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This study sought to evaluate the role and trajectory of spontaneous swallowing frequency (SFA) in patients with head and neck cancer (HNC) undergoing chemoradiotherapy (C/RT).University comprehensive cancer center.A prospective cohort of 80 patients with HNC was followed from baseline to 3 months post-C/RT. Subjects were evaluated for performance on swallowing function, functional diet consumed, weight, swallowing frequency rate, perceived xerostomia, perceived pain, and mucositis. Relationships were evaluated using univariate correlations,In general, patients with HNC demonstrated a parabolic decline in most measures over the C/RT trajectory. SFA and perceived xerostomia did not show improved recovery by 3 months. SFA was related to swallow function, xerostomia, and functional diet consumed posttreatment and pain at 3 months. The ability of SFA to correctly identify clinical dysphagia (Mann Assessment of Swallowing-Cancer version [MASA-C]) and reduced oral intake (Functional Oral Intake Scale [FOIS]) at posttreatment was strong (AUROC MASA-C: 0.824 [95% CI, 0.63-1.00],This exploratory study suggests SFA may provide a useful method to identify dysphagia after HNC treatment. Furthermore, SFA may offer a simple, objective measure of swallowing function change in HNC over the C/RT trajectory.

This study described swallowing patterns in a large head/neck cancer (HNC) cohort.In a retrospective review of data from a randomized controlled trial, we studied timing of penetration events as they related to aspiration and oral/pharyngeal residue.Retrospective review of a multicenter randomized controlled trial.In total, 168 patients who were3 months postradiation received baseline modified barium swallow evaluations. Retrospective analyses of data from these exams were studied, including Penetration-Aspiration Scale (PAS) scores and timing of these events (before, during, or after the swallow), as well as percentage of oral and pharyngeal residue.Aspiration occurred more frequentlyThe predominant pattern for this sample of postradiation patients with HNC with dysphagia was aspiration that occurred after the swallow, rather than before or during the swallow. The aspiration was directly caused by penetration events that occurred during the swallow, resulting in aspiration as the airway reopened. Patients demonstrated more pharyngeal residue than oral residue, but a weak relationship was found between residue and penetration/aspiration events. These results guide clinicians in targeting appropriate swallowing interventions.

We aimed to determine the prevalence and co‐occurrence of tobacco smoking, alcohol consumption, and depressive symptoms among a sample of head and neck cancer (HNC) patients undergoing radiotherapy. A total of 307 HNC patients participated in a multi‐site stepped‐wedge randomized controlled trial (RCT) evaluating the effectiveness of a dietitian‐delivered health behavior intervention in patients with HNC undergoing radiotherapy. During week one of radiotherapy patients completed measures of smoking, alcohol consumption, and level of depression. Approximately one‐fifth (21%) of patients had two or more co‐occurring problems: current smoking, hazardous alcohol use, and/or likely presence of a major depressive episode (MDE). Approximately one‐third (34%) of the sample were current smokers, one‐third (31%) were drinking hazardously and almost one‐fifth (19%) had likely cases of depression. Comorbidity of smoking, hazardous alcohol use, and MDE is high in HNC patients, and interventions need to address this cluster of cancer risk factors.

Objectives Tracheostomy is commonly used in intensive care units and in head and neck departments. Airway obstruction due to occluded cuffless tracheostomy tubes themselves remains unknown, although capping trials are commonly used before decannulation. The aim of this study was to evaluate the extent to which airway obstruction can be caused by occluded cuffless tubes in patients who underwent head and neck surgery. Design Prospective Research Outcome. Settings University teaching hospital. Participants Fifty patients requiring transient tracheostomy after head and neck surgery. Main outcome measures A flow-volume loop (FVL) through the mouth using a portable spirometer, with the occluded fenestrated cuffless tube, was measured before and immediately after decannulation, by obstructing the orifice of tracheostomy tube. The measurement of FVL recorded the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), forced expiratory flow at 50% of FVC, peak inspiratory flow (PIF) and forced inspiratory flow at 50% of FVC. Results A statistically significant difference between all spirometric parameters was found. Mean PEF and PIF, respectively, increased from 2.8 to 4.5 L/s (P < .0001) and 2.3 to 2.7 L/s (P < .01) before and after decannulation, with a strong positive correlation (r = 0.7; P < .05). A mean expiratory (34%) and inspiratory (9%) airflow reduction was observed due to cannula. Conclusions Occluded cuffless tracheostomy tubes cause a dramatic airflow obstruction, mainly in the expiratory phase of FVL. This should be taken into account during capping trials.

