancer Research ,Lung Neoplasms ,Time Factors ,Systemic therapy ,0302 clinical medicine ,Neoplasm Metastasis ,030223 otorhinolaryngology ,Aged, 80 and over ,education.field_of_study ,Clinical Trials as Topic ,Human papillomavirus 16 ,Brain Neoplasms ,Liver Neoplasms ,Smoking ,Middle Aged ,Phenotype ,Oropharyngeal Neoplasms ,Research Design ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Female ,Oral Surgery ,Adult ,medicine.medical_specialty ,Population ,Bone Neoplasms ,Lesion Number ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,education ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Postoperative Care ,Radiotherapy ,Proportional hazards model ,business.industry ,Squamous Cell Carcinoma of Head and Neck ,Clinical study design ,Head and neck cancer ,Papillomavirus Infections ,medicine.disease ,Clinical trial ,Multivariate Analysis ,business - Abstract
Objectives Patients with human papillomavirus (HPV) associated squamous cell carcinoma of the oropharynx (SCC-OP) have improved overall survival (OS) after distant metastasis (DM) compared to HPV negative patients. These patients may be appropriate candidates for enrollment on clinical trials evaluating the efficacy of metastasis-directed therapy (MDT). This study seeks to identify prognostic factors associated with OS after DM, which could serve as enrollment criteria for such trials. Materials and methods From an IRB approved multi-institutional database, we retrospectively identified patients with HPV/p16 positive SCC-OP diagnosed between 2001 and 2018. Patterns of distant failure were assessed, including number of lesions at diagnosis and sites of involvement. The primary outcome was OS after DM. Prognostic factors for OS after DM were identified with Cox proportional hazards. Stepwise approach was used for multivariable analysis. Results We identified 621 patients with HPV-associated SCC-OP, of whom 82 (13.2%) were diagnosed with DM. Median OS after DM was 14.6 months. On multivariable analysis, smoking history and number of lesions were significantly associated with prolonged OS. Median OS after DM by smoking (never vs ever) was 37.6 vs 11.2 months (p = 0.006), and by lesion number (1 vs 2–4 vs 5 or more) was 41.2 vs 17.2 vs 10.8 months (p = 0.007). Conclusion Among patients with newly diagnosed metastatic HPV-associated SCC-OP, lesion number and smoking status were associated with significantly prolonged overall survival. These factors should be incorporated into the design of clinical trials investigating the utility of MDT, with or without systemic therapy, in this population.
- Published
- 2020
28. Evaluating compliance with process-related quality metrics and survival in oral cavity squamous cell carcinoma: Multi-institutional oral cavity collaboration study
- Author
-
Neil M. Woody, Jessica L. Geiger, Jimmy J. Caudell, Wei Wei, Nikhil P. Joshi, Sara W Liu, Eric Lamarre, Kevin J. Contrera, Swathi Appachi, Ahmed I Ghanem, David J. Adelstein, Brandon Prendes, B. Matia, Brian B. Burkey, Nancy Y. Lee, Shlomo A. Koyfman, Jillian Tsai, Jamie A. Ku, Joseph Scharpf, Neal Dunlap, Farzan Siddiqui, Howard Liu, and Sandro V. Porceddu
- Subjects
Oncology ,medicine.medical_specialty ,media_common.quotation_subject ,Oral cavity ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Quality (business) ,Oral Cavity Squamous Cell Carcinoma ,030223 otorhinolaryngology ,Distributed File System ,media_common ,Neoplasm Staging ,Retrospective Studies ,Mouth ,Proportional hazards model ,business.industry ,Squamous Cell Carcinoma of Head and Neck ,Head and neck cancer ,Retrospective cohort study ,medicine.disease ,Prognosis ,stomatognathic diseases ,Benchmarking ,Otorhinolaryngology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Cohort ,business - Abstract
Background: Process-related measures have been proposed as quality metrics in head and neck cancer care. A recent single-institution study identified four key metrics associated with increased survival. This study sought to validate the association of these quality metrics with survival in a multi-institutional cohort. Methods: Multicenter retrospective study of patients with oral cavity squamous cell (1/2005-1/2015). Baseline patient and disease characteristics and compliance with quality metrics was evaluated. Association between compliance with quality metrics with overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) was evaluated using Cox proportional hazards models. Results: Failure to comply with two or more of the quality metrics was associated with worse OS, DFS, and DSS. Adherence to all or all but one of the quality metrics was found to be associated with improved survival. Conclusions: Process-related quality metrics are associated with increased survival in patients with oral cavity squamous cell carcinoma in a multi-institutional cohort.
