HEAD NECK

1. Normative Responses to Clinical Tests for Cervicogenic Dizziness: Clinical Cervical Torsion Test and Head-Neck Differentiation Test. Science.gov (United States) Treleaven, Julia; Joloud, Vladimir; Nevo, Yoav; Radcliffe, Clare; Ryder, Mollie 2019-10-04  PubMed DOI: 10.1093/ptj/pzz143  ISSN: 0031-9023 Keywords: Asymptomatic, Cervical Torsion Test, Cervicogenic Dizziness, Head-Neck Differentiation Test The clinical diagnosis of cervicogenic dizziness (CGD) is challenging because of a lack of sensitive and specific diagnostic tests. It is vital for clinicians to know normative responses to suggested clinical tests to help them develop the method and interpretation of these tests and maximize their diagnostic value for CGD. The purpose of the study was to determine normative responses to the clinical application of the cervical torsion test and the head-neck differentiation test (HNDT) with consideration of different age groups and sex. This was an observational study. One hundred forty-seven people who were healthy and asymptomatic served as controls and performed both tests, which involved 3 components: cervical torsion, cervical rotation, and en bloc rotation (head and trunk rotation together). Thirty-five (23.81%) of the 147 participants reported some symptoms (mild dizziness, visual disturbances, unusual eye movements on opening eyes after the test, motion sickness, or nausea) on 1 or more of the 3 test components in either test. The specificity when using a positive response to torsion alone (ie, a negative response to the rotation or en bloc component) was high (for the cervical torsion test, 98.64%; for the head-neck differentiation test, 89.8%), as participants with likely global sensorimotor sensitivity were eliminated. The combined specificity was 100%, as no participants presented with exclusive positive torsion results in both tests. Age and sex did not influence the results. There were several examiners who were not blinded. Confirmation of the high specificity of these clinical tests with the method used in this study to conduct and interpret the results will allow future research to determine the sensitivity of these clinical measures in a population with CGD and specificity in those with dizziness of other origins. © American Physical Therapy Association 2019. All rights reserved. For permission, please email: journals.permissions@oup.com. 2. Head and Neck Cancer Detection in Digitized Whole-Slide Histology Using Convolutional Neural Networks. Science.gov (United States) Halicek, Martin; Shahedi, Maysam; Little, James V; Chen, Amy Y; Myers, Larry L; Sumer, Baran D; Fei, Baowei 2019-10-01  PubMed DOI: 10.1038/s41598-019-50313-x  ISSN: 2045-2322  Volume: 9  Issue: 1  Pages: 14043 Primary management for head and neck cancers, including squamous cell carcinoma (SCC), involves surgical resection with negative cancer margins. Pathologists guide surgeons during these operations by detecting cancer in histology slides made from the excised tissue. In this study, 381 digitized, histological whole-slide images (WSI) from 156 patients with head and neck cancer were used to train, validate, and test an inception-v4 convolutional neural network. The proposed method is able to detect and localize primary head and neck SCC on WSI with an AUC of 0.916 for patients in the SCC testing group and 0.954 for patients in the thyroid carcinoma testing group. Moreover, the proposed method is able to diagnose WSI with cancer versus normal slides with an AUC of 0.944 and 0.995 for the SCC and thyroid carcinoma testing groups, respectively. For comparison, we tested the proposed, diagnostic method on an open-source dataset of WSI from sentinel lymph nodes with breast cancer metastases, CAMELYON 2016, to obtain patch-based cancer localization and slide-level cancer diagnoses. The experimental design yields a robust method with potential to help create a tool to increase efficiency and accuracy of pathologists detecting head and neck cancers in histological images. 3. Head and Neck Melanoma Incidence Trends in the Pediatric, Adolescent, and Young Adult Population of the United States and Canada, 1995-2014. Science.gov (United States) Bray, Haley N; Simpson, Matthew C; Zahirsha, Zisansha S; Brinkmeier, Jennifer V; Walen, Scott G; Fosko, Scott W; Osazuwa-Peters, Nosayaba 2019-10-03  PubMed DOI: 10.1001/jamaoto.2019.2769  ISSN: 2168-6181 Melanoma is one of the most common cancers worldwide, typically diagnosed in older adults. There is an increasing incidence in the younger population (age ≤40 years) in America. In addition, approximately 1 in 5 cases of melanoma affect the head and neck. However, there are limited data on the incidence of head and neck melanoma in the pediatric, adolescent, and young adult population