Search

Background: Lymphatic mapping with SPECT–CT has been demonstrated to accurately define lymphatic drainage patterns in oropharyngeal cancer but there has yet to be a study demonstrating its feasibility across multiple institutions. Methods: Twelve adult patients with lateralized oropharyngeal carcinoma (T1‐T3) who were planned for definitive or adjuvant radiotherapy without contralateral nodal disease underwent injection of 99‐m technetium sulfur colloid followed by static planar lymphoscintigraphy to verify tracer migration, and SPECT–CT acquired at 30 ± 15 min (optional) and 3 h (±1 h) (mandatory time‐point). Results: All 12 patients completed the study with 7/12 patients having the injections performed under local anesthetic and 5 patients requiring general anesthetic. There were no tracer migration failures and there were no serious adverse events or complications encountered. Four out of 12 patients (33%) showed contralateral drainage patterns. Conclusions: Lymphatic mapping with SPECT–CT of lateralized oropharyngeal squamous cell carcinoma can be performed safely across multiple institutions. [ABSTRACT FROM AUTHOR]

Objective: Stage 3 patients with clinically positive nodal metastasis are treated with therapeutic neck dissection and adjuvant systemic therapy. The aim of our study was to examined the predictability of pre‐operative CT as a nodal drainage assessment tool. Methods: Retrospective review of all patients with clinically positive head and neck cutaneous melanoma between 2010 and 2019. Clinical disease was diagnosed as radiological suspicious, biopsy‐proven node. A pre‐operative CT evaluation for nodal metastasis was compared to pathology report. Results: A total of 53 patients were included. Forty patients (75.5%) were males with a mean age of 59 (SD 15.52). The majority of patients (26.4%) had an unknown primary site. The most common sites for primary were the cheek in eight patients (15.1%) followed by forehead (9.4%) and lateral neck (9.4%). Preoperative CT predicted nodal disease in 84.6% of cases. The primary region that mainly failed from the previously described clinical prediction was the upper anterior neck with 83.3% parotid involvement. A total of 10 patients (18.9%) were diagnosis with non‐clinical nodes on pathology with a median non‐clinical node of 1 (range 1–2). Of them, 9 (90%) were in the same clinical levels detected by CT. Pre‐operative CT was associated with a neck level accuracy of 98.1%. Conclusion: Stage 3 head and neck melanoma with clinically positive nodal metastasis that are eligible for an adjuvant systemic treatment, may benefit from a highly selective neck dissection according to their pre‐operative imaging studies. This should be further evaluated in a large‐scale clinical trial. Level of Evidence: 3 Laryngoscope, 134:4292–4297, 2024 [ABSTRACT FROM AUTHOR]

Importance: A gap in knowledge exists concerning the functional outcomes and complications when comparing various surgical approaches for retropharyngeal lymph node (RPLN) metastases. Objective: To explore perioperative outcomes, functional outcomes, and complications associated in the treatment of RPLN metastases Design: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) protocol was used to conduct a scoping review of the PubMed and Scopus databases Review Methods: We systematically searched 2 databases from inception to January 2023 for articles examining the treatment approaches and postoperative outcomes in the retropharyngeal space. We included English records about surgical approaches, complications, functional outcomes for patients >18 years old with retropharyngeal lymphadenopathy. Results: One-hundred ninety-nine articles were identified, of which 17 were included in the analysis. Three studies assessed RPLN dissection in the postradiation setting. We identified limited knowledge about functional outcomes and complications following surgery for retropharyngeal lymphadenopathy. Overall, acute postoperative dysphagia was documented in 35/170 patients (20.5%). However, the assessment of dysphagia was limited, and not described in the majority of studies. The overall rate of postoperative neuropathy and hematoma were 4.1% and 4.7%, respectively. No postoperative hematomas were documented in the transcervical approach. Conclusion: Our findings underscore the need for further research on postoperative outcomes following RPLN dissection. We recommend further studies focusing on objective swallow assessments and long-term outcomes of either surgical approaches. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate whether patient, tumour and radiation therapy factors are associated with development of middle ear effusion (MEE) in nasopharyngeal carcinoma (NPC) patients. Deign, Settings, and Participants: A retrospective review of NPC patients treated between January 2000 and June 2018 at Rabin Medical Center. Patient factors, tumour factors, radiation doses, and radiation fields were collected and outlined if needed (middle ear, eustachian tube [ET], tensor veli palatini [TVP], and levator palatini [LVP] muscles), then analysed and compared between patients with MEE and those without and between sides in patients with unilateral MEE. Main Outcome Measures and Results: Seventy‐three patients were enrolled. Most were males (71.2%) with advanced‐stage diseases (78%). At the time of diagnosis 14 patients (19.2%) presented with MEE. Following radiation, 18 patients, with no evidence of MEE at presentation, developed MEE. Tumour stage, histology, and laterality were not associated with development of MEE. Comparison of mean radiation field dosages including—gross target volume, clinical target volume, and patient target volume showed no association with post‐radiation MEE. In addition, no difference was found in the radiation doses to the middle ear, ET or the LVP nor the TVP between ears with and without MEE. Conclusions: Post‐irradiation MEE remains a common adverse effect in NPC patients. Surprisingly, tumour stage, tumour laterality, and histology were not associated with MEE. Similar findings were observed for total radiation doses and specific doses to the middle ear, ET, and ET muscles. [ABSTRACT FROM AUTHOR]