Objective Extensive research has documented the negative nutritional impact of head neck cancer (HNC) treatment, but few studies have addressed the patients' experiences. The purpose of this study was to describe how patients with HNC experience the nutritional situation and perceive nutritional support from diagnosis to the post‐treatment phase. Methods Patients with HNC were recruited from a randomised pilot study. Individual interviews were conducted after radiotherapy with 10 participants aged 49 – 70 years and analysed by qualitative content analysis. Results Undergoing surgery was experienced as a poor nutritional starting point for the upcoming radiotherapy. During radiotherapy, increasing side effects made the participants customise their meals to improve food intake. About halfway through radiotherapy, virtually no food intake was experienced and hospital admissions and initiations of tube‐feeding occurred in this period. Oral nutritional supplements were recommended for all, but eventually became unbearable to ingest. When radiotherapy was finally completed, the participants felt discouraged about the persistent side effects preventing them from resume eating. The participants missed tailored information about development of side effects and involvement of a dietitian when reflecting on the treatment‐period. Conclusion The comprehensive nutritional problems experienced by patients with HNC require early nutritional assessments and improved individually tailored nutritional support. © 2019 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Background and Objectives: PET-CT has shown promise in the management of head neck cancers. However, there have been only few studies evaluating its impact on management of patients with recurrent cancers in the presence of available clinicoradiologic methods of assessment. We conducted this study to assess the same in patients with suspected recurrent head and neck cancer. Methods: Case histories were presented to two oncologists, who were blinded to PET-CT reports. Treatment plans were made by these oncologists based on clinical findings and other conventional imaging. These plans were then compared to the actual treatment received by patients after PET-CT. Any change was recorded as “change in management.” Results: Forty-nine patients with suspected recurrent head and neck cancer were evaluated in the study. Overall, there was a 38.7% change in management because of the addition of PET-CT to conventional methods of assessment. Eight patients (16.3%) had a major change in therapy while in 11 patients (22.4%), diagnostic procedures like endoscopies, biopsies and examination under anesthesia were avoided. Conclusion: In our study, PET-CT had a significant impact on the management of patients with suspected recurrent head neck cancer. J. Surg. Oncol. 2009;100:401‐403. 2009 Wiley-Liss, Inc.

ProblemWe previously proposed that head and neck squamous cell carcinoma (HNSCC) presents in three histopathologically similar but molecularly distinct types where p16 expression combined with high-risk Human Papillomavirus (HPV) presence defines three distinct subgroups: Class I (HPV-), Class II (HPV16+/p16-), Class III (HPV16+/p16+). In this study we sought to further explore and validate this classification schema.MethodsParaffin-embedded specimens from 77 patients with OSCC classified into the 3-class model based on p16 expression and HPV DNA presence were previously queried for expression of 14 target proteins with known involvement in tumor progression using AQUA(tm). We calculated pairwise associations by Spearman correlation and performed hierarchical clustering analysis to assess global expression patterns of class I, II and III tumors.ResultsHierarchical clustering analysis demonstrated class I and class II tumors displayed similar clustering patterns. Class III tumors (HPV+/p16+) displayed uniq...