in North America (United States and Canada). To assess 20-year demographic and incidence changes associated with head and neck melanoma in the pediatric, adolescent, and young adult population in North America. A descriptive analysis of retrospective data on head and neck melanoma from the North American Association of Central Cancer Registries' Cancer in North America public use data set from 1995 to 2014 was conducted. The data set currently includes 93% of the United States and 64% of the Canadian populations. Eligible data were from 12 462 pediatric, adolescent, and young adult patients (aged 0-39 years) with a confirmed diagnosis of melanoma (International Classification of Diseases-Oncology 3 histologic types 8720-8790) in primary head and neck sites: skin of lip, not otherwise specified (C44.0); eyelid (C44.1); external ear (C44.2); skin of other/unspecified parts of face (C44.3); and skin of scalp and neck (C44.4). The study was conducted from January 26 to July 21, 2019. Log-linear regression was used to estimate annual percentage change in age-adjusted incidence rates (AAIRs) of head and neck melanoma. Of the 12 462 patients with head and neck melanoma included in the study, 6810 were male (54.6%). The AAIR was 0.51 per 100 000 persons (95% CI, 0.50-0.52 per 100 000 persons). In North America, the incidence of head and neck melanoma increased by 51.1% from 1995 to 2014. The rate was higher in the United States (AAIR, 0.52; 95% CI, 0.51-0.53 per 100 000 person-years) than Canada (AAIR, 0.43; 95% CI, 0.40-0.45 per 100 000 persons). In the United States, the incidence increased 4.68% yearly from 1995 to 2000 and 1.15% yearly from 2000 to 2014. In Canada, the incidence increased 2.18% yearly from 1995 to 2014. Male sex (AAIR, 0.55; 95% CI, 0.54-0.57 per 100 000 persons), older age (AAIR, 0.79; 95% CI, 0.79-0.80 per 100 000 persons), and non-Hispanic white race/ethnicity (AAIR, 0.79; 95% CI, 0.77-0.80 per 100 000 persons) were associated with an increased incidence of head and neck melanoma. The incidence of pediatric, adolescent, and young adult head and neck melanoma in North America appears to have increased by 51.1% in the past 2 decades, with males aged 15 to 39 years the main cohort associated with the increase. 4. Gorlin's Syndromes of the Head and Neck  NARCIS (Netherlands) Hennekam, Raoul C. M.; Krantz, Ian D.; Allanson, Judith E. 2010-01-01 5. Nontraumatic Head and Neck Emergencies. Science.gov (United States) Kamalian, Shervin; Avery, Laura; Lev, Michael H; Schaefer, Pamela W; Curtin, Hugh D; Kamalian, Shahmir 2019-10-01  PubMed DOI: 10.1148/rg.2019190159  ISSN: 0271-5333  Volume: 39  Issue: 6  Pages: 1808-1823 Head and neck imaging is an intimidating subject for many radiologists because of the complex anatomy and potentially serious consequences of delayed or improper diagnosis of the diverse abnormalities involving this region. The purpose of this article is to help radiologists to understand the intricate anatomy of the head and neck and to review the imaging appearances of a variety of nontraumatic head and neck conditions that bring patients to the emergency department, including acute infectious and inflammatory diseases and acute complications of head and neck neoplasms. These conditions are presented in five sections on the basis of their primary location of involvement: the oral cavity and pharynx, neck, sinonasal tract, orbits, and ears. Important anatomic landmarks are reviewed briefly in each related section. Online supplemental material is available for this article. © RSNA, 2019. 6. Reconstruction of animal bite injuries to the head and neck. Science.gov (United States) Mendoza, Joshua M; Chi, John J 2019-10-01  PubMed DOI: 10.1097/MOO.0000000000000564  ISSN: 1068-9508  Volume: 27  Issue: 5  Pages: 407-412 The aim if this review is to provide an update on the existing literature of animal bite treatment strategies and provide a systematic approach to animal bites from presentation to reconstruction. Dog bites cause 80-90% of animal bites with 26.8-56.5% occurring in the head and neck. Infection rates may be as low as 5.7-9.7%. Primary closure alone is sufficient in 69.8% of dog bites within the first 24 h. Animal bite injuries to the head and neck are common, especially in the younger population. Dogs cause a majority of these bite injuries. Injuries can include simple lacerations or punctures, avulsions with tissue present, or avulsions with loss of tissue. The most common locations are the cheek, nose, and lips. It is important to gather the vaccination status of the animal and patient and to administer tetanus/rabies prophylaxis if indicated. Antibiotics are typically prescribed for 3-5 and 7-14 days for uninfected and infected wounds, respectively. These wounds require evaluation, irrigation, and occasionally debridement or repair in the operating room. The type of repair is determined based on the location and extent of injury and can range from primary closure to microsurgical replantation, skin grafts, flaps, or even facial transplantation. 