Background: Regional metastases are considered the most important prognostic factor in OSCC patients. We aimed to investigate the impact of regional disease among different age groups with OSCC. Methods: A retrospective comparison between patients 40 years old or younger, 41–69 years old, and 70 years or older treated for OSCC between 2000 and 2020 in a tertiary‐care center. Results: 279 patients were included. The mean age was 65 ± 17.7 and 133 were male (47.7%). Thirty‐six (12.9%) were 40 years old or younger, 101 (36.2%) were 41–69 years and 142 (50.9%) were 70 years or older. Five‐year overall survival and disease‐specific survival (DSS) were significantly better among patients younger than 40 compared to the mid‐age group and patients 70 years or older (76.7% vs. 69.4% vs.48.2%, Log‐rank p < 0.001, and 76.7% vs. 75.3% vs. 46.5%, Log‐rank p < 0.001, respectively). While an association between regional spread and overall survival and DSS was demonstrated among all age groups, the odds ratio (OR) for death of any cause and death of disease regarding cervical metastasis was much higher among patients younger than 40 compared with the 41–69 and 70+ age groups (death of any cause‐OR = 23, p‐value = 0.008, OR = 2.6, p‐value = 0.026, OR = 2.4, p‐value = 0.13, respectively. Death of disease‐OR = 23, p‐value = 0.008, OR = 2.3, p‐value = 0.082, OR = 4.1, p‐value = 0.001, respectively). In univariate analysis, regional metastasis was associated with disease‐free survival only among patients younger than 40 (p‐value = 0.04). Conclusions: Regional metastases correspond with worse prognosis in young patients compared to older patients. These patients may benefit from a comprehensive treatment approach with close post‐treatment follow‐up. Level of Evidence: 3 Laryngoscope, 134:2212–2220, 2024 [ABSTRACT FROM AUTHOR]

Background: While almost one-third of patients treated for laryngeal cancer will experience disease recurrence, the current National Comprehensive Cancer Network guidelines do not recommend routine post-treatment imaging follow-up. We aimed to examine the yield of post-treatment imaging surveillance among patients with primary advanced laryngeal cancer. Methods: Patients treated for advanced-stage laryngeal carcinoma between 2000 and 2020 in a tertiary care medical center were retrospectively reviewed. Data collected included demographics, clinical and pathological features, treatment modalities, tumor recurrence data including the diagnostic modality (patient's symptoms, physical examination, or imaging), and outcome. Results: The cohort included 123 patients with advanced-stage laryngeal cancer. Thirty-five (28.7%) patients experienced disease recurrence with fourteen recurrences (40%) diagnosed by imaging. Patients diagnosed by imaging had a shorter time to recurrence diagnosis (23.8 vs. 45.9 months, p-value = 0.016), with similar 5-year overall and disease-specific survival (20.6% vs. 26.6%, log-rank p-value = 0.53 and 62.1% vs. 59.7%, log-rank p-value = 0.87, respectively). Conclusions: Performance of routine post-treatment imaging follow-up in patients with advanced laryngeal cancer was associated with a shorter time to diagnosis of recurrence and similar survival rates. Imaging follow-up should be considered in cases where clinical follow-up is limited and according to the judgment of the treating physician. [ABSTRACT FROM AUTHOR]

Background: An international survey was conducted to investigate the preferences for completion lymph node dissection (CLND) in head and neck melanomas. Methods: A questionnaire was sent through the American Society of Head & Neck Surgery (AHNS) and Canadian Society of Otolaryngology‐Head and Neck Surgery (CSO). Results: Hundred and forty‐nine surgeons completed the survey. Response rate was 6.3% and 9.7% from AHNS and CSO members, respectively. When presented the scenario of a 47‐year‐old male with a clinical T3bN0 cheek melanoma, with 1/1 positive sentinel lymph node (SLN) with nodal deposit <2 mm, 72 of respondents (48.3%) would perform a CLND. Reasons for CLND included multiples positive SLN (64.1%), size of nodal deposits (54.2%), and perceived lack of compliance to follow‐up (54.2%). Surgeons with access to immunotherapy treatment were less likely to recommend CLND (p = 0.025). Conclusions: Following SLN biopsy, nearly half of the surveyed head and neck surgeons would recommend CLND, which contrasts with the current melanoma practice patterns in other anatomic locations. However, compared with an earlier study in the literature it does seem that there has been a shift away from completion neck dissection. Further investigation into understanding practice variations is warranted. [ABSTRACT FROM AUTHOR]

Objectives: Tumor satellites are defined as islands of tumor cells completely separated from the border of the main tumor. They are believed to be a sign of aggressive disease. Our goal was to investigate the association between tumor satellites and outcome in patients with oral squamous cell carcinoma. Materials and Methods: A retrospective analysis of all patients treated for oral squamous cell carcinoma at a university‐affiliated tertiary care center between 2010 and 2018 was performed. Data collected included demographics, clinical and pathological features including tumor satellites, staging, treatment modalities, and outcomes. Results: A total of 144 patients were included. The mean age of all patients was 63.5 and 50.7% were males. The mean follow‐up time was 40.5 months. Seventeen patients (11.8%) had tumor satellites. These patients had a higher rate of involved margins, peri‐neural invasion, lympho‐vascular invasion, and extra‐nodal extension. Tumor, nodal and overall classification were significantly more advanced in patients with satellites. Disease‐specific and overall survival rates were significantly lower among satellites patients (28.7% vs. 59.7% and 28.7% vs. 54.9%, respectively). Conclusions: Tumor satellites are associated with several adverse features and advanced locoregional disease. Patients with satellites should be treated aggressively with a combination of surgery aimed at achieving free surgical margins and adjuvant treatment, as they have a worse prognosis compared with patients without satellites. Further prospective studies are mandatory to consolidate the importance of adjuvant treatment in these patients. Level of Evidence: 3 Laryngoscope, 133:336–343, 2023 [ABSTRACT FROM AUTHOR]