- Published
- 2020
29. Limited Toxicity of Hypofractionated Intensity Modulated Radiation Therapy (H-IMRT) for Head and Neck Cancer
- Author
-
Robert R. Lorenz, E. Ilori, Shauna R. Campbell, Shlomo A. Koyfman, J. Ku, B. Matia, Chandana A. Reddy, Neil M. Woody, Eric Lamarre, N.P. Joshi, Brandon Prendes, Brian B. Burkey, Z S Mayo, C.W. Fleming, Joycelin F. Canavan, and Joseph Scharpf
- Subjects
Cancer Research ,medicine.medical_specialty ,Radiation ,Osteoradionecrosis ,business.industry ,Head and neck cancer ,medicine.disease ,Trismus ,Primary tumor ,Surgery ,Dysgeusia ,Oncology ,Tolerability ,Median follow-up ,medicine ,Mucositis ,Radiology, Nuclear Medicine and imaging ,medicine.symptom ,business - Abstract
Purpose/objective(s) Hypofractionated intensity modulated radiation therapy (H-IMRT) is uncommonly used in head and neck cancers due to concern for toxicity. This study reviews our experience using H-IMRT for head and neck cancers and explores its tolerability and efficacy. Materials/methods This single institution IRB approved retrospective study includes patients with head and neck cancers treated with definitive or post-operative H-IMRT from 2011-2020. Patients treated with ≥50Gy in 20 fractions to the primary tumor site and/or neck with at least 3 months of follow up were included. Patients treated to a superficial target only without proximity to mucosal surfaces or coverage of the elective neck (e.g., scalp; skin only targets) were excluded. Patients undergoing re-irradiation were excluded. Toxicity was scored using CTCAE v4.0. Acute toxicity included events occurring within 90 days of H-IMRT completion. Late toxicities occurred any time thereafter. Multiple toxicities in the same patient were scored separately. Results Fifty-nine patients with a median follow up of 10.9 months (range 3.0-111.5) were included. The majority of patients were white (93%) and male (78%) with a median age of 79.1. The most common primary tumor sites were skin (42%), major salivary glands (22%), and oral cavity (9%). The most frequent histologies included squamous cell carcinoma (66%) followed by thyroid cancer (7%), melanoma (5%), and Merkel cell carcinoma (5%). Treatment was delivered post-operatively in 80% and definitively in 20% of patients. All patients were treated with ≥50 Gy in 20 fractions, with the most common dose being 50 Gy (53%) followed by 55 Gy (44%). In 64% of patients a secondary elective dose of 45-50 Gy was used. Site treated included primary tumor site/bed with unilateral neck (54%), primary tumor site/bed with bilateral neck (19%), primary tumor site/bed alone (14%), unilateral neck (8%), and bilateral neck (5%). Five patients (8%) experienced a locoregional failure at a median time of 5.4 months (range 2.8-13.9). There were no grade 4 or 5 toxicities. Ten patients (17%) experienced acute grade 3 toxicity including mucositis (12%) and dermatitis (5%). Forty-six patients (78%) had an acute grade 2 toxicity, most commonly dermatitis (41%), pain (32%), fatigue (32%), dysgeusia (31%) and xerostomia (22%). Five patients (8%) experienced grade 2 late complications including neck fibrosis in three patients and trismus, aspiration pneumonia, and osteoradionecrosis in one patient each. No patient experienced grade 3 or higher late toxicity. No patients required the placement of a feeding tube or tracheostomy. Conclusion Hypofractionated IMRT in the definitive or post-operative treatment of head and neck cancers using ≥50Gy in 20 fractions appears safe and well tolerated with modest toxicity. Prospective studies comparing the safety and efficacy of H-IMRT to conventionally fractionated IMRT are warranted.
- Published
- 2021
30. Predictors Of Locoregional And Distant Recurrence In HPV-Related Oropharyngeal Cancer Patients Treated With Cisplatin-Based Chemoradiation: A Recursive Partitioning Analysis
- Author
-
Eric Lamarre, John F. Greskovich, Shlomo A. Koyfman, D. Xiong, Jessica L. Geiger, C.W. Fleming, Brandon Prendes, Chengetai Mahomva, Brian B. Burkey, J. Ku, Wei Wei, Neil M. Woody, Nikhil P. Joshi, James R. Broughman, Kevin J. Contrera, Robert R. Lorenz, L. Schwartzman, Timothy D. Smile, David J. Adelstein, and Joseph Scharpf
- Subjects
Cisplatin ,Oncology ,Cancer Research ,medicine.medical_specialty ,Radiation ,business.industry ,Distant recurrence ,Cancer ,Recursive partitioning ,medicine.disease ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,business ,medicine.drug - Published
- 2020
31. A matched comparison of human papillomavirus–induced squamous cancer of unknown primary with early oropharynx cancer
- Author
-
Shlomo A. Koyfman, Robert R. Lorenz, N. Houston, Matthew C. Ward, Brandon Prendes, Richard Blake Ross, Jessica L. Geiger, Chandana A. Reddy, Joseph Scharpf, Nikhil P. Joshi, John F. Greskovich, Eric Lamarre, Neil M. Woody, David J. Adelstein, and Brian B. Burkey
- Subjects
