Showing papers in "Head and Neck-journal for The Sciences and Specialties of The Head and Neck in 2011"

Transoral laser microsurgery as primary treatment for advanced-stage oropharyngeal cancer: A united states multicenter study

Abstract: Background. Nonsurgical modalities are some- times advocated as the standard of care for advanced oropha- ryngeal tumors. Oncologic and functional results have been modest. The aim of our study was to evaluate outcomes of a minimally invasive approach, using transoral laser microsur- gery (TLM) as the primary treatment for advanced oropharyn- geal carcinoma. Methods. A prospectively assembled database of 204 patients with American Joint Committee on Cancer (AJCC) stages III and IV tonsil or tongue base cancer, treated primar- ily with TLM during 1996-2006 at 3 centers with minimum 2- year follow-up was analyzed. Survival, locoregional control, and swallowing status were recorded. Results. Mean follow-up was 49 months and 79.4% of patients were alive. Three-year overall survival, disease-spe- cific survival, and disease-free survival were 86%, 88%, and 82%, respectively. Local control was 97%, and 87% of patients had normal swallowing or episodic dysphagia. Conclusions. TLM as a primary treatment for advanced oropharyngeal malignancy confers excellent survival and swal- lowing proficiency. V C 2011 Wiley Periodicals, Inc. Head Neck 33: 1683-1694, 2011

Transoral robotic surgery and human papillomavirus status: Oncologic results.

Abstract: Background Patients with oropharyngeal squamous cell carcinoma (OPSCC) have been shown to have distinct outcome profiles based on their human papillomavirus (HPV) status. The purpose of this study was to assess HPV-related outcomes after transoral robotic surgery (TORS) with adjuvant therapy as indicated. Methods This study consisted of a retrospective review of 50 patients with OPSCC within a prospective single-arm cohort study. Outcome measures included HPV status, margin status, relapse pattern, and survival. Results Thirty-seven patients were HPV-positive (74.0%) with 34 patients (91.9%) being serotype-16. Negative margins were achieved in 92.3% (HPV-negative) and 94.6% (HPV-positive). In the HPV-negative group, there were no local recurrences and 1 patient had both regional and distant recurrence (7.7%). In the HPV-positive group, there were no local or regional recurrences and 2 patients (5.4%) had distant recurrences. There were no statistically significant differences in survival between the 2 cohorts (overall survival, disease-specific survival, disease-free survival). Conclusion TORS as a primary surgical modality, followed by adjuvant therapy as indicated, offers disease control in both HPV-negative and HPV-positive groups. We believe that multi-institutional studies are warranted to further evaluate this novel approach for patients who are HPV negative and HPV positive. © 2010 Wiley Periodicals, Inc. Head Neck, 2011

Overall and cause-specific survival for patients undergoing lobectomy, near-total, or total thyroidectomy for differentiated thyroid cancer.

Abstract: Background The extent of surgery for well-differentiated thyroid cancer remains controversial. The purpose of this study was to evaluate the type of resection, age, T classification, nodal status, tumor size, and year of diagnosis for overall survival (OS) and cause-specific survival (CSS) using a large database. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, 23,605 subjects were identified with papillary or follicular thyroid cancer between 1983 and 2002. OS and CSS were estimated, and outcomes for local excision, lobectomy, near-total thyroidectomy, or total thyroidectomy were compared. Results Ten-year OS and CSS by surgery were: total thyroidectomy, 90.4% and 96.8%, respectively; near-total thyroidectomy, 89.5% and 96.6%, respectively; and lobectomy, 90.8% and 98.6%, respectively. Controlling for risk factors, near-total thyroidectomy was inferior to total thyroidectomy for OS (hazard ratio [HR] 1.21; p = .019) and CSS (HR 1.39; p = .019). Age, T3/T4 disease, positive nodes, and tumor size were associated with poorer outcomes. Conclusion Total thyroidectomy resulted in improved survival. Therapy should be individualized, accounting for potential complications and recurrence patterns. © 2010 Wiley Periodicals, Inc. Head Neck, 2011

Nasal morbidity following endoscopic skull base surgery: a prospective cohort study.