7. Elective neck dissection in adenoid cystic carcinoma of head and neck: yes or no? A systematic review. Science.gov (United States) Luksic, Ivica; Suton, Petar 2019-10-03  PubMed DOI: 10.1007/s00405-019-05669-1  ISSN: 0937-4477 Keywords: Adenoid cystic carcinoma, Elective neck dissection, Head neck, Occult neck metastasis, Recurrence, Survival Adenoid cystic carcinoma of head and neck (AdCCHN) is salivary gland malignancy known for its slow progression accompanied with perineural invasion, rare lymphatic spread to the neck, high rate of local recurrence and delayed onset of distant metastases. While local recurrence and distant metastases are most common patterns of relapse and cause of death in AdCCHN, it has been debated whether lymph node involvement affects the course of the disease. The aim of this systematic review was to address this important issue and to recommend guidelines on clinically node-negative neck management in patients with AdCCHN. A systematic review of the published literature on cases of elective neck dissection (END) among patients with AdCCHN was performed. This analysis included a total of 5767 AdCCHN patients with 2450 ENDs, ranging from 10 to 1190. Elective lymphadenectomy was employed in 42.5% of patients with AdCCHN (range 9.2-100%). The overall rate of occult neck metastases in patients with AdCCHN was reported to range between 0 and 43.7%, the average being 13.9%. If performed, END should be limited to levels I-III of the ipsilateral neck since occult metastases are exclusively located within these neck regions. Although END is associated with a prolonged regional recurrence-free period, it influence on final outcome or survival is still controversial. This review strongly supports conduction of prospective trials on indications, prognostic significance and extent of END in AdCCHN. 8. Wide local excision prior to sentinel lymph node biopsy for primary melanoma of the head and neck. Science.gov (United States) May, Matthew M; Lohse, Christine M; Moore, Eric J; Price, Daniel L; Van Abel, Kathryn M; Brewer, Jerry D; Janus, Jeffrey R 2019-10-01  PubMed DOI: 10.1111/ijd.14435  ISSN: 0011-9059  Volume: 58  Issue: 10  Pages: 1184-1190 Previous wide local excision prior to sentinel lymph node biopsy (SLNB) may have the potential to disrupt lymphatic channels, thus incorrectly identifying the sentinel node. The purpose of this study was to investigate: (1) regional recurrence rates of prior wide local excision compared to other biopsy techniques and (2) survival outcomes in patients with melanoma of the head and neck. Between the years 2000 and 2016, 391 cases were reviewed with a median follow-up time of 30 months in a large tertiary care center. Biopsy practices included shave, punch, wide local excision, and narrow margin excisional/Mohs, and associations with time to local or regional relapse and death from melanoma were evaluated. Main outcomes included identification of sentinel lymph nodes, overall survival, and melanoma-specific survival. Of the 391 patients, biopsy patterns were as follows: 77 (19%) unknown biopsy, 30 (8%) prior wide local excision (WLE), 105 (27%) narrow margin excisional biopsy, 69 (18%) punch biopsy, and 110 (28%) shave biopsy. SLNB was successfully identified in all 30 patients whom had a prior WLE. There were 50 regional recurrences in the neck and 27 local recurrences with the median (IQR) at 1.2 years and 1.0 years, respectively. Multivariable associations of type of prior biopsy, depth of invasion, and nodal status with time to regional recurrence, local recurrence, overall survival, and melanoma-specific survival were not significantly different. Sentinel lymph node biopsy for melanoma of the head and neck can be successfully performed in patients after previous wide local excision. © 2019 The International Society of Dermatology. 