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The purpose of this paper is to determine whether prophylactic gabapentin usage in patients undergoing definitive concurrent chemotherapy and radiation therapy (chemoRT) for oropharyngeal cancer (OPC) improves treatment-related oral mucositis pain, opioid use, and feeding tube (FT) placement.This double-blind, randomized phase 3 study for patients with locally advanced OPC undergoing chemoRT randomly allocated patients to prophylactic gabapentin (600 mg thrice daily) or placebo. The primary endpoint was change in Patient-Reported Oral Mucositis Symptom (PROMS) scores over the entire treatment period (baseline to 6 weeks post-radiation therapy [RT] follow-up) with higher scores indicating worse outcomes. Opioid requirements, FT placement, and other patient-reported quality of life (QOL) metrics (Functional Assessment of Cancer Therapy-Head and Neck [FACT-HN] and Patient-Reported Outcomes version of the National Cancer Institute Common Terminology Criteria for Adverse Events [PRO-CTCAE]) were assessed. Lower scores suggested poorer QOL with the FACT-HN questionnaire, and higher scores suggested worse outcomes with the PRO-CTCAE questionnaire. Questionnaires were administered at baseline, weekly during RT, and at 6 weeks post-RT follow-up. Repeated measures analysis of variance was used to detect differences in PROMS scores and change in opioid use from baseline. Wilcoxon rank sum tests were used to compare averages for the other secondary endpoints. A P value less than .05 was considered statistically significant.Treatment arms were well balanced overall, including T and N staging and dosimetric variables. There were 58 patients analyzed. No significant difference was found in PROMS scores (mean 29.1, standard deviation [SD] 22.5 vs 20.1, SD 16.8 for gabapentin vs placebo, respectively, P = .11). The FACT-HN functional well-being index had a significant decrease in scores from baseline to follow-up in the gabapentin arm (median -6, interquartile range [IQR] -10.0 to -0.5 vs -1, IQR -5.5 to 3.0, P = .03). PRO-CTCAE scores increased significantly at follow-up for gabapentin (median 6.5, IQR 3.5-11.8 vs 1, IQR -2.0 to 6.0, P = .01). There was no significant difference in average or change in opioid use. FT placement was significantly higher in the gabapentin arm (62.1% vs 20.7%, P.01).This study suggests that prophylactic gabapentin is not effective in improving treatment-related oral mucositis symptoms in a select population of patients with OPC undergoing definitive chemoRT.

Identifying prognostic risk factors and determining the efficacy of common surgical treatments is critical to determine optimal treatment strategies for patients with medullary thyroid carcinoma (MTC). The objective of this study was to review a contemporary institutional experience with MTC primary treatment with 2 goals: to identify prognostic factors that impact survival and to study the effect of neck dissection on those outcomes.This study was a retrospective case series of patients with MTC who underwent at least a total thyroidectomy with curative intent. Clinical parameters including tumor and nodal staging with corresponding pathology findings were identified. Survival endpoints included overall survival, disease-free survival, and biochemical cure.Sixty-seven patients were included. The majority presented with early T-stage disease. Fifty (76%) patients were N0 at presentation. Seventeen (24%) had some evidence of neck disease on clinical examination or imaging. Forty (71%) achieved biochemical cure, and the 5-year biochemical recurrence-free survival for those cases was 86.5%. Among patients who had successful resection of all gross disease, 92% had no evidence of structural disease at 5 years. Overall survival was 91% at 5 years. Increased pre-operative calcitonin (Ct) level, primary tumor size, extrathyroidal extension, and neck metastases decrease the rate of biochemical cure. Larger tumor size increases the risk of structural disease recurrence and biochemical relapse after initial cure. The presence and number of neck metastases correlate with biochemical relapse. The presence of lateral neck nodes (pN1b) does not have different survival implications than centrally confined disease (pN1a).This study shows increasing tumor size, increased Ct level, and cervical metastases are poor prognostic factors. Patients with large tumors, high Ct level, or unfavorable pathologic findings may warrant more aggressive initial treatment, although limitations of the study prevent any conclusion regarding the effect of neck dissection.ATA = American Thyroid Association BRFS = biochemical recurrence-free survival CND = central neck dissection Ct = calcitonin DFS = disease-free survival MTC = medullary thyroid carcinoma OR = odds ratio OS = overall survival pCND = prophylactic CND.