Abstract: Background. Nasal morbidity following skull base surgery necessitates follow-up for postoperative care. We describe nasal morbidity following endoscopic skull base surgery. Methods. Patient and operative data and postoperative subjective and objective measures of morbidity were prospectively collected for 1 year. Time to absence of crusting and remucosalization were determined. Risk factor analyses for crusting and nasal discharge were performed. Results. Nasal crusting (98%) and discharge (46%) were the most common postoperative symptoms. Median time to absence of crusting was 101.0 days, with longer times for complex cases (p = .033) but not for patients with septal flaps or fat grafts. Median time to remucosalization after nasoseptal flap was 89.0 days. There were no risk factors for crusting, although surgical complexity was a risk factor for postoperative discharge (odds ratio [OR] = 5.17). Conclusions. Nasal morbidity following endoscopic skull base surgery is common and may be affected by surgical complexity and use of the nasoseptal flap. © 2010 Wiley Periodicals, Inc. Head Neck, 2011

Comparison of morbidity between sentinel node biopsy and elective neck dissection for treatment of the n0 neck in patients with oral squamous cell carcinoma.

Abstract: Background Sentinel node biopsy (SNB) has been proposed for staging of the cN0 neck in early oral/oropharyngeal squamous cell carcinomas (SCC). Because SNB is a minimally invasive procedure, it is thought to be associated with less morbidity than elective neck dissection. Methods Sixty-two consecutive patients were included from 2000 to 2009. Two groups were analyzed consisting of 33 patients after SNB and 29 after elective neck dissection. Subjective impairment and functional shoulder status were assessed with the Neck Dissection Impairment Index (NDII) questionnaire and the modified individual relative Constant Score. Postoperative complications were retrieved from the clinical charts. Results The investigated scores were significantly better in the SNB group. All postoperative complications occurred in the elective neck dissection group. Conclusion SNB is associated with significantly less postoperative morbidity and better shoulder function than elective neck dissection. This supports our opinion that patients with nodal negative early SCC of the oral cavity should be offered SNB. © 2010 Wiley Periodicals, Inc. Head Neck, 2010

ALTERATION OF microRNA PROFILES IN SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK CELL LINES BY HUMAN PAPILLOMAVIRUS

Abstract: Squamous cell carcinoma of the head and neck (SCCHN) ranks sixth among cancers worldwide.1 Many of these cases are associated with heavy consumption of alcohol and/or tobacco use, which over time induce mutations in essential genetic pathways that regulate the cell cycle. However, human papillomavirus (HPV) type 16 DNA has been found in up to 30 percent of these cancers, most often in the oropharynx region, and such cases of SCCHN are often found in individuals without the risk factors of alcohol and tobacco use.1, 2 The HPV-positive SCCHN subset has increased in the past 10 years.2 Because of this demographic shift and distinct clinical behavior, the association and relevance of HPV in SCCHN is under intense investigation. Characteristics of HPV-associated SCCHN are very different from HPV-negative SCCHN, causing disputes whether these cancers should be classified as distinct tumors.3 HPV-positive oral tumors often exhibit loss of cell cycle control proteins, including pRb and cyclin D1, whereas these two proteins are commonly overexpressed in HPV-negative oral tumors.1, 3 One of the most common tumor suppressor proteins, p53, is mutated in up to half of oral cancers, but is very rarely mutated in HPV-positive SCCHN, and tumors with a high viral load have a better prognosis compared to tumors with a low viral load or tumors that are HPV-negative.1, 3 Patients with HPV-positive oral tumors have a better response to chemotherapy, radiation, and surgery,3 and have evidence of immune activation against viral antigens,4 despite having frequent metastasis to regional lymph nodes.3 The biological basis for the differential behavior of HPV-positive SCCHN is not understood. Micro (mi) RNAs are small, ∼22 nt long, chromosome-encoded single-stranded RNAs that are commonly associated with negative regulation of gene expression.5 MiRNAs are transcribed and exported to the cytoplasm where further processing takes place, and the mature miRNA strand is incorporated into the RNA-induced silencing complex (RISC).5 The miRNA guides the RISC to the 3′ untranslated region of its target mRNA where, depending upon the degree of complementarity, the miRNA either translationally represses the mRNA or targets it for degradation.5 MiRNA dysregulation has been implicated in many different types of human cancers.6, 7 Previous reports have shown altered miRNA profiles in head and neck cancers compared to the normal oral tissue.8-11 MiRNAs with high expression in the tumors compared to the normal oral tissue included miR-21, while miR-125b was downregulated.8, 10, 11 Basal miRNA expression in nine head and neck cancer cell lines found that 33 miRNAs were expressed at a high level and 22 miRNAs were expressed at a low level.12 Interestingly, one of these cell lines, UM-SCC47, is HPV-16-positive.13 In all nine cell lines, let-7a, miR-16, miR-21, and miR-205 were highly expressed, and miR-342, miR-346, and miR-373* were expressed at low levels.12 Although these studies show alterations in miRNA levels in head and neck cancer, they do not address the role of HPVs. Since the number of cases of HPV-16-positive SCCHN have been increasing in the past 10 years,2 and the characteristics of HPV-positive and HPV-negative SCCHN support distinction between these cancers,3 we sought to analyze the miRNA profiles in HPV-positive and HPV-negative SCCHN cell lines. In this study, we demonstrate that miRNA expression profiles in HPV-16-positive SCCHN cells are distinctly different from those in HPV-negative SCCHN cells and in normal oral keratinocytes (NOKs) that have been immortalized by activation of h-TERT. Using human foreskin keratinocytes expressing either the HPV-16 E6 or E7 oncogene, we also demonstrate that expression of the E6 oncogene results in upregulation of miR-363 and downregulation of miR-181a, mR-218 and miR-29a. Furthermore, siRNA knockdown of HPV-16 E6 in the HPV-positive SCCHN cell line SCC2 reduced expression of miR-363.

