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Background:A lymph node yield (LNY) over 20 is considered a quality metric for lateral neck dissection to ensure an oncologic representative sample. Anecdotally, however, LNY in patients undergoing neck dissection after radiation therapy (RT) is lower due to atrophy and fibrosis.Objective:To determine whether preoperative RT decreases LNY in patients with laryngeal cancers undergoing surgery.Methods:Medical record database was queried for patients presenting between 2006 and 2015 with laryngeal cancer. Tabulation was made for location (glottic/supraglottic), stage, and side for the total number of lymph nodes between primary surgery and RT (salvage surgery) groups. Descriptive analysis and a paired Student t test were used for statistical analysis.Results:Fifty-nine patients were included in the study for a total of 98 neck dissections. Twenty-six (44%) patients had primary surgery, and 33 (56%) patients had salvage surgery. The mean left and right total LNY in the salvage surgery group was 27.6 and 29.5, respectively, and 32.2 and 33.7 for the primary surgery group. A difference of 4.5 (left) and 4.3 (right) in LNY between the salvage surgery and primary surgery group was found. A Student t test showed no statistically significant difference in LNY between both groups when analyzed per site (glottic and supraglottic), side, and stage (III-IV).Conclusion:Although patients with prior RT had a lower mean of LNY, our results did not demonstrate a statistically significant difference. Further studies with a larger number of patients are recommended.

To understand measures of frailty among preoperative patients and explain how these can predict perioperative outcomes among patients with head and neck cancer.Retrospective cross-sectional case series with chart review.Academic tertiary medical center.A retrospective review was performed of patients presenting to an academic hospital following a surgical procedure for a head and neck cancer diagnosis. Charts were queried for preoperative medical diagnoses to calculate 2 frailty scores: the American College of Surgeons National Surgical Quality Improvement Program modified frailty index and the Johns Hopkins Adjusted Clinical Groups frailty index. The American Society of Anesthesiologists classification system was also analyzed as a predictor. Primary outcomes were mortality, 30-day readmission, and length of stay. Perioperative complications and discharge disposition were also evaluated.A total of 410 charts were queried between January 2014 and December 2017. Mortality was 11%; mean ± SD length of stay was 7.4 ± 5.5 days; and the readmission rate was 17%. The modified frailty index score significantly increased the odds of mortality (odds ratio = 1.475, P = .012) and readmission (odds ratio = 1.472, P = .004), the length of stay (relative risk = 1.136, P = .001), and the number of perioperative complications. The American Society of Anesthesiologists classification was also significantly associated with poor outcomes, including readmission, length of stay, and perioperative complications. The Adjusted Clinical Groups index was not a significant predictor of outcomes in this study population.This study demonstrated a significant increase in poor perioperative outcomes and mortality among patients with head and neck cancer and increased frailty, as measured by the modified frailty index.

Objective To determine whether an enhanced recovery after surgery (ERAS) nutrition protocol is reasonably possible among our head and neck cancer (HNC) population with respect to system feasibility and patient compliance. Second, we aim to identify improvements in patient outcomes as a result. Methods Preexperimental research design among patients undergoing major HNC surgery after implementation of the ERAS nutrition protocol from July 2018 to July 2019 as quality improvement (QI). Preoperative clinical nutritional assessment and laboratory values were completed the same day as informed surgical consent in the clinic. Protocol focus was patient consumption of nutritional supplements perioperatively, monitored by our outpatient dietitian. Early postoperative enteral nutrition was initiated with monitoring of nutritional laboratory values. To support our model, we provide preliminary analysis of HNC patient outcomes after implementation of the ERAS nutritional protocol. Results Twenty-five patients were enrolled. Preoperatively, 40% of patients were malnourished, and 100% complied with perioperative nutrition supplementation. Health care provider compliance obtaining preoperative laboratory values was 56%. There was a strong negative correlation between modified Nutrition-Related Index (mNRI) and number of complications (P = .01), specifically, fistula rate (P = .04) and unplanned reoperation (P = .04). Enrolled patient average length of stay was 7 ± 4.4 days. Discussion Our patients demonstrated compliance with implementation of an ERAS nutrition protocol likely facilitated by dietitian engagement. mNRI potentially reflects risk for head and neck surgery complications. Implications for practice QI processes demand reassessment and modification to ensure efficient and targeted approaches to improving patient care.