9. Head repositioning accuracy is influenced by experimental neck pain in those most accurate but not when adding a cognitive task. Science.gov (United States) Christensen, Steffan Wittrup McPhee; Peolsson, Anneli; Agger, Simone May; Svindt, Mikkel; Graven-Nielsen, Thomas; Hirata, Rogerio Pessoto 2019-09-25  PubMed DOI: 10.1515/sjpain-2019-0093  ISSN: 1877-8860 Keywords: attention, head, neck, pain, perception, repositioning Background and aims Neck pain can impair perception of cervical movement, but how this is affected by attention is unknown. In this study, the effects of experimental neck pain on head repositioning accuracy during standardized head movements were investigated. Methods Experimental neck pain was induced by injecting hypertonic saline into the right splenius capitis muscle in 28 healthy participants (12 women). Isotonic saline was used as control. Participants were blindfolded while performing standardized head movements from neutral (start) to either right-rotation, left-rotation, flexion or extension, then back to neutral (end). Movements were triplicated for each direction, separated by 5-s, and performed with or without a cognitive task at baseline, immediately after the injection, and 5-min after pain disappeared. Repositioning accuracy was assessed by 3-dimensional recordings of head movement and defined as the difference between start and end position. Participants were grouped into most/least accurate based on a median split of head repositioning accuracy for each movement direction at baseline without the cognitive task. Results The most accurate group got less accurate following hypertonic injection during right-rotation without a cognitive task, compared with the least accurate group and the isotonic condition (p head repositioning accuracy while the participants where distracted by the cognitive task. Conclusions Experimental neck pain alters head repositioning accuracy in healthy participants, but only in those who are most accurate at baseline. Interestingly, this impairment was no longer present when a cognitive task was added to the head repositioning accuracy test. Implications The results adds to our understanding of what factor may influence the head repositioning accuracy test when used in clinical practice and thereby how the results should be interpreted. 10. Outcomes for elderly patients 75 years and older treated with curative intent radiotherapy for mucosal squamous cell carcinomas of the head and neck. Science.gov (United States) Horsley, Patrick J; Perera, Lakmalie; Veness, Michael J; Stevens, Mark J; Eade, Thomas N; Back, Michael; Brown, Chris; Jayamanne, Dasantha T 2019-10-08  PubMed DOI: 10.1002/hed.25969  ISSN: 1043-3074 Keywords: elderly, geriatric oncology, head and neck cancer, performance status, radiotherapy Elderly patients with mucosal squamous cell carcinomas of the head and neck (mHNSCC) represent a challenging clinical dilemma. A retrospective review was performed of patients ≥75 years, treated with curative-intent radiotherapy for mHNSCC in two quaternary Sydney hospitals between 2007 and 2017. Ninety-five patients met inclusion criteria. The median age was 79 years (75-94). Patients received radiotherapy alone (n = 24), concurrent chemoradiotherapy (n = 22), surgery and adjuvant radiotherapy (n = 45), or surgery with adjuvant chemoradiotherapy (n = 4). Median follow-up was 4.5 years, median overall survival (OS) was 3.8 years, and 2-year and 5-year OS were 56% and 43%, respectively. Eastern Cooperative Oncology Group performance status of ≥2 (P < .001) was a statistically significant predictor of reduced OS. Thirty-four patients (36%) required hospitalization, 5 (5%) did not complete radiotherapy, and 9 (9%) were feeding tube dependent beyond 6 months. Appropriately selected elderly patients can achieve durable outcomes from curative intent radiotherapy with acceptable treatment toxicity. © 2019 Wiley Periodicals, Inc. 11. Response to salvage chemotherapy after progression on immune checkpoint inhibitors in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck. Science.gov (United States) Saleh, Khalil; Daste, Amaury; Martin, Nicolas; Pons-Tostivint, Elvire; Auperin, Anne; Herrera-Gomez, Ruth Gabriela; Baste-Rotllan, Neus; Bidault, Francois; Guigay, Joel; Le Tourneau, Christophe; Saada-Bouzid, Esma; Even, Caroline 2019-09-28  PubMed DOI: 10.1016/j.ejca.2019.08.026  ISSN: 0959-8049  Volume: 121  Pages: 123-129 Keywords: CTLA-4, Immune checkpoint inhibitor, PD-1, PD-L1, Salvage chemotherapy, Squamous cell carcinoma of head and neck Immune checkpoint inhibitors (ICI) are active in patients with recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). Recent data suggest that exposure to ICI improves response to salvage chemotherapy (SCT) in advanced non-small-cell lung cancer. We evaluated response to chemotherapy in patients who had progressed on ICI in patients with R/M SCCHN. A retrospective study was conducted at 4 French centres. Eligibility criteria were patients who progressed after treatment with ICI for R/M SCCHN and received SCT and for whom efficacy data were available between September 2014 and January 2018. Of 232 patients treated with ICI, 82 met eligibility criteria: 84% were male. ICI was given as monotherapy in 45% of patients or as combination in 55%. SCT included taxanes (56.1%), cetuximab in combination with taxanes or platinum (50%), platinum-based regimen (36.6%). The median