Results of a prospective study of positron emission tomography–directed management of residual nodal abnormalities in node‐positive head and neck cancer after definitive radiotherapy with or without systemic therapy

Abstract: Background. The purpose of this study was to present our prospectively evaluated positron emission tomog- raphy (PET)-directed policy for managing the neck in node- positive head and neck squamous cell carcinoma (NþHNSCC) after definitive radiotherapy (RT) with or without concurrent sys- temic therapy. Methods. One hundred twelve consecutive patients who achieved a complete response at the primary site underwent a 12-week posttherapy nodal response assessment with PET and diagnostic CT. Patients with an equivocal PET underwent a repeat PET 4 to 6 weeks later. Patients with residual CT nodal abnormalities deemed PET-negative were uniformly observed regardless of residual nodal size. Results. Median follow-up from commencement of RT was 28 months (range, 13-64 months). Residual CT nodal abnormal- ities were present in 50 patients (45%): 41 PET-negative and 9 PET-positive. All PET-negative residual CT nodal abnormalities were observed without subsequent isolated nodal failure. Conclusion. PET-directed management of the neck after definitive RT in node-positive HNSCC appropriately spares neck dissections in patients with PET-negative residual CT nodal abnormalities. V C 2011 Wiley Periodicals, Inc. Head Neck 00:000-000, 2011

Human papillomavirus infections in laryngeal cancer

Abstract: Although the association and clinical significance of human papillomavirus (HPV) infections with a subset of head and neck cancers, particularly for oropharyngeal carcinoma, has recently been well documented, the involvement of HPV in laryngeal cancer has been inadequately evaluated. Herein we review the currently known associations of HPV infections in diseases of the larynx and their potential for oncogenicity. Using several methods of detection, HPV DNA has been detected in benign (papillomatosis), indolent (verrucous carcinoma), and malignant (squamous cell carcinoma) lesions of the larynx. Consistent with the known oncogenic risk of HPV infections, common HPV types associated with laryngeal papillomatosis include low-risk HPV types 6 and 11, with high-risk HPV types 16 and 18 more commonly present in neoplastic lesions (verrucous carcinoma and squamous cell carcinoma). Although a broad range of prevalence has been noted in individual studies, approximately 25% of laryngeal squamous cell carcinomas harbor HPV infections on meta-analysis, with common involvement of high-risk HPV types 16 (highest frequency) and 18. Preliminary results suggest that these high-risk HPV infections seem to be biologically relevant in laryngeal carcinogenesis, manifested as having viral DNA integration in the cancer cell genome and increased expression of the p16 protein. Despite this knowledge, the clinical significance of these infections and the implications on disease prevention and treatment are unclear and require further investigation.

Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto's thyroiditis

Abstract: Background. Hashimoto's thyroiditis (HT) and higher levels of thyroid-stimulating hormone (TSH) have been proposed as risk factors for papillary thyroid cancer (PTC), but this issue is still being debated. The purpose of this study was whether HT was related to the risk of PTC over TSH. Methods. We enrolled 1329 patients (1028 with PTC, 52 with follicular thyroid cancer, and 249 with benign disease) of 1490 patients who underwent thyroidectomy. Results. The TSH concentration was not different among patients with PTC or benign disease. Our study showed that men (odds ratio [OR] = 1.54; p = .049) and the presence of HT (OR = 2.96; p <.001) increased the risk of PTC. Moreover, HT was associated with multifocal cancer (p = .005) and smaller tumor size (p = .031), but it did not influence the extrathyroidal invasion or nodal metastasis. Conclusion. Clinicians who deal with thyroid nodules should pay particular attention to HT because it is a stronger predictor for PTC than other risk factors. © 2010 Wiley Periodicals, Inc. Head Neck, 2011

Outcomes after definitive treatment for cutaneous angiosarcoma of the face and scalp.