Introduction As traditional measures such as overall survival (OS) or disease-free survival (DFS) alone do not give a holistic view of the outcomes of a treatment paradigm, we determine to add the evidence of quality-adjusted life year (QALY) and disability-adjusted life year (DALY) to the outcomes of the nasopharyngeal carcinoma patients (NCP) treated with definitive chemoradiation therapy (chemoRT) with or without induction chemotherapy (induction chemo). Methods This is a retrospective analysis of 85 NCPs treated at an academic state institution. The OS estimated by the Kaplan-Meier method and the multivariate Cox regression model determined the co-variables associated with the OS. The relationship between QALYs gained and DALYs saved were calculated from age of the disease onset, duration of the disease, quality of life (QoL) and disability weights. Results Of the 85 eligible NCPs of this cohort, the disease frequency distribution per the World Health Organization (WHO) classification was 41.2% for Type-I, 42.4% for Type-II, and 16.5% for Type-III. The median follow-up (24 months). The five-year OS of patients treated with concurrent chemoRT vs. induction chemo followed by concurrent chemoRT was 54.7 vs. 14.8% for WHO Type I, 60.1 vs. 58.3% for WHO Type II, and 83.3 vs. 50.0% for WHO Type III (p=0.029). The average DALYs saved with concurrent chemoRT were 12.2 years vs. 5 years for induction chemo followed by concurrent chemoRT. The average QALYs gained with concurrent chemoRT were 6.9 years vs. 3.1 years for induction chemo followed by concurrent chemoRT. Conclusion Patients treated with concurrent chemoRT had an increased QoL when compared to induction chemo followed by concurrent chemoRT. The average DALYs saved were higher in the patients treated with concurrent chemoRT than treated with induction chemo followed by concurrent chemoRT.

Purpose: To assess the prognostic significance of tumor HPV/p16 status among oropharyngeal squamous-cell carcinoma (SCC) patients. Methods: A retrospective analysis of 80 patients diagnosed with oropharyngeal SCC between 2008 and 2018 at an academic medical center with known HPV/p16 status was performed. Pearson’s Chi-squared test was used to compare the proportional differences between the known tumor HPV status among positive and negative p16 staining groups. Kaplan- Meier analysis was used to estimate overall survival [OS] and local control [LC] between the HPV groups stratified by risk and compared using the log-rank test. Uni and multi-variable Cox hazard regression analyses were used to compare the risk of death among patients with HPV- positive and HPV- negative cancer. The SPSS v.24.0 was used for all statistical analyses. Results: Our patient cohort included 37.5% HPV- positive and 62.5% HPV-negative (median age, 61 y; range 45-86 y) patients. Patient groups were classified on the basis of risk factors: HPV/p16 status, pack-years [py] of tobacco smoking, and tumor stage into low (p16+, ≤ 10 py), intermediate (p16+, > 10 py/p16-, < 10 py), and high risk (p16-, > 10 py/ any T4), accounting for 36.7%, 36.7% and 26.7% of HPV-positive and 0%, 20% and 40% of HPV-negative patients, respectively (p=0.000). The median follow-up duration for this cohort was 34 months (range 0 to 154 months). The low risk HPV-positive group had better 5-year OS rates (87.5%, vs. 59.5% and 27.2%) compared to intermediate and high risk groups (p=0.003 by the log-rank test). After adjustment for gender, age, race, income level, distance travelled, tobacco exposure, alcohol history, tumor stage, and treatment modality, this group had a 63% reduction in the risk of death (hazard ratio, 0.37; 95% CI, 0.18-0.77; p= 0.008). Insurance and BMI was associated with a 71% reduction (hazard ratio, 0.29; 95% CI, 0.97-0.89; p=0.032), and a 49% reduction in the risk of death (hazard ratio, 0.51; 95% CI, 0.37-0.71; p=0.000), respectively. In terms of LC, the low risk HPV-positive patients had better 3-year rates 70.1%, vs. 55.7% and 39.9% compared to the intermediate and, high risk groups (p=0.379). Conclusion: Tumor HPV/p16 status may be an independent prognostic factor along with insurance status and BMI for overall survival among oropharyngeal SCC patients. Citation Format: Mary R. Nittala, Eswar K. Mundra, Ashley Albert, William C. Woods, Maria L. Smith, Robert D. Hamilton, Lana Jackson, Gina Jefferson, Satyaseelan Packianathan, Eldrin Bhanat, Varsha Manucha, Srinivasan Vijayakumar. Univariate and multivariate prognostic factors for overall survival among oropharyngeal cancer patients with known HPV/p16 status [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-232.