Adult ,Male ,Oncology ,medicine.medical_specialty ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Cause of Death ,Internal medicine ,Humans ,Medicine ,Treatment Failure ,Human papillomavirus ,030223 otorhinolaryngology ,Papillomaviridae ,Aged ,Retrospective Studies ,Aged, 80 and over ,Gynecology ,business.industry ,Papillomavirus Infections ,Cancer ,Retrospective cohort study ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Occult ,Clinical trial ,Oropharyngeal Neoplasms ,ROC Curve ,Otorhinolaryngology ,Cancer of unknown primary ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,Unknown primary ,Neoplasms, Unknown Primary ,T-stage ,Female ,business ,Follow-Up Studies - Abstract
Objectives/Hypothesis Patients with human papillomavirus (HPV)–induced cancer of unknown primary (CUP) are generally excluded from clinical trials, despite surgical series reporting detection rates of occult oropharynx primaries of >80%. We performed a matched-pair analysis to compare outcomes between T0N1-3M0 HPV+ CUP and T1-2N1-3M0 HPV+ oropharynx known primary (OPX). Study Design Retrospective cohort study at a single institution. Methods Patients with early T stage, node positive HPV+ OPX or CUP treated with curative intent between 1998 and 2016 were identified. For a subgroup of CUP patients with an unknown HPV status, we imputed HPV status and included patients with a >80% probability of being HPV+. Cohorts were matched based on patient demographics using a nearest neighbor propensity technique. After matching, patients were grouped according to either a favorable or unfavorable risk stratification designations per current NRG Oncology clinical trial enrollment criteria. Disease-free survival (DFS) and overall survival (OS) were calculated using Kaplan-Meier analysis. Results Of 298 patients with T1-2N1-3 OPX, 48 were matched to 48 HPV+ CUP patients (32 with confirmed and 16 imputed HPV status). Median follow-up for CUP (34.1 months) and OPX (27.8 months) patients were similar (P = .23).There were no significant differences between the CUP and OPX groups for 3-year DFS (89% vs. 85%, P = .44), and 3-year OS (91% vs. 91%, P = .11), respectively. Conclusions Patients with T0N+M0 HPV-induced CUP have similar survival outcomes to matched patients with T1-2N+M0 HPV+ OPX. These patients can reasonably be included in clinical trials investigating the role of treatment deintensification and risk stratified similar to patients with early-stage known primary OPX cancer. Level of Evidence 4. Laryngoscope, 2017
- Published
- 2017
32. Primary Surgery for Locally Advanced Sinonasal Cancer: Influence of Dural and Orbital Resection
- Author
-
David J. Adelstein, Hong Li, Eric Lamarre, Varun R. Kshettry, Shlomo A. Koyfman, Neil M. Woody, Pablo F. Recinos, Troy D. Woodard, Nikhil P. Joshi, J. Imamura, Pranay Soni, Jessica L. Geiger, Dennis Tang, and Raj Sindwani
- Subjects
Cancer Research ,medicine.medical_specialty ,Radiation ,Oncology ,business.industry ,Locally advanced ,Medicine ,Radiology, Nuclear Medicine and imaging ,Sinonasal cancer ,business ,Surgery ,Resection - Published
- 2020
33. Outcomes of Locally Advanced Sinonasal Cancer in the Modern Era: Surgery and Adjuvant Therapy remains an Optimal Treatment Strategy
- Author
-
Varun R. Kshettry, Hong Li, Neil M. Woody, Nikhil P. Joshi, Eric Lamarre, Troy D. Woodard, J. Imamura, Pranay Soni, David J. Adelstein, Shlomo A. Koyfman, Pablo F. Recinos, Dennis Tang, Jessica L. Geiger, and Raj Sindwani
- Subjects
Cancer Research ,medicine.medical_specialty ,Radiation ,Oncology ,business.industry ,Optimal treatment ,medicine ,Locally advanced ,Adjuvant therapy ,Radiology, Nuclear Medicine and imaging ,Sinonasal cancer ,business ,Surgery - Published
- 2020
34. Complications, Mortality, and Functional Decline in Patients 80 Years or Older Undergoing Major Head and Neck Ablation and Reconstruction
- Author
-
Jason I. Kass, Kevin Higgins, Rui Fernandes, Mohamedkazim Alwani, Karthik Rajasekaran, Avinash V. Mantravadi, Heidi E. L'Esperance, Caitlin McMullen, Ofer Azoulay, Andrew T. Huang, Jesse T. Ryan, Jason T. Rich, Swar Vimawala, Mitchell L. Worley, Samer Al-Khudari, Tanya Fancy, Michael Abdelmalik, Eric Lamarre, Mark K. Wax, Richard A. Goldman, Evan M. Graboyes, Patrick Tassone, Eric Abello, Susannah C. Orzell, Andrés M. Bur, Dorina Kallogjeri, Taylor Cave, and Rahul S. Subbarayan
- Subjects
Male ,medicine.medical_specialty ,Free flap ,Logistic regression ,Preoperative care ,Free Tissue Flaps ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Medicine ,Humans ,030223 otorhinolaryngology ,Retrospective Studies ,Original Investigation ,Aged, 80 and over ,Frailty ,business.industry ,Odds ratio ,Plastic Surgery Procedures ,medicine.disease ,Comorbidity ,United States ,Surgery ,Survival Rate ,Otorhinolaryngology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Maxilla ,Female ,business ,Body mass index ,Cohort study ,Follow-Up Studies - Abstract