Abstract: Background The aim of the present analysis was to retrospectively evaluate outcomes in patients with cutaneous angiosarcoma of the face/scalp treated curatively with surgery, radiation therapy (RT), or a combination of surgery and RT. Methods In all, 70 patients with nonmetastatic angiosarcoma underwent surgery, RT, or combined-modality therapy. Of these, 20 patients (29%) were treated with surgery alone, 27 patients (39%) with RT alone, and 23 patients (33%) with combined-modality therapy; 44 patients received chemotherapy, either neoadjuvantly or adjuvantly or both. Results Median follow-up was 2.1 years. The overall survival (OS) rate was 43% at 5 years, and disease-specific survival (DSS) was 46% at 5 years. Tumor size > 5 cm and satellitosis were prognostic for inferior OS and DSS. Combined-modality therapy (vs surgery alone or RT alone) was associated with improved OS, DSS, and local control. Conclusions Primary local therapy with combined-modality therapy was associated with improved local control, OS, and DSS for patients with angiosarcoma of the face/scalp. © 2010 Wiley Periodicals, Inc. Head Neck, 2011

Chemotherapy and targeted therapy in adenoid cystic carcinoma of the head and neck: a review.

Abstract: Adenoid cystic carcinoma (ACC) is an uncommon tumor usually arising in the head and neck region, mainly in the salivary glands. It demonstrates an indolent prolonged course and is characterized by perineural invasion. Primary treatment of local and locoregional disease consists mainly of surgery and/or irradiation. During follow-up these patients frequently develop local recurrences and distant metastases, especially in the lung, although long-term survival is possible. The role of chemotherapy in ACC is limited, and studies with only a limited number of patients are performed. In this article we review the literature on chemotherapy regimens, including monotherapy and combination chemotherapy schedules, as well as the new targeted therapies.

Aggressive variants of papillary thyroid carcinoma.

Abstract: A number of histologic variants of well-differentiated papillary carcinoma have been found to be associated with more aggressive tumor behavior. Tall cell, columnar cell, diffuse sclerosing, solid/trabecular, and insular variants of well-differentiated papillary thyroid cancer are all potentially more aggressive than conventional papillary thyroid cancer. When subjected to multivariate analysis, however, evidence that the histologic subtype of tumor is an independent predictor of outcome is weak. Rather, the aggressive variants tend to present with features recognized by other staging systems as associated with a worse prognosis, including higher histologic grade, extracapsular spread, large tumor size, and the presence of distant metastases. Prognosis is directly related to the presence of these features. The state of our knowledge is limited by the relatively small number of cases that have been studied. The presence of an aggressive variant of papillary carcinoma should alert the surgeon that he is dealing with a potentially aggressive tumor. Clinical treatment decisions should be based on the stage of the disease, influenced by the knowledge that the aggressive variants tend to be associated with higher risk factors. The surgeon must be prepared to perform at the first, or second stage, a total thyroidectomy, central compartment neck dissection, additional lymphadenectomy, and/or resection of invaded surrounding structures, and search for distant metastasis. Postoperative radioactive iodine should generally be administered for these variants as they will generally be intermediate to advanced tumors. The tall cell variant is often refractory to such treatment but may be susceptible to treatment targeted against BRAF mutation. External beam irradiation may be used in cases of incomplete resection.

Association of p16INK4a overexpression with improved outcomes in young patients with squamous cell cancers of the oral tongue

Abstract: Background. The aim of this study was to exam- ine biomolecular profiles in a cohort of young adults with squa- mous cell cancers (SCCs) of the oral tongue. Methods. We identified all patients aged 18 to 39 years diagnosed with SCC of the oral tongue at our institution. Immu- nohistochemical (IHC) staining was performed for p16 INK4a , epidermal growth factor receptor (EGFR), phosphorylated- EGFR (pEGFR), p53, and ERCC1. Human papillomavirus (HPV) testing was performed using in situ hybridization (ISH) and polymerase chain reaction (PCR). Biomarker expression and HPV status were correlated with outcomes. Results. We identified 25 patients with sufficient tumor sam- ples. Median age at diagnosis was 30 years (range, 20-39 years). p16 INK4a overexpression was observed in 11 of 25 patients,