Purpose: To evaluate the impact of race (African-American [AA] vs. Caucasians [C]) on the survival outcome in patients with oropharyngeal squamous-cell carcinoma (SCC) known HPV/p16 status. Methods: Between 2008 and 2018, eighty patients with known HPV/p16 status were diagnosed with oropharyngeal SCC in our academic state institution. Chi-square test, Kaplan-Meier method, and Cox regression models were used to assess for racial influence; p-values less than 0.05 were considered statistically significant. The SPSS v.24.0 was used for all statistical analyses. Results: The median follow-up duration was 34 months (range 0 to 154 months). Our patient cohort included 48.8% AA and 51.2% C (median age, 61 y; range 45-86 y) patients. Patient risk groups were stratified based on HPV/p16 status, pack-years [py] of tobacco smoking, and tumor stage into low (p16+, ≤10 py), intermediate (p16+, >10 py/p16-, 10 py/ any T4), accounting for 2.6%, 25.6% and 71.8% of AA vs. 24.4%, 26.8% and 48.8% of C patients, respectively (p=0.013). The C patients had better 5-year overall survival [OS] rates (88.9%, 62.2% and 37.5% vs. na, 48.0% and 25.6% compared to AA patients stratified by risk (p=0.009). The OS of low risk AA patients was not assessable because of a low number (1) of patients in that group. In the bivariate Cox regression analysis, the covariates stratified by race, type of insurance, BMI level, HPV/p16 status, risk groups, and 8th AJCC staging were statistically significant with p-value less than 0.05. In the multivariate analysis, the covariates of insurance-private was associated with 87% reduction (hazard ratio, 0.13; 95% CI, 0.03-0.61; p=0.010), insurance-Medicare was associated with 71% reduction (hazard ratio, 0.29; 95% CI, 0.11-0.74; p=0.010), and AJCC TNM stages III, IV and IVB (98%, 97% and 93%) with reduction in the risk of death (hazard ratio, 0.02; 95% CI, 0.00-0.38; p=0.009), (hazard ratio, 0.03; 95 CI, 0.00-0.55; p=0.017), (hazard ratio, 0.07; 95% CI, 0.00-0.92), respectively. In terms of local control [LC], the C patients also had better 3-year rates 66.4%, vs. 32.8% compared to AA patients (p=0.049). Conclusion: In our patient population, race appears to be an independent prognostic factor for OS and LC in oropharyngeal SCC patients with known HPV/p16 status. Citation Format: Mary R. Nittala, Eswar K. Mundra, Maurice L. King, Ashley Albert, Williams C. Woods, Maria L. Smith, Robert D. Hamilton, Lana Jackson, Gina Jefferson, Satyaseelan Packianathan, Varsha Manucha, Srinivasan Vijayakumar. Impact of race on outcomes in oropharyngeal squamous-cell carcinoma patients with known HPV/p16 status [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-104.

Introduction/Objective HPV-positive oropharyngeal squamous cell carcinoma is biologically and clinically unique and has a survival advantage over other head and neck squamous cell carcinomas. In December 2017 College of American Pathologist published guidelines for testing HPV status in head and neck cancer. It was recommended that pathologists perform HR-HPV testing on head and neck squamous cell carcinomas from all patients with known oropharyngeal SCC not previously tested for HR-HPV, with suspected oropharyngeal SCC, or with metastatic SCC of unknown primary. The aim of this study was to determine the compliance of pathologists following the CAP guidelines. Methods Cases that underwent HPV testing using p16 immunohistochemistry for the years 2017 and 2019 were retrieved. Based on the guidelines, p16 testing was designated as “indicated” or “not indicated”. Results There were 196 cases in which p16 testing was performed in a period of 3 consecutive years. Of these, 175 were FNA/ biopsies and 21 were surgical resections. In 69 cases (56 FNAs and 13 biopsies) the biopsy was performed on neck masses with unknown primary. The compliance for p16 testing in OPC and Lymph nodes with metastatic SCC of unknown primary was 100%. In 34 (17.3%) cases p16 testing was not indicated, the most common reason being wrong site (85%) including the larynx, oral tongue, the floor of the mouth, buccal mucosa, and nasal mass. Of the unindicated p16s, 20 (58%) were received in consultation for continuity of care. Conclusion Not being clear about the site of the tumor is the most common reason for unindicated p16 testing. A clear designation of biopsy site and proper communication between pathologist and surgeon can improve utilization of p16 testing in head and neck carcinomas.