Introduction. There are 12 cancer registries. The process of cancer registration within the United Kingdom is similar. The Welsh Cancer Intelligence & Surveillance Unit (WCISU) has published a report ‘Cancer Incidence in Wales 1992--2001’. Objective. The aim of the study was to validate head and neck section of the report. Material and method. Data of cancer patients travels from the clinical notes through clinical coding to Patient Administration System (PAS) at each Trust, then to the Patient Episode Database for Wales (PEDW), and finally to WCISU. The processed data used for the publication of this report was retrieved from WCISU and was compared to that received from the clinical notes, PAS and PEDW. Results. 12% of the notes examined were inappropriately coded in terms of gross anatomical tumour site. If non-melanoma skin cancers are included in the definition of Head and Neck Cancer 80% (17\,101) of the patients appear to not be included in the WCISU report. If skin cancer is excluded from the definition 57% (5750) of head and neck cancer patients appear to not be included. Conclusion. The definition of Head & Neck Cancer appears to differ between clinicians and that used in the WCISU report. This difference will create an apparent gross underestimate in the true incidence of Head and Neck cancer in Wales when viewed from a clinical or workload perspective. It appears that this report could not be used for the present and future planning of Head & Neck services in Wales.

Purpose:Treatment uncertainties are not included in modeling dose response of hearing loss. We determine uncertainty of accumulated dose to cochleas of head & neck cancer patients due to setup error during treatments of external beam IMRT.Methods: We studied 8 patients: 1 planning CT for each patient and total 40 cone beam CTs. Those patients were treated with 33 fractions. Treatments delivered 70 Gy to PTV, 50 to 60 Gy to nodal and sub‐clinical disease using IMRT dose painting. Setup error was measured using 6‐dimensional rigid registration between planning CT and cone beam scans obtained prior to treatment. Planning CTs were transformed and resliced to produce ‘treatment CTs’ according to the measured setup error matrix to simulate the cochlea position during treatment. We calculated dose delivered to cochleas at each treatment position. Treated dose to the cochlea from each fraction was accumulated on the planning CT using its registration with each ‘treatment CT’. Results: The RMS value of set error of left cochlea is 0.48pm0.28cm, right cochlea is 0.47pm0.26cm. Mean values of left and right cochleas are ∼zero. Uncertainty in the dose to cochlea depends on each treatment plan and relative positions of the cochlea and target volumes. Average uncertainty of mean dose to cochlea is 5.0%, or 5.2cGy per fraction. Conclusion: Patient setup error introduces uncertainty to the position of the cochlea and consequent uncertainties in accumulated dose. Our method calculates accumulated dose delivered to the same cochlea volume at different treatment positions due to setup error. We found uncertainty in cochlea doses was 5% of planned dose after 4 to 7 fractions. The largest uncertainty was 17 cGy per fraction. Our Results will be used to determine uncertainties in dose response of hearing loss in head and neck patients. NIH R01‐CA129182

Purpose: Volumetric Modulated Arc Therapy (VMAT) is an arc‐based technique that utilizes dynamically modulated arcs to deliver intensity‐modulated radiation therapy(IMRT)treatments on a conventional linear accelerator. In this work, we evaluate VMAT as a treatment technique for patients with carcinomas of the head‐and‐neck. Method and Materials: Five complex head and neck cancer patients, with multiple prescription levels, were selected for this study. Fully inverse planned VMAT plans were optimized for these patients using our homegrown arc‐sequencing software. The software uses simulated annealing to optimize the aperture shapes and weights while minimizing the differences between the optimized (ideal) and sequenced intensities. The optimized plans were compared with step‐and‐shoot IMRT plans generated using the Pinnacle3treatment planning system. VMAT plan verifications have also been performed using Elekta's Precise Beam Infinity™ control system which has been installed on an Elekta Precise linear accelerator in our clinic. Results: Using our arc‐sequencing tool, VMAT can be used to create highly conformal head‐and‐neck treatment plans. As compared with traditional fixed‐field plans, VMAT was able to reduce the average parotid dose from 85.3 cGy to 73.6 cGy per fraction. Additionally, the average number of monitor units was reduced from 1058.3 to 502.3 per fraction. Initial delivery tests demonstrate that using VMAT complex head‐and‐neck deliveries can be completed in under 6 minutes. Conclusion: VMAT should serve as an important tool in the delivery of radiation therapy for head‐and‐neck carcinomas. By utilizing the dosimetric advantages of rotational IMRT, VMAT can provide more uniform target doses and reduced critical structure doses as compared with fixed field IMRT.Conflict of Interest: Research partially sponsored by Elekta Corporation.