Introduction Use of balloon catheter dilation in the management of paranasal sinus diseases, including chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis, remains controversial. In an effort to gain some clarity about its evolving role, we surveyed members of the American Rhinologic Society (ARS). Method Online survey. Results ARS Members were sent an invitation by e-mail to participate in an online, anonymous 23-item survey. A total of 231 participants completed the survey, for an overall response rate of 25%. Balloon catheter technology (BCT) played no role in the practices of one-third of all the respondents. Of those who did use BCT, more than 50% performed only 1–4 cases per month on average. This did not differ significantly with practice type (p = 0.2988). The overall use of BCT differed between types of practices with those in private practice reporting greater use of the technology for maxillary and sphenoid sinuses (p = 0.0003 and p = 0.0073, respectively). Participants in private practice appeared significantly more impressed with the results of BCT when compared with those in academia (p = 0.0005) and also thought that patients were more satisfied (p = 0.0002). Opinions toward the strength of available evidence also differed significantly between the two groups (p = 0.0007). Thirty-two respondents had experienced a complication with BCT, although the majority of these did not require any intervention. Conclusions ARS members surveyed used BCT infrequently in their practices. Attitudes on the role of this technology in CRS management differed between academic and private practitioners, but, despite this, the volume of reported BCT use was the same. Surgeons are more accepting of the technology now compared with 5 years ago, and many of them believe that their use of BCT will increase in the future.

Physicians recognize the value of accurate documentation to facilitate patient care, communication, and the distribution of professional fees. However, the association between inpatient documentation, hospital billing, and quality metrics is less clear.To identify areas of deficiency in inpatient documentation and to instruct health care professionals on how to improve the quality and accuracy of clinical records.A single-arm pre-post study was conducted from January 1, 2013, to December 31, 2014, among 17 attending and 12 resident physicians treating 1188 patients at an academic medical center. Data from 1 year prior to the intervention were compared with data for 10 months following the intervention. All increases were analyzed as a percentage increase after the intervention relative to before the intervention.Areas for improvement were identified, and all physicians in the department received education on inpatient coding and documentation.The capture rate for complications or comorbidities and major complications or comorbidities, the case mix index (the average diagnosis related group relative weight for a hospital or department), and severity of illness and risk of mortality scores.A total of 1188 inpatients were included in the analysis: 743 in the preintervention period and 445 in the postintervention period. Review of our documentation identified major areas of comorbidity that were frequently underreported. Inadequate nutrition diagnoses (moderate malnutrition, severe protein-calorie malnutrition) were most often underreported. In addition, we found inadequate documentation supporting the presence of neck metastases. Among 1188 patients, the case mix index increased 5.3% (from 2.81 to 2.96) after the intervention, but this was not a statistically significant difference (P = .21). The normalized case mix index increased 21.7% (from 37.3 to 45.4; P .01). The percentage of patients with a documented complication or comorbidity or major complication or comorbidity increased 27.1% (from 50.2% to 63.8%; P .01). The percentage of patients assigned a severity of illness score of 3 or 4 increased 24.3% (from 34.7% to 43.0%; P .01). The percentage of patients assigned a risk of mortality score of 3 or 4 increased 32.1% (from 18.7% to 24.7%; P = .01).After educational sessions, multiple measures of patient acuity increased significantly owing to improved documentation of common comorbid conditions. Although physicians intuitively appreciate the importance of good documentation, education on the technical aspects of coding can significantly improve the quality and accuracy of clinical records.

Fewer than five case reports of primary large cell neuroendocrine carcinoma of the nasopharynx are known to the authors. No previous reports have included examples of cytomorphology or have proven association with Epstein-Barr virus. We herein illustrate MRI findings, histopathologic features, immunohistochemical characterization, cytologic details, and in situ hybridization studies from a unique case of primary large cell neuroendocrine carcinoma of the nasopharynx in a 38-year-old Caucasian male patient. Recognition of rare tumor types of the nasopharynx allows for refinements in disease management and prognostication.

Objectives:(1) Compare outcomes of patients with sinonasal malignancies (SNM) treated with an open resection to patients treated with an exclusively endoscopic or endoscopic-assisted approach. (2) Analyze the differences in surgical complications, length of hospital stay, and margin status between open and endoscopic approaches.Methods:A retrospective review was performed on 102 patients with a pathologically diagnosed T3 or T4 SNM treated definitively at a tertiary care academic center from 1995 to 2012. Oncologic outcomes were determined.Results:Of the 102 patients, 29 presented with T3 disease while 73 presented with T4 disease. The most common histologic subtype was squamous cell carcinoma (56.9%). Fifty-three patients (52.0%) underwent open resection while 26 (25.5%) underwent an endoscopic or endoscopic-assisted resection. The 5- and 10-year disease-specific survival (DSS) for the 2 surgically treated groups was 67.6% and 65.2%, respectively. There was no significant difference between patients trea...