Objective This study investigated the role of intravenous acetaminophen for alleviation of postoperative pain after surgical resection of head and neck cancers. Methods A single-center study was conducted, which investigated a prospective group of 48 participants who underwent surgery between April 2016 and May 2017 and postoperatively received scheduled IV acetaminophen (1 g every 6 hours for 4 doses) plus the standard opioid PCA and breakthrough narcotics. These were compared to a similar retrospective cohort of 51 patients who had surgery between January 2014 to March 2015 and only received an opioid patient controlled analgesia (PCA) pump and breakthrough narcotics. Outcome measures included averaged pain scores, total amount of narcotics received (in morphine equivalents), and number of PCA attempts measured in 8-hour intervals over the first 24 hours, as well as duration of PCA and length of stay. Statistical measures included descriptive analysis and gamma regression analysis. Results The acetaminophen group achieved equally low pain scores (0.8 ± 1.2 vs. 1.0 ± 1.3, P = .408) with significantly less total narcotics in the first 8 hours after surgery (13.5 ± 13.3 vs. 22.5 ± 21.5 MEs, P = .014). This group had a significantly decreased length of stay (7.8 ± 4.6 vs. 10.6 ± 7.6 days, P = .03). Conclusion This study demonstrates that intravenous acetaminophen may play a role in reducing the total narcotic requirement in the first 8 hours after surgery and contribute to a decreased length of stay and potentially decrease cost to the patient and hospital overall. Future research should be aimed at comparing these groups in a randomized control study/setting. Level of Evidence 3.

Triple primary head and neck carcinoma is a rare occurrence. In our case, a patient presented with early stage triple primary head and neck squamous cell carcinoma (HNSCC). Early stage HNSCC is usually treated with surgery and/or radiation. However, treatment of triple primary head and neck malignancies is not clearly defined in the literature, and although our patient presented with early stage lesions, our multidisciplinary team recommended concomitant chemoradiotherapy. Our patient subsequently had resolution of disease after completion of therapy but was lost to long-term follow-up.

Introduction: Decreased expression of syndecan-1 has been reported in dysplasia and squamous cell carcinoma (SCCA) of the oral cavity and appears to correlate with decreasing histological differentiation and poor clinical outcome. Assays of syndecan-1 expression to date have utilized manual microscopic analysis with qualitative grading of immunohistochemical staining intensity, which may introduce observer bias. We evaluated syndecan-1 expression in dysplasia and squamous cell carcinoma (SCCA) of the oral cavity, using a novel automated cellular imaging system that incorporates both staining intensity as well as the percentage of positively stained cells to yield a quantitative value for syndecan-1 expression. Materials and Methods: We performed a quantitative immunohistochemical analysis of syndecan-1 expression using an automated cellular image analysis system. We analyzed specimens from cases of mild dysplasia (N = 55), moderate dysplasia (N = 38), severe dysplasia (N = 25), carcinoma in situ (CIS) (N = 43), and SCCA of the oral cavity (N = 45), using normal mucosal epithelium (N = 21) as a positive control. The SCCA specimens were further subdivided by degree of differentiation. We retrospectively reviewed patient charts to identify tumor stage at diagnosis, recurrence, and disease-specific survival. Results: Syndecan-1 expression was significantly greater in normal controls than in specimens of mild, moderate, or severe dysplasia, CIS, or invasive SCCA (P < .05). Syndecan-1 expression did not differ significantly among specimens of mild, moderate, or severe dysplasia, CIS or SCCA. There was no significant difference in syndecan-1 expression between specimens from patients with no evidence of disease at 3 years follow-up and patients with local, regional, or distant recurrence. Conclusions: Syndecan-1 expression does not appear to be useful as a marker of differentiation or as a prognostic indicator in dysplasia and SCCA of the oral cavity. The search for a suitable and reliable marker of biological aggressiveness is ongoing.