number of treatment lines before SCT was 2 (range 1-6). The objective response rate (ORR) to SCT was 30%. Three patients (4%) presented complete response and 22 patients (27%) had partial response. Median progression-free survival was 3.6 months and median overall survival was 7.8 months. The age at SCT, initial tumour location, number of prior chemotherapy regimens, type of chemotherapy before ICI, best response to ICI, site of relapse and Eastern Cooperative Oncology Group at SCT were not associated with response to SCT on univariate analysis. In R/M SCCHN, the ORR to SCT was high (30%) suggesting that exposure to ICI may increase tumour sensitivity to chemotherapy. Copyright © 2019 Elsevier Ltd. All rights reserved. 12. Patients with head and neck cancer: Are they frailer than patients with other solid malignancies? Science.gov (United States) Bras, Linda; Driessen, Daphne A J J; de Vries, Julius; Festen, Suzanne; van der Laan, Bernard F A M; van Leeuwen, Barbara L; de Bock, Geertruida H; Halmos, Gyorgy B 2019-09-30  PubMed DOI: 10.1111/ecc.13170  ISSN: 0961-5423  Pages: e13170 Keywords: frail elderly, frailty, geriatric assessment, geriatric oncology, head and neck cancer, quality of life We aimed to compare frailty status between patients with head and neck cancer (HNC) and other solid malignancies. Data collection was prospective, and the following were compared between cohorts at baseline: patient and tumour characteristics, Charlson Comorbidity Index (CCI), Groningen Frailty Indicator (GFI), Mini Mental State Examination (MMSE), Activities of Daily Living (ADLs), Instrumental ADLs (IADLs), Timed Up and Go (TUG) and Quality of Life (QoL). Univariate and multivariate logistic regression analyses were performed, and odds ratios (ORs) with their 95% confidence intervals (95% CIs) were estimated. In total, 242 patients with HNC and 180 with other oncology diagnoses were enrolled, of whom 32.6% and 21.8% were frail according to the GFI respectively. Comorbidity scores were not significantly different between the cohorts (7.4% vs. 13.1%; OR 0.54; 95% CI 0.28-1.02). In the univariate analysis, the GFI was significantly worse in the HNC cohort (OR 1.74; 95% CI 1.11-2.71). However, in the multivariate analysis, the MMSE, TUG and global QoL were significantly worse in the HNC cohort, with ORs of 20.03 (95% CI 2.44-164.31), 11.56 (95% CI 1.86-71.68) and 0.98 (95% CI 0.97-1.00) respectively. Patients with HNC appear to be frailer than patients with other solid malignancies despite comparable levels of comorbidity. © 2019 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd. 13. Emerging evidence of occipital nerve compression in unremitting head and neck pain  Directory of Open Access Journals (Sweden) Pamela Blake; Rami Burstein 2019-07-01  The Journal of Headache and Pain DOI: 10.1186/s10194-019-1023-y  ISSN: 1129-2369  Volume: 20  Issue: 1  Pages: 1-7 Keywords: Occipital nerve, Extracranial, Neck pain, Chronic migraine, Cervicogenic headache, Nerve compression Full Text Available Abstract Unremitting head and neck pain (UHNP) is a commonly encountered phenomenon in Headache Medicine and may be seen in the setting of many well-defined headache types. The prevalence of UHNP is not clear, and establishing the presence of UHNP may require careful questioning at repeated patient visits. The cause of UHNP in some patients may be compression of the lesser and greater occipital nerves by the posterior cervical muscles and their fascial attachments at the occipital ridge with subsequent local perineural inflammation. The resulting pain is typically in the sub-occipital and occipital location, and, via anatomic connections between extracranial and intracranial nerves, may radiate frontally to trigeminal-innervated areas of the head. Migraine-like features of photophobia and nausea may occur with frontal radiation. Occipital allodynia is common, as is spasm of the cervical muscles. Patients with UHNP may comprise a subgroup of Chronic Migraine, as well as of Chronic Tension-Type Headache, New Daily Persistent Headache and Cervicogenic Headache. Centrally acting membrane-stabilizing agents, which are often ineffective for CM, are similarly generally ineffective for UHNP. Extracranially-directed treatments such as occipital nerve blocks, cervical trigger point injections, botulinum toxin and monoclonal antibodies directed at calcitonin gene related peptide, which act primarily in the periphery, may provide more substantial relief for UHNP; additionally, decompression of the occipital nerves from muscular and fascial compression is effective for some patients, and may result in enduring pain relief. Further study is needed to determine the prevalence of UHNP, and to understand the role of occipital nerve compression in UHNP