Importance Data regarding outcomes after major head and neck ablation and reconstruction in the growing geriatric population (specifically ≥80 years of age) are limited. Such information would be extremely valuable in preoperative discussions with elderly patients about their surgical risks and expected functional outcomes. Objectives To identify patient and surgical factors associated with 30-day postoperative complications, 90-day mortality, and 90-day functional decline; to explore whether an association exists between the type of reconstructive procedure and outcome; and to create a preoperative risk stratification system for these outcomes. Design, Setting, and Participants This retrospective, multi-institutional cohort study included patients 80 years or older undergoing pedicle or free-flap reconstruction after an ablative head and neck surgery from January 1, 2015, to December 31, 2017, at 17 academic centers. Data were analyzed from February 1 through April 20, 2019. Main Outcomes and Measures Thirty-day serious complication rate, 90-day mortality, and 90-day decline in functional status. Preoperative comorbidity and frailty were assessed using the American Society of Anesthesiologists classification, Adult Comorbidity Evaluation–27 score, and Modified Frailty Index. Multivariable clustered logistic regressions were performed. Conjunctive consolidation was used to create a risk stratification system. Results Among 376 patients included in the analysis (253 [67.3%] men), 281 (74.7%) underwent free-flap reconstruction. The median age was 83 years (range, 80-98 years). A total of 193 patients (51.3%) had 30-day serious complications, 30 (8.0%) died within 90 days, and 36 of those not dependent at baseline declined to dependent status (11.0%). Type of flap (free vs pedicle, bone vs no bone) was not associated with these outcomes. Variables associated with worse outcomes were age of at least 85 years (odds ratio [OR] for 90-day mortality, 1.19 [95% CI 1.14-1.26]), moderate or severe comorbidities (OR for 30-day complications, 1.80 [95% CI, 1.34-2.41]; OR for 90-day mortality, 3.33 [95% CI, 1.29-8.60]), body mass index (BMI) of less than 25 (OR for 30-day complications, 0.95 [95% CI, 0.91-0.99]), high frailty (OR for 30-day complications, 1.72 [95% CI, 1.10-2.67]), duration of surgery (OR for 90-day functional decline, 2.94 [95% CI, 1.81-4.79]), flap failure (OR for 90-day mortality, 3.56 [95% CI, 1.47-8.62]), additional operations (OR for 30-day complications, 5.40 [95% CI, 3.09-9.43]; OR for 90-day functional decline, 2.94 [95% CI, 1.81-4.79]), and surgery of the maxilla, oral cavity, or oropharynx (OR for 90-day functional decline, 2.51 [95% CI, 1.30-4.85]). Age, BMI, comorbidity, and frailty were consolidated into a novel 3-tier risk classification system. Conclusions and Relevance Important demographic, clinical, and surgical characteristics were found to be associated with postoperative complications, mortality, and functional decline in patients 80 years or older undergoing major head and neck surgery. Free flap and bony reconstruction were not independently associated with worse outcomes. A novel risk stratification system is presented.
- Published
- 2019
35. Analysis of Process-Related Quality Metrics and Survival of Patients with Oral Cavity Squamous Cell Carcinoma
- Author
-
Eric Lamarre, Andrew J. Bowen, Janki Shah, Shlomo A. Koyfman, Swathi Appachi, and Chandana A. Reddy
- Subjects
Oncology ,Male ,medicine.medical_specialty ,Referral ,Disease ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Radiation oncology ,medicine ,Humans ,Oral Cavity Squamous Cell Carcinoma ,Stage (cooking) ,030223 otorhinolaryngology ,Retrospective Studies ,business.industry ,Survival Rate ,Dissection ,Benchmarking ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Carcinoma, Squamous Cell ,Neck Dissection ,Surgery ,Female ,Mouth Neoplasms ,business - Abstract
To analyze the association of prior reported key quality metrics-neck dissection ≥18 nodes, radiation oncology referral for stage III/IV disease, unplanned surgery ≤14 days, and unplanned readmission ≤30 days-with disease-free survival (DFS) and overall survival (OS) in oral cavity cancer (OCC).A retrospective chart review.A tertiary care center from 1995 to 2016.Data from patients with OCC who underwent primary surgery were studied. The association of quality metrics and pathology with DFS/OS was determined by Cox proportional hazards regression analysis.A total of 514 patients were included, and 398 (77.4%) underwent elective neck dissection. Key metrics were not associated with DFS on analysis, but higher pathologic stage and extracapsular extension (ECE) were. When stratified by stage, unplanned readmission within 30 days was associated with decreased survival on multivariate analysis (HR = 0.40; 95% CI, 0.20-0.85;In this study, aggressive pathology, rather than adherence to key quality metrics, was associated with lower DFS and OS among patients with OCC. More studies are needed to elucidate the association of quality metrics with survival.
- Published
- 2019
36. Impact of active smoking on outcomes in HPV+ oropharyngeal cancer
- Author
-
Robert R. Lorenz, David J. Adelstein, Brandon Prendes, Matthew C. Ward, Shlomo A. Koyfman, Neil M. Woody, N. Houston, Nikhil P. Joshi, Roy Xiao, Y.D. Pham, Jessica L. Geiger, Joseph Scharpf, Chandana A. Reddy, Eric Lamarre, Deborah J. Chute, Brian B. Burkey, and John F. Greskovich
- Subjects