Since the description of the systematic en bloc neck dissection by Crile in 1906, neck dissections have evolved to include functional and minimally invasive techniques. Evidence-based medicine has allowed for the adoption of the selective neck dissection in a number of circumstances. Furthermore, as the primary disease becomes better understood and life expectancies increase, cosmetic outcomes have become an increasing concern in patient care. While this remains secondary to oncologic outcomes, reducing the morbidity of neck dissections has become of great interest. When the primary operative purpose is as a staging procedure, the minimally invasive approach is particularly desirable.

OBJECTIVE: HSPB1 functions to prevent stress-induced cellular damage and has is elevated in multiple cancer types. The significance of HSPB1 in HNSCC remains controversial. We sought to perform a meta-analysis of HSPB1 expression to clarify previous findings. STUDY DESIGN: Meta-analysis of all published studies of HSPB1 in HNSCC patients using IHC techniques. METHODS: A literature review was performed on PubMed and Google Scholar search engines using terms HSP27, HSPB1, Heat Shock Proteins, Cancer, Head and Neck Squamous Cell Carcinoma. Additional studies were added by review of manuscript bibliographies. Means and standard deviations for continuous data were obtained for overall HSPB1 expression (in cancer, normal and dysplasia), nodal status and TNM stage. Chi-square and Cochran's Q test were used to test statistical significance. RESULTS: There were 77 studies identified in the context of HSPB1 and cancer in general. Of these, 7 studies (total patients n=347) met inclusion criteria and reported findings in HNSCC using IHC scoring techniques. For the mean difference in HSPB1 expression; cancer vs. normal, cancer vs. dysplasia, and dysplasia vs. normal all showed significance (p

The objective of this study was to obtain more accurate quantitation of HSPB1 expression in HNSCC using a novel quantitative protein expression analysis system based on multispectral imaging. The study was a retrospective laboratory study of HNSCC patients treated at tertiary care academic medical center. Archival tissue samples from forty seven patients with HNSCC were subjected to immunohistochemistry using primary antibody to HSPB1. Seven of the patients had early stage cancers (TNM stage I/II) and forty patients had advanced stage cancers (TNM stage III/IV). HSPB1 expression was increased in advanced stage versus early stage cancers. Further investigation of HSPB1 as a potential biomarker for HNSCC is warranted.

Objectives/Hypothesis: Mortality for black males with head and neck squamous cell carcinoma (HNSCC) is twice that of white males or females. Human papillomavirus (HPV)-active HNSCC, defined by the concurrent presence of high-risk type HPV DNA and host cell p16INK4a expression, is associated with decreased mortality. We hypothesized that prevalence of this HPV-active disease class would be lower in black HNSCC patients compared to white patients. Study Design: Multi-institutional retrospective cohort analysis. Methods: Real-time polymerase chain reaction was used to evaluate for high-risk HPV DNA presence. Immunohistochemistry for p16INK4a protein was used as a surrogate marker for HPV oncoprotein activity. Patients were classified as HPV-negative (HPV DNA-negative, p16INK4a low), HPV-inactive (HPV DNA-positive, p16INK4a low), and HPV-active (HPV DNA-positive, p16INK4a high). Overall survival and recurrence rates were compared by Fisher exact test and Kaplan-Meier analysis. Results: There were 140 patients with HNSCC who met inclusion criteria. Self-reported ethnicity was white (115), black (25), and other (0). Amplifiable DNA was recovered from 102/140 patients. The presence of HPV DNA and the level of p16INK4a expression were determined, and the results were used to classify these patients as HPV-negative (44), HPV-inactive (33), and HPV-active (25). Patients with HPV-active HNSCC had improved overall 5-year survival (59.7%) compared to HPV-negative and HPV-inactive patients (16.9%) (P = .003). Black patients were less likely to have HPV-active disease (0%) compared to white patients (21%) (P = .017). Conclusions: The favorable HPV-active disease class is less common in black than in white patients with HNSCC, which appears to partially explain observed ethnic health disparities. Laryngoscope, 2010