Changes in nutritional status and dietary intake during and after head and neck cancer treatment

Abstract: Background. The purpose of this study was to test whether nutritional status of patients with head and neck cancer changes during and after treatment. Methods. Nutritional status (including body weight, lean mass, and fat mass) and dietary intake were assessed in 29 patients with head and neck cancer. Patients were assessed 1 week before, and 1 and 4 months after treatment (radiotherapy, either alone or combined with chemotherapy or surgery). Results. During treatment, body weight (-3.6 +/- 5.3 kg; p = .019) and lean mass (-2.43 +/- 2.81 kg; p = .001) significantly declined. Patients with sufficient intake (>= 35 kcal and >= 1.5 grams protein/kg body weight) lost less body weight and lean mass than patients with insufficient intake (mean difference, -4.0 +/- 1.9 kg; p = 0.048 and -2.1 +/- 1.0 kg; p = .054, respectively). After treatment, only patients with sufficient intake gained body weight (2.3 +/- 2.3 kg) and lean mass (1.2 +/- 1.3 kg). Conclusion. Patients with head and neck cancer fail to maintain or improve nutritional status during treatment, despite sufficient intake. (C) 2010 Wiley Periodicals, Inc. Head Neck 33: 863-870, 2011

Salivary gland carcinomas in children and adolescents: a population-based study, with comparison to adult cases.

Abstract: Background. Salivary gland carcinomas are rare malignancies, particularly in young individuals in whom only scanty data are available from published studies. Methods. We searched the SEER database (1973–2006) for patients with a reported diagnosis of salivary gland carcinoma; children/adolescents (<20 years old) were compared with adults. Results. We identified 263 children/adolescents (58% girls) and 12,571 adults (43% women). The most common histology was mucoepidermoid carcinoma in both groups, but the percentages of other histologies were different. Children/adolescents had more favorable features with most tumors being localized, with no extension to adjacent tissues or lymphatic spread (76% vs 50% in adults, p < .001). Also most tumors were well differentiated or moderately differentiated (88% vs 49% in adults, p < .001). The 5-year overall survival for children/adolescents was 95% ± 1.5%, compared with 59% ± 0.5% for adults (p < .001). Conclusion. When compared with adults, salivary gland carcinomas in children/adolescents are less advanced, and have more favorable features and better outcome. © 2010 Wiley Periodicals, Inc. Head Neck, 2010

Role of core needle biopsy and ultrasonographic finding in management of indeterminate thyroid nodules

Abstract: Background. Thyroid fine-needle aspiration (FNA) is used as a screening test of choice for evaluation of thyroid nodules. However, approximately 15% to 25% of the cases are classified as indeterminate, posing dilemmas in decision-making. This study was designed to compare the diagnostic performances of second FNA and core needle bi- opsy of indeterminate nodules by initial FNA. Methods. From February 2005 through June 2009, 258 patients who completed scheduled follow-ups were enrolled and the follow-up results were analyzed. Results. Nondiagnostic results were obtained in 41.8% of the second FNA group and in 1.7% of the core needle biopsy group (p < .001; chi-square). The nodules that show border- line features in preoperative ultrasonography had a malignancy rate of 18.3% and could be identified successfully with core needle biopsy. Conclusion. Core needle biopsy is a better method for evaluating indeterminate nodules by initial FNA than second FNA, especially in patients with ultrasonographic findings of a borderline nodule. V

Evidence-based review of treatment options for patients with glottic cancer

Abstract: Evidence-based medicine integrates the best available data in decision making, with the goal of minimizing physicians' and patients' subjectivity. In 2006, the American Society of Clinical Oncology edited clinical practice guidelines for the use of larynx preservation strategies. The objective of this review was to evaluate the current levels of evidence for glottic squamous cell carcinoma. Current guidelines for early stage glottic cancer are based on low-level evidence. Conservation surgery (open or transoral) and radiation therapy are all valid options for T1 and selected T2 lesions. For advanced lesions, surgery and combined chemotherapy and radiation are options. High-level evidence favors combined chemotherapy and radiation therapy or altered fractionation radiation therapy as nonsurgical strategies for organ preservation, compared with radiation therapy alone. The optimal combination of chemotherapy, targeted therapy, and radiation therapy remains to be demonstrated, however, and for high-volume tumors, total laryngectomy may still be warranted.