Oncology ,medicine.medical_specialty ,Smoking history ,03 medical and health sciences ,0302 clinical medicine ,Primary outcome ,Internal medicine ,medicine ,Overall survival ,Humans ,030212 general & internal medicine ,Active smoking ,Human papillomavirus ,Retrospective Studies ,business.industry ,Papillomavirus Infections ,Smoking ,Cancer ,Retrospective cohort study ,medicine.disease ,Former Smoker ,Prognosis ,Oropharyngeal Neoplasms ,Otorhinolaryngology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,business - Abstract
BACKGROUND The role of smoking among patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is unclear. METHODS A retrospective cohort study of patients with HPV(+) OPSCC from 2001 to 2015 at a tertiary-care institution was conducted. The primary outcome was overall survival (OS). RESULTS Among 484 included patients, 94 (19.4%) were active smokers, 226 (46.7%) were former smokers, and 164 (33.9%) never smoked. Among active smokers, 82 patients (87.2%) had a ≥10 pack-year and 69 (73.4%) had a ≥20 pack-year smoking history. After adjusting for covariates, active smoking was a significant predictor of inferior OS (HR 2.28, P
- Published
- 2019
37. Prognostic Impact of Baseline and Delta Tumor Radiomics Features in Patients With Oropharyngeal Cancer (OPC) Treated With Adaptive Image-Guided Radiotherapy (IGRT)
- Author
-
Joseph Scharpf, Y. Chen, S. Rao, Deborah J. Chute, Robert R. Lorenz, C.W. Fleming, Shlomo A. Koyfman, Hesham Elhalawani, G. Kuzmin, Brandon Prendes, Neil M. Woody, T. Ma, Nikhil P. Joshi, Jessica L. Geiger, Eric Lamarre, J. Ku, Brian P. Hobbs, David J. Adelstein, and Brian B. Burkey
- Subjects
Cancer Research ,medicine.medical_specialty ,Radiation ,business.industry ,Cancer ,medicine.disease ,Image guided radiotherapy ,Oncology ,Radiomics ,medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Radiology ,Baseline (configuration management) ,business ,Image-guided radiation therapy - Published
- 2020
38. Impact of Insurance and Socioeconomic Status on HPV-related Oropharyngeal Cancer
- Author
-
Eric Lamarre, Brian B. Burkey, Joseph Scharpf, Neil M. Woody, Kailin Yang, Kevin J. Contrera, Robert R. Lorenz, Shlomo A. Koyfman, David J. Adelstein, C.W. Fleming, C. Lu, K. Bera, A. Madabhushi, Brandon Prendes, Nikhil P. Joshi, and Jessica L. Geiger
- Subjects
Cancer Research ,Radiation ,Oncology ,business.industry ,Environmental health ,medicine ,Cancer ,Radiology, Nuclear Medicine and imaging ,medicine.disease ,business ,Socioeconomic status - Published
- 2020
39. A Comparison Of Prognostic Factors For Survival After Distant Metastasis In HPV+ And HPV- Head And Neck Cancers
- Author
-
A. Faruqi, J. Ku, Shlomo A. Koyfman, Deborah J. Chute, C.W. Fleming, Robert R. Lorenz, Kevin J. Contrera, Joseph Scharpf, Eric Lamarre, R. Parikh, D. Xiong, David J. Adelstein, Nikhil P. Joshi, Neil M. Woody, John F. Greskovich, Brian B. Burkey, Lisa Rybicki, Jessica L. Geiger, L. Schwartzman, and Brandon Prendes
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Radiation ,business.industry ,Internal medicine ,medicine ,Distant metastasis ,Radiology, Nuclear Medicine and imaging ,business ,Head and neck - Published
- 2020
40. Tumor Volume As A Predictor Of Locoregional Failure In Locally Advanced Laryngeal Cancer
- Author
-
Brian B. Burkey, Brandon Prendes, James R. Broughman, John F. Greskovich, Jessica L. Geiger, Nikhil P. Joshi, Matthew C. Ward, J.M. Sharrett, Joseph Scharpf, Eric Lamarre, David J. Adelstein, Eric Murray, Neil M. Woody, Robert R. Lorenz, and Shlomo A. Koyfman
- Subjects
Cancer Research ,medicine.medical_specialty ,Radiation ,Locoregional failure ,business.industry ,Locally advanced ,Cancer ,medicine.disease ,Oncology ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Volume (compression) - Published
- 2020
41. Impaired vocal cord mobility in T2N0 glottic carcinoma: Suboptimal local control with Radiation alone
- Author
-
Grant H. Hunter, Shlomo A. Koyfman, John F. Greskovich, Eric Lamarre, Priyanka Bhateja, Matthew C. Ward, Chandana A. Reddy, Brian B. Burkey, David J. Adelstein, and Tobenna Nwizu
- Subjects
medicine.medical_specialty ,Chemotherapy ,Univariate analysis ,Cord ,Glottis ,business.industry ,medicine.medical_treatment ,Urology ,medicine.disease ,Surgery ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,medicine ,Vocal cord paralysis ,030223 otorhinolaryngology ,business ,Survival analysis ,Chemoradiotherapy - Abstract
Background T2 glottic cancer with impaired vocal cord mobility (T2b) is known to have higher local failure rates when compared with T2 cancers without impaired cord mobility (T2a) treated with radiotherapy (RT) alone. Methods In this retrospective review, we identified and compared the local control rates of 3 groups: T2aN0 treated with RT; T2bN0 treated with RT; and T2b-3N0-2 treated with chemoradiotherapy (CRT). Results The 3-year local control rate was 95.1% for T2aN0, 73.2% for T2bN0 treated with RT, and 91.5% for the CRT group (p = .01). On univariate analysis, T2bN0 disease versus T2aN0 treated with RT alone (p = .03) was significantly associated with inferior local control. Conclusion Patients with glottic cancer with impaired vocal cord mobility (T2b) have a high rate of local failure with RT alone. The addition of concurrent chemotherapy should be considered for patients highly motivated toward larynx preservation and willing to accept the potential toxicity. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