Identify proteins that are differentially expressed between head and neck squamous cell cancer (HNSCC) and patient-matched normal adjacent tissue, and validate findings in a separate patient cohort.Cross-sectional study of surgical specimens.Tertiary care academic medical center.Laser capture microdissection and two-dimensional difference gel electrophoresis were used previously to establish proteomic profiles for tumor and normal adjacent tissue from 14 patients. Here, significance analysis of microarray was used to rank candidate biomarkers. Spots meeting statistical and biological criteria of significance were analyzed by liquid chromatography and tandem mass spectrometry to obtain protein identifications. The expression pattern of the highest-ranked candidate biomarker (cornulin) was validated in a larger, independent patient cohort (n = 68) by immunohistochemical staining of a tissue microarray.Of 732 spots, 117 (15.9%) met criteria for significance. Identities were obtained for 39 spots, representing 17 different proteins. Four proteins were novel in the context of HNSCC: glutathione synthetase, which was upregulated; and cornulin (squamous epithelial heat shock protein 53), guanylate binding protein 6, and heat shock 70 kDa protein 5 (glucose-regulated protein, 78 kDa), which were downregulated. Cornulin functions in the stress response in normal squamous epithelium, and reduced expression has been proposed as a marker of susceptibility to laryngopharyngeal reflux and other stressors. Loss of cornulin expression was confirmed in an independent HNSCC patient cohort (P0.001).Downregulation of cornulin is a prominent feature of the molecular signature of HNSCC identified by comparative proteomics. Cornulin may represent a link between HNSCC and other pathologies arising in stratified squamous epithelium.

A stepwise evaluation of patients who have CRS allows a management approach that is tailored to each individual patient and to the specific type of disease.

Objectives: Use of the harmonic scalpel in superficial parotidectomy for benign parotid disease has been shown to reduce surgical time as well as intraoperative blood loss. We sought to determine whether similar results could be achieved with the expanded use of the harmonic scalpel in parotidectomy for both benign and malignant disease. Study Design: Retrospective review. Methods: The medical records of all patients undergoing superficial or total parotidectomy from 1999 to 2004 were reviewed. Patients were excluded for a history of bleeding disorder, prior facial nerve weakness, or concurrent neck dissection at the time of parotidectomy. Results: Forty-four patients underwent harmonic scalpel parotidectomy and 41 patients underwent conventional cold knife parotidectomy (control group). Use of the harmonic scalpel was associated with a significant reduction in intraoperative blood loss (38.0 ± 3.6 mL vs. 66.0 ± 10.8 mL for controls, P < 0.05) and duration of drainage (31.80 ± 2.4 h vs. 39.29 ± 2.21 h for controls, P < 0.05). Use of the harmonic scalpel in superficial parotidectomy (n = 35) compared to controls (n = 37) was associated with a significant reduction in intraoperative blood loss (38.0 ± 4.23 mL vs. 68.0 ± 12.0 mL, P < 0.05) and reduced incidence of facial nerve injury (P < 0.05). In patients undergoing total parotidectomy, no significant differences were observed between the harmonic scalpel (n = 9) and control groups (n = 4) in length of surgery, intraoperative blood loss, postoperative drainage, duration of drainage, and facial nerve injury. Conclusions: Use of the harmonic scalpel in the surgical treatment of parotid disease is safe and confers some advantages over conventional methods of parotid dissection.

From August 2002 to October 2009, 32 patients undergoing primary parotidectomy for mass lesions of undetermined pathology underwent preoperative imaging which included either CT (16 patients), MRI (6 patients) or both (1 patient). Imaging reports were reviewed to determine whether malignancy and specific histologic diagnosis were suggested by the interpreting radiologist. The radiologic interpretation was then compared to the final pathologic diagnosis.