Neck treatment and shoulder morbidity: Still a challenge†

Abstract: Shoulder complaints and functional impairment are common sequelae of neck dissection. This is often attributed to injury of the spinal accessory nerve by dissection or direct trauma. Nevertheless, shoulder morbidity may also occur in cases in which the spinal accessory nerve has been preserved. In this article, the physiology and pathophysiology of the shoulder are discussed, followed by a consideration of the impact of neck dissection on shoulder complaints, functional impairment, and quality of life. Finally, rehabilitation will be considered.

Limitations and complications of endoscopic surgery for treatment for sinonasal inverted papilloma: A reassessment after 212 cases

Abstract: Background The purpose of this study was to define the optimal surgical strategy for sinonasal inverted papilloma in relation to the site of origin and tumor extent. Methods Retrospective analysis of patients affected by inverted papilloma treated by purely endoscopic or combined approaches at the Department of Otorhinolaryngology of the University of Brescia and Pavia–Varese from November 1991 to December 2007. Results Two hundred twelve patients were considered eligible for this study. An exclusive endoscopic approach was performed in 198 patients (93.4%); the remaining 14 patients (6.6%) underwent an endoscopic approach combined with an osteoplastic frontal flap. Follow-up ranged from 24 to 192 months (mean, 53.8 months). A single recurrence was observed in 12 patients (5.7%). Twenty complications (9.4%) were observed. Conclusion Endoscopic surgery is the first choice in the treatment of inverted papilloma; only lesions with extensive involvement of frontal sinus and/or supraorbital cell may require a combined approach. A minimum follow-up of 5 years is recommended. © 2010 Wiley Periodicals, Inc. Head Neck, 2011

Lymph node ratio as an independent prognostic factor in oral squamous cell carcinoma

Abstract: Background We aimed to validate the lymph node ratio (LNR) as an independent prognostic factor in oral squamous cell carcinoma (OSCC) and compare its utility with the current nodal staging system. Methods We conducted a retrospective analysis of 313 patients with OSCC undergoing neck dissection. The LNR was adjusted by relevant covariates in a multivariable Cox regression model. Results LNR displaced conventional nodal staging and was shown to be an independent predictor of regional failure (p = .020), disease-specific (p = .003) and overall survival (p = .001). Patients with an LNR of 2.5% to 7.5%, 7.5% to 20%, and >20% had 2.6, 3.7, and 4.4 times the risk of death from OSCC, respectively, when compared with patients with an LNR <2.5%. Conclusions The LNR is an independent prognostic factor in OSCC and may be used in conjunction with the current TNM staging to enable better risk stratification and selection for adjuvant therapy. © 2010 Wiley Periodicals, Inc. Head Neck, 2010

Determinants of head and neck cancer survival by race.

Abstract: Background Several factors contribute to the documented racial disparity in head and neck cancer (HNSCC), among which are socioeconomic status, access to care and biologic factors.

Associations between quality of life, coping styles, optimism, and anxiety and depression in pretreatment patients with head and neck cancer

Abstract: Background. Head and neck cancer is often diagnosed at a late stage and consequently radical treatment is necessary. The pretreatment phase is a time of high anxiety and depression for patients. This study aimed to investigate whether anxiety and depression are related to quality of life, coping styles, and dispositional optimism. Methods. One hundred and three patients were recruited after diagnosis to a questionnaire study. Measures included the Hospital Anxiety and Depression Scale; SF12v2 Health Survey; Brief COPE, and the Revised Life Orientation Test. Results. Quality of life, in particular emotional role explained a large proportion of the variance in pretreatment anxiety and depression. In addition, the use of negative coping styles was related to high anxiety levels and low levels of optimism were related to higher levels of depression. Conclusion. There are a small but significant proportion of pretreatment patients that may benefit from individualized support.

Sclerotherapy of lymphangiomas of the head and neck.

Abstract: Lymphangiomas are congenital malformations of the lymphatic system that consist of cysts of varying size. Although they are benign, they can undergo progressive growth with compression and infiltration of adjacent structures. Surgical excision has been the cornerstone of treatment, although total excision of the lymphangioma can be a major challenge and may be associated with severe complications. Therefore, a variety of nonsurgical methods have been proposed to reduce the surgical morbidity and to decrease the recurrence rate. Percutaneous sclerotherapy of lymphangioma involves the injection of sclerosing substances into the lymphangioma cysts. During the past years, different sclerosants and sclerosant techniques have been developed. This review summarizes the current knowledge on sclerotherapy of lymphangiomas of the head and neck. © 2010 Wiley Periodicals, Inc. Head Neck, 2011