- Published
- 2016
42. Severe late dysphagia and cause of death after concurrent chemoradiation for larynx cancer in patients eligible for RTOG 91-11
- Author
-
Brian B. Burkey, Priyanka Bhateja, Robert R. Lorenz, John F. Greskovich, Joseph Scharpf, David J. Adelstein, Tobenna Nwizu, Matthew C. Ward, N. Houston, Eric Lamarre, and Shlomo A. Koyfman
- Subjects
Adult ,Male ,0301 basic medicine ,Larynx ,Cancer Research ,Pediatrics ,medicine.medical_specialty ,Aspiration pneumonia ,03 medical and health sciences ,0302 clinical medicine ,Cause of Death ,medicine ,Humans ,Cumulative incidence ,Laryngeal Neoplasms ,Feeding tube ,Aged ,Retrospective Studies ,Cause of death ,business.industry ,Incidence (epidemiology) ,Chemoradiotherapy ,Middle Aged ,medicine.disease ,Dysphagia ,Surgery ,Survival Rate ,030104 developmental biology ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Esophageal stricture ,Female ,Neoplasm Recurrence, Local ,Oral Surgery ,medicine.symptom ,Deglutition Disorders ,business - Abstract
Summary Purpose The long-term results of RTOG 91-11 suggested increased deaths not attributed to larynx cancer after concomitant chemoradiotherapy (CRT) despite no apparent increase in late effects. Because the timing of events was not reported by RTOG 91-11, one possibility is that severe late dysphagia (SLD) develops beyond five years and leads to unreported treatment-related deaths. Here we explore the timing of SLD after CRT. Methods Patients who would have met eligibility criteria for RTOG 91-11 and were treated with CRT between 1993 and 2013 were identified. Events occurring beyond 3 months after treatment and suggestive of SLD were recorded including esophageal stricture dilations, hospital admissions for aspiration pneumonia or feeding-tube insertion. Feeding-tube dependence beyond one year was also considered SLD. The cumulative incidence of SLD and its components was quantified using Gray’s competing risk analysis with recurrence or death considered competing risks. Results Eighty-four patients were included with a median follow-up of 43 months. The 5-year overall survival was 70% (95% CI 58–80%). No death was directly a result of treatment-induced late dysphagia. The 5-year incidence of SLD was 26.5%. While 15 of 18 (83%) first stricture dilations occurred within 5 years after CRT, 3 of 5 (60%) aspiration admissions and 5 of 8 late feeding tube insertions occurred beyond five years from CRT. Conclusions SLD is common after CRT for larynx cancer and can occur beyond 5 years from the end of treatment, emphasizing the importance of survivorship follow-up. Despite the incidence of SLD, death related to dysphagia is uncommon.
- Published
- 2016
43. The prognostic value of pretreatment FDG-PET parameters in HPV-associated oropharynx cancer
- Author
-
Ping Xia, Eric Lamarre, Matthew C. Ward, David J. Adelstein, John F. Greskovich, Tobenna Nwizu, Joseph Scharpf, Brian B. Burkey, Shlomo A. Koyfman, and Ankeet Shah
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,Proportional hazards model ,medicine.medical_treatment ,Cancer ,Standardized uptake value ,medicine.disease ,030218 nuclear medicine & medical imaging ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Cervical lymph nodes ,Surgical oncology ,030220 oncology & carcinogenesis ,Internal medicine ,Medicine ,Stage (cooking) ,business ,Chemoradiotherapy - Abstract
18Fluorodeoxyglucose positron-emission tomography (FDG-PET) has shown prognostic value in oropharynx cancer but data regarding patients with known human papillomavirus (HPV) status is limited. If prognostic, FDG-PET may play a role in the identification of patients suitable for treatment de-intensification. Patients with stage III-IVB squamous cell carcinoma of the oropharynx treated with definitive chemoradiation with known HPV status were identified. Clinical and PET parameters were compared between HPV-positive and HPV-negative patients and evaluated for prognostic value via Cox proportional hazards univariate and multivariate regression. Seventy patients were identified (58 HPV-positive, 12 HPV-negative) with a median follow-up of 41.5 months. HPV-negative tumors were associated with increased metabolic activity at the primary site but smaller cervical lymph nodes compared to HPV-positive tumors. Univariate and multivariate analysis identified the nodal maximum standard uptake value (SUVmax) as a predictor of disease-free (DFS) and overall survival (OS) among HPV-positive patients independent of other commonly used prognostic factors such as smoking and nodal stage. Pretreatment SUVmax in the nodal volume is a simple parameter that retains prognostic value in the HPV-era. Increased PET activity portends inferior DFS and OS and may be used in conjunction with other known prognostic factors, to identify patients inappropriate for treatment de-intensification strategies in the future.