Rectus Abdominis free flap was used for reconstruction. Patient M.G. was a 47 year old previously healthy, athletic male who presented to our Multidisciplinary Tumor Board and was diagnosed with a T1N2AM0 squamous cell carcinoma of the right tonsil. It was the consensus of the Tumor Board that he would best be treated with Radiation and Chemotherapy, followed by the possibility of a post-treatment neck dissection should his cervical lymphadenopathy not resolve. His biopsy at the time of diagnosis revealed high risk HPV status.

As with many epithelial cancers, presence of nodal metastases in patients with Head and Neck Squamous Cell Carcinoma (HNSCC) predicts early recurrence and poor survival. Determination of occult metastases in the clinically N-zero (cN0) patient remains problematic and therefore prophylactic neck dissections are routinely performed for high risk cN0 patients. A cohort of 7 cN0 HNSCC patients who subsequently underwent planned neck dissection as part of their treatment was selected. Snap frozen tissue was enriched for tumor and adjacent normal tissue by laser capture microdissection. Total protein was extracted and separated by saturation-labeling 2D difference in-gel electrophoresis (2D-DIGE). Significance analysis of Microarray (SAM) method was used to evaluate for differential protein expression between patients with (n=3) and without (n=4) occult nodal metastases on neck dissection pathologic evaluation. Spot maps were generated for 14 gels (7 HNSCC, 7 normal) and relative abundance values calculated for each of 662 protein spots common to >90% of gels. A 5% false discovery rate and 2-fold change were used as criteria for significance in the defintion of candidate biomarkers. Protein spots meeting these criteria were then extracted, digested and analyzed by liquid chromatography and tandem mass spectrometry to obtain protein identifications. For tumor tissue, there was no significant difference between groups. There were considerable differences in protein expression for normal adjacent tissue between patients with and without occult metastases, with 60 spots meeting criteria for significance (FDR Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3286.

Figure 1: Relationship of Serum Survivin Presence and Tumor Stage. Significant correlation of Tumor stage and Presence of Survivin in Serum (0.048) Inhibitors of Apoptosis have been theorized to be potential future targets for cancer treatment due to the role of radiationinduced apoptosis in cancer cell death during treatment1. One particular member of this family of interest in cancer therapy and prognosis is Survivin. Survivin is a small molecular protein involved in both the apoptosis and mitosis cellular pathways. This protein is expressed during embryonic and fetal development, but is normally undetectable in adult tissues2. Recent studies have shown Survivin to be over expressed in lung, gastric, colorectal, and breast cancer. The level of expression of Survivin in many of these cancers has been associated with decreased survival, increased metastasis, and increased risk of recurrence3,4. Survivin has also been shown to be a promising target for future chemotherapy3.

1. Bien S, Rinaldo A, Silver CE, et al. History of voice rehabilitation following laryngectomy. Laryngoscope 2008; 118: 453-8 2. Blom ED, Singer MI, Hamaker RC. A Prospective study of tracheoesophageal speech. Arch Otolaryngol Head Neck Surg 1986; 112: 440-7 3. Singer MI, Blom ED. An endoscopic technique for restoration of voice after Laryngectomy. Ann Otol Rhinol Laryngol 1980; 89: 529-33 4. Singer MI, Blom ED, Hamaker RD. Further Experience with voice restoration after total Laryngectomy. Ann Otol Rhinol Laryngol 1981; 90: 498-502 5. Cheng E, Ho M, Ganz C et al. Outcomes of primary and secondary tracheoesophageal puncture: A 16 year retrospective analysis. ENT 2006; 85: 262-67 OBJECTIVE This study was designed to evaluate the success of voice rehabilitation and complication rate in patients who underwent laryngectomy with primary tracheoesophageal puncture (pTEP). INTRODUCTION The first successful laryngectomy was performed in 1873 by Theodore Billroth and by 1874, Gussenbauer had devised the first artificial larynx for Billroth’s patients. Yet it wasn’t until 1979 when Singer and Blom developed the tracheoesophageal puncture (TEP) prosthesis that would forever change voice rehabilitation in total laryngectomy patients. Voice rehabilitation with esophageal speech has been documented in the literature between 24% to 32% successful. When Singer and Blom first popularized the TEP as a technique for voice rehabilitation, 88% of their patients had attained successful vocalization following total laryngectomy (1). Since this historical publication, many studies have looked at the success rates for TEP and reported rates have ranged from 40 to 90%.