Clinical utility of PET/CT in the evaluation of head and neck squamous cell carcinoma with an unknown primary: A prospective clinical trial

Abstract: Background. Metastatic head and neck squa- mous cell carcinoma with an unknown primary is an uncom- mon but important problem. PET/CT, as an adjunct to diagnosis, is potentially useful but has never been studied in a prospective, single-blinded clinical trial. Methods. In all, 20 subjects with cervical metastases from an unknown head and neck primary were enrolled in a pro- spective clinical trial. A standard protocol was used in both clinic and operating room (OR). Study surgeons were blinded to the PET/CT result upon completion of the standard work-up. Results. PET/CT increased the detection of a primary site from 25% to 55% (5 vs 11 subjects). This difference was statis- tically and clinically significant (p ¼ .03, McNemar's test). There was 1 false negative PET/CT scan. Conclusions. An unknown primary should be diagnosed only after a complete head and neck examination, flexible endoscopy, and CT or MRI. PET/CT performed prior to panen- doscopy will increase the diagnostic yield in the unknown head and neck primary population, leading to more targeted, and less morbid, treatment. V

Late side effects of radioactive iodine on salivary gland function in patients with thyroid cancer

Abstract: Background. The purpose of this study was to assess the late side effects of radioiodine therapy (RIT) on salivary gland function. One hundred eighty two patients were evaluated. Methods. Assessment of salivary gland function was performed with salivary gland scintigraphy (SGS), sialometry, and subjective open questions to determine common side effects of RIT on salivary gland function. Results. RIT had a strong association with decreased elimination counts by SGS. Patient age was the only variable associated with sialometry; age and the use of xerostomic drugs were strongly associated with decreased mean values of salivary flow. Dysphagia was strongly associated with RIT. Using multiple logistic regression analysis, age was determined to be an important factor associated with salivary gland dysfunction, and RIT was associated with impairment of saliva excretion. Conclusion. These results show that patients subjected to RIT have more difficulty in draining saliva, mainly from the parotid glands, which is associated with clinical dysphagia in this subset of patients. © 2010 Wiley Periodicals, Inc. Head Neck, 2011

Surgical salvage of persistent or recurrent nasopharyngeal carcinoma with maxillary swing approach — Critical appraisal after 2 decades

Abstract: Background The purpose of this study was to report on our experience on salvage nasopharyngectomy using the maxillary swing approach for persistent or recurrent nasopharyngeal carcinoma after primary treatment. Methods Over the past 2 decades, we have performed salvage nasopharyngectomies for 246 patients. Thirty-seven patients (15%) had persistent disease and 209 (85%) had recurrent tumors. Results All patients survived the operation with minimal morbidity. Negative resection margins were achieved in 191 patients (78%), and 55 patients (22%) had microscopic residual disease. The median follow-up was 38 months. The 5-year actuarial control of disease in the nasopharynx was 74%. The 5-year disease-free survival was 56%. Cox regression model identified the negative resection margin and the size of the tumor as 2 independent factors that affected local control of disease and survival. Conclusion Maxillary swing nasopharyngectomy is an effective salvage procedure for a small, persistent, or recurrent tumor in the nasopharynx after primary therapy. © 2010 Wiley Periodicals, Inc. Head Neck, 2011

Immunoregulatory properties of CD44+ cancer stem-like cells in squamous cell carcinoma of the head and neck