- Published
- 2015
44. Does the Incorporation of Chemotherapy to Adjuvant Radiation Skew the Influence of Treatment Package Time in High-risk Oral Cavity Carcinoma? A Multi-institutional Collaborative Study
- Author
-
Shlomo A. Koyfman, Howard Liu, C. Jillian Tsai, Sandro V. Porceddu, Matthew Shymick, Jimmy J. Caudell, Farzan Siddiqui, Jessica L. Geiger, Nahyun Lee, Eric Lamarre, Neil M. Woody, Ahmed I Ghanem, Brian B. Burkey, David J. Adelstein, and Neal Dunlap
- Subjects
Oncology ,Cancer Research ,Chemotherapy ,medicine.medical_specialty ,Adjuvant radiotherapy ,Radiation ,business.industry ,medicine.medical_treatment ,Skew ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Oral Cavity Carcinoma ,business - Published
- 2020
45. Does neck dissection affect post-operative outcomes in parotidectomy? A national study
- Author
-
Brandon Prendes, Eric Lamarre, Jamie A. Ku, Chandana A. Reddy, and Philip R. Brauer
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Operative Time ,Oral Surgical Procedures ,Patient Readmission ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Parotid Gland ,Blood Transfusion ,Post operative ,030223 otorhinolaryngology ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Neck dissection ,Parotidectomy ,Length of Stay ,Middle Aged ,Parotid Neoplasms ,Surgery ,Treatment Outcome ,Otorhinolaryngology ,Data Interpretation, Statistical ,030220 oncology & carcinogenesis ,Parotid cancer ,National study ,Neck Dissection ,Female ,Safety ,business - Abstract
To characterize post-operative complications in parotidectomy with neck dissection.Patients age ≥ 18 receiving a parotidectomy or parotidectomy with neck dissection between 2005 and 2017 were eligible for inclusion. Patients with unknown demographic variables were excluded. Univariate and multivariable logistic regression analyses were performed.A total of 13,609 parotidectomy patients were analyzed, 11,243 (82.6%) without neck dissection and 2366 (17.4%) with neck dissection. Both length of surgery (mean minutes ± standard deviation [SD] = 335.9 ± 189.2 vs. 152.9 ± 99.0, p 0.001) and length of hospital stay (mean days ± SD = 3.90 ± 4.76 vs. 1.04 ± 2.14, p 0.001) were greater with dissection. 13.9% of parotidectomies with neck dissection and 3.5% without dissection (p 0.001) had at least one complication, which remained significant after multivariable adjustment (Odds Ratio[OR] = 1.565 (95%CI = 1.279-1.914), p 0.001). The increase in post-operative complications was predominately driven by an increased transfusion rate (7.4% vs. 0.5%, p 0.001). Multivariable analysis also demonstrated no significant difference in rates of returning to the operating room (OR = 1.122 (95%CI 0.843-1.493), p 0.05) or rates of readmission (OR = 1.007 (95%CI 0.740-1.369), p 0.05). Parotidectomy with neck dissection was more likely to be inpatient (OR = 4.411 (95%CI 3.887-5.004), p 0.001) and to be ASA class 3 (OR = 1.367 (95%CI 1.194-1.564), p 0.001).Nationwide data demonstrates that parotidectomy with neck dissection is associated with increased rates of post-operative complications; however, neck dissection did not significantly impact readmission or reoperation rates. These findings indicate that neck dissection is a relatively safe addition to parotidectomy and provide novel evidence in the management of parotid malignancies.
- Published
- 2020
46. Single-institute outcomes of palliative chemotherapy in metastatic head and neck squamous cell carcinoma (HNSCC)
- Author
-
Nikhil P. Joshi, Brian B. Burkey, Chandana A. Reddy, Shlomo A. Koyfman, Rujul H Parikh, Jessica L. Geiger, Neil M. Woody, Eric Lamarre, Joseph Scharpf, J. Ku, C.W. Fleming, Robert R. Lorenz, L. Schwartzman, Brandon Prendes, and David J. Adelstein
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Poor prognosis ,business.industry ,Treatment options ,Palliative chemotherapy ,medicine.disease ,Distantly Metastatic ,Head and neck squamous-cell carcinoma ,Internal medicine ,Medicine ,business - Abstract
e18513 Background: Distantly metastatic HNSCC carries a poor prognosis with limited palliative systemic treatment options and a paucity of literature examining factors impacting outcomes of such therapy. We sought to evaluate characteristics conferring more favorable responses to frontline palliative systemic therapy after distant failure (DF). Methods: From an IRB-approved database, we identified 332 pts with metastatic HNSCC treated from 1999 to 2019. Pts with locoregional HNSCC who developed DF and subsequently were treated with palliative systemic therapy were included. Pts were categorized by disease factors, and outcomes were analyzed for progression-free survival (PFS) and overall survival (OS) with Kaplan-Meier curves and log-rank p-values. Results: A total of 85 pts were identified with median age 59.5 years (37-89); 82.4% male, 90.6% Caucasian, 52.9% with > 10 pack-years tobacco use history. Oropharynx primary was the most common site (36.5%) followed by oral cavity (23.5%). All 31 oropharynx cancer pts were HPV-related. Sixty-six pts initially received definitive chemoradiotherapy, with 43 receiving concurrent radiosensitizing cisplatin. Median time to DF was 15 months (m). Thirty pts (35.3%) had concurrent locoregional failure with DF. 62.4% had only one metastatic organ site, with lung-only metastasis in 43.5%. Carboplatin/paclitaxel was the most commonly used frontline palliative chemotherapy (50.6%); 22.4% received frontline nivolumab or pembrolizumab, and 9.4% were treated with frontline platinum/5-FU/cetuximab (9.4%). 63.5% of pts achieved a best response of stable disease or better with frontline therapy. At two years after initial DF, 6 pts (7%) were disease-free. Sixteen pts were alive at last follow-up. After DF, median PFS was 6.5 m and median OS was 10.6 m. On univariate analysis, HPV-related disease was associated with increased PFS (9.5 vs 5.1 m, p < 0.0001) and increased OS (21.1 vs 7.7 m, p < 0.0001). Pts with one metastatic organ site had better OS (11.0 vs 6.2 m, p = 0.047). There was a trend of increased OS with lung-only metastasis (14.4 vs 7.7 m, p = 0.0776), and absence of concurrent locoregional failure (10.8 vs 8.3 m, p = 0.1153). Conclusions: Our results demonstrate that HPV-related metastatic HNSCC is associated with a statistically significant increased PFS and OS. Additionally, there was a trend of increased OS with lower locoregional and distant metastatic burden at DF though statistical significance was not achieved.