Abstract: It is well recognized that solid tumors are heterogeneous, composed of cells with different phenotypic characteristics, proliferative, differentiated, and/or with malignant potential. Recently, there has been overwhelming evidence that only a minority of cancer cells with stem cell properties, cancer stem cells (CSCs), are responsible for the maintenance and growth of the tumor. These CSC subpopulations show a capacity for highly tumorigenicity, self-renewal, and differentiation. To date, human CSCs have been identified and purified in a variety of malignancies, including those of the brain, breast, prostate, colon, pancreas, and head and neck.1–6 Moreover, several studies have demonstrated that drug or radiation treatment of tumor cells can enrich and maintain the CSC subpopulation in vitro and in vivo,7–10 suggesting that CSCs are responsible for tumor regeneration after conventional cancer treatments. Thus, CSCs have high malignant potential; however, the immunologic properties of CSCs remain unclear. In general, it has long been thought that antitumor immunity plays an important role in the protection against the development of malignancy. In earlier stages of cellular transformation, immunosurveillance can detect and eliminate tumor cells; however, with a developing tumor, tumor variants with reduced immunogenicity, and/or acquired various mechanisms to corrupt the host antitumor response and escape from the host immune system arise, survive and grow in the host.11,12 As a result, interactions between tumor cells and host immune cells in the tumor microenvironment create an immunosuppressive network in which CSCs might actively participate in inducing immunosuppressive ability and promoting evasion from immunosurveillance due to their malignant potential. Indeed, Levina et al13 have reported that lung CSCs selected by treatment with chemotherapeutic drugs produce higher levels of angiogenic and growth factors, such as vascular endothelial growth factor (VEGF), interleukin (IL)-6, IL-8, and granulocyte colony-stimulating factor (G-CSF), than a parental cell line. Moreover, CSCs expressed higher levels of cancer-associated antigens, including embryonic cancer antigens, which are often detected in malignantly transformed cells.13 On the other hand, Kawasaki et al14 found that CSCs derived from a prostate cancer cell line showed an increased expression of the glycoprotein CD200, which is involved in immunosuppression and immune tolerance. More recently, we have demonstrated the identification, expansion, and characterization of CD44+ cancer stem-like cells in a squamous cell carcinoma of the head and neck (SCCHN) cell line.15 Under serum-free medium culture conditions, we enriched a subpopulation of CD44+ cells that possess marked capacity for forming tumor spheres, proliferation, migration, and invasion in vitro. Furthermore, the CD44+ cell population that had been purified using immunomagnetic beads was significantly more resistant to various chemotherapeutic agents than the CD44− cell population. In the present study, we compared the immunologic properties of CD44+ cancer stem-like cells with CD44− cells. Our findings provide new insights into our understanding of immunosuppressive mechanisms in the tumor microenvironment and novel therapeutic approaches against CSCs in SCCHN.

SPECT/CT for sentinel lymph node mapping in head and neck melanoma

Abstract: Background. The additional value of single photon emission computed tomography with CT (SPECT/CT) for detection and localization of sentinel nodes in patients with a melanoma of the head and neck was determined. Methods. Thirty-eight patients received conventional lymphoscintigraphy followed by hybrid SPECT/CT. The number of sentinel nodes visualized and anatomic information provided were analyzed. Changes in surgical approach due to additional information from the SPECT/CT were evaluated in 20 patients. Results. SPECT/CT visualized a mean of 2.6 sentinel nodes per patient (range, 1–6). SPECT/CT depicted an additional sentinel node in 16% of the patients and clearly showed the anatomic location of the hot nodes in all patients. The surgical approach was adjusted on the basis of SPECT/CT images in 11 patients (55%). Conclusion. SPECT/CT visualizes more sentinel nodes than conventional images and shows their anatomic location. SPECT/CT is recommended in patients with a melanoma in the head or neck. © 2010 Wiley Periodicals, Inc. Head Neck, 2011

Differences in history of sexual behavior between patients with oropharyngeal squamous cell carcinoma and patients with squamous cell carcinoma at other head and neck sites.

Abstract: Background An emerging epidemic of human papillomavirus (HPV)-associated oropharyngeal cancer has been proposed. We compared the sexual behaviors of patients with squamous cell carcinoma of the oropharynx (SCCOP) and patients with squamous cell carcinoma of non-oropharyngeal head and neck sites (SCCNOP) to expand our understanding of sexual behavior as a risk factor for HPV-associated head and neck cancer.

Coexistence of Hashimoto's thyroiditis with papillary thyroid carcinoma: the influence of lymph node metastasis.

Abstract: Background The aim of this study was to evaluate the influence of coexistent Hashimoto's thyroiditis with papillary thyroid carcinoma on lymph node metastasis. Methods The coexistent Hashimoto's thyroiditis group was defined by the presence of thyroid autoantibodies or pathologic confirmation. The control group did not have autoantibodies, disease, or ultrasound findings of Hashimoto's thyroiditis. Results For the Hashimoto's thyroiditis group, only central lymph node metastasis had a lower frequency and the mean number of central metastatic lymph nodes was lower than in the control group after adjustment. With regard to lateral lymph node involvement, there was no significant difference between the 2 groups. The multivariate analysis showed a negative association between the coexistence of Hashimoto's thyroiditis and central lymph node metastasis. Conclusions Coexisting Hashimoto's thyroiditis in patients with papillary thyroid carcinoma was identified as a negative independent predictive factor for central lymph node metastasis. © 2010 Wiley Periodicals, Inc. Head Neck, 2010