- Published
- 2020
47. Selection of patients for surveillance imaging after radiotherapy for squamous cell carcinoma of oral cavity and oropharynx
- Author
-
J. Ku, Deborah J. Chute, Jessica L. Geiger, C.W. Fleming, Brandon Prendes, Eric Lamarre, Nikhil P. Joshi, David J. Adelstein, Lisa Rybicki, Brian B. Burkey, Maxwell Lee, Johnathan Zeng, Larisa Schwartzman, Shlomo A. Koyfman, Rujul H Parikh, Joseph Scharpf, Neil M. Woody, and Robert R. Lorenz
- Subjects
Radiation therapy ,Cancer Research ,medicine.medical_specialty ,Oncology ,business.industry ,medicine.medical_treatment ,medicine ,Basal cell ,Radiology ,Surveillance imaging ,Oral cavity ,business ,Selection (genetic algorithm) - Abstract
6533 Background: NCCN guidelines do not recommend routine surveillance imaging for distant failure (DF) after definitive treatment of head & neck squamous cell carcinoma (SCC). We hypothesized that there exists a subset of patients with sufficiently high enough risk for DF to benefit from surveillance imaging. This study attempts to define high risk cohorts of oropharynx (OP) and oral cavity (OC) patients. Methods: A retrospective review was conducted of patients with SCC of the OP or OC at a single tertiary care institution from 1994-2019. Patients were staged according to AJCC 7th edition and included in this study if they completed definitive-intent treatment and received 60 Gray or higher of radiotherapy (RT). Local, regional, and distant failure were estimated with cumulative incidence. Univariable & multivariable risk factors for DF were identified with Fine & Gray competing risk regression. Significant variables were compiled to calculate a risk score. Results: 863 patients were included (676 OP/187 OC). OC patients were 60.4% male, median age 61, with median follow up of 77.5 months. Smoking status was 27.3% current, 44.4% former, 28.3% never, with 30 median pack years. Disease was 57.3% T1-2, 42.7% T3-4, 55.6% N0-2a, 44.4% N2b-3. 94.1% had surgery & 34.3% had concurrent systemic therapy. OP patients were 87.9% male, median age 58, 96.3% HPV+, with median follow up of 60.8 months. Smoking status was 20.9% current, 44.5% former, 34.6% never, with 20 median pack years. Disease was 67.9% T1-2, 32.1% T3-4, 29.9% N0-2a, 70.1% N2b-3. 11.5% had surgery & 87.3% had concurrent systemic therapy. Specifically, 52.2% of OP patients received concurrent cisplatin, 10.6% concurrent cetuximab, and 24.5% other systemic therapies. 11.7% of patients experienced DF, of which 77% failed in the lung. Within the OC cohort, nodal stage 2b or higher was the only predictive factor (HR 3.26, p < 0.001), conferring a 3 year risk of DF of 34% vs 10%. Within the OP cohort, a high risk cohort of 87 patients (12.9%) was identified with a 3 year incidence DF of 22%, compared to 10% or less in lower risk cohorts. This high risk cohort consisted of active smokers treated with definitive RT and either concurrent cisplatin or no concurrent therapy, with at least T3 and N2b disease, as well as any patients treated with definitive RT and concurrent cetuximab. Conclusions: We identified groups of OC & OP patients with greater than 20% risk of developing DF at 3 years, the majority of which occurred in the lung. Surveillance imaging of the chest should be considered for patients meeting these criteria.
- Published
- 2020
48. Definitive Radiotherapy for Elderly Patients with Locally Advanced Squamous Cell Head and Neck Cancer (LAHNSCC): A Single-Institution Experience
- Author
-
Chaim Domb, Nikhil P. Joshi, Deborah J. Chute, Brandon Prendes, C.W. Fleming, Eric Lamarre, Brian B. Burkey, Shlomo A. Koyfman, Chandana A. Reddy, Joseph Scharpf, Timothy D. Smile, Jessica L. Geiger, Neil M. Woody, David J. Adelstein, J. Ku, and B. Matia
- Subjects
Cancer Research ,medicine.medical_specialty ,Radiation ,business.industry ,Head and neck cancer ,Locally advanced ,medicine.disease ,Oncology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Single institution ,business ,Definitive radiotherapy - Published
- 2020
49. Time to Treatment Initiation is Associated with Clinical-to-Pathologic Upstaging in Primary Total Laryngectomy
- Author
-
Shlomo A. Koyfman, B. Matia, Brandon Prendes, David J. Adelstein, M.Y. Lee, Eric Lamarre, Neil M. Woody, Robert R. Lorenz, Brian B. Burkey, Deborah J. Chute, Jessica L. Geiger, Nikhil P. Joshi, M. Belfiglio, C.W. Fleming, and J. Ku
- Subjects
Laryngectomy ,Cancer Research ,medicine.medical_specialty ,Radiation ,Primary (chemistry) ,Oncology ,business.industry ,medicine.medical_treatment ,Time to treatment ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business - Published
- 2020
50. Updated outcomes of split course accelerated hypofractionated radiotherapy for the treatment of head and neck cancers
- Author
-
Chaim Domb, Chandana A. Reddy, Timothy D. Smile, Brandon Prendes, Shlomo A. Koyfman, J. Ku, Nikhil P. Joshi, Brian B. Burkey, Eric Lamarre, Jessica L. Geiger, David J. Adelstein, Joseph Scharpf, Robert R. Lorenz, Neil M. Woody, Deborah J. Chute, and C.W. Fleming
- Subjects
Hypofractionated Radiotherapy ,Cancer Research ,medicine.medical_specialty ,Radiation ,Oncology ,business.industry ,medicine ,Split course ,Radiology, Nuclear Medicine and imaging ,Radiology ,Head and neck ,business - Published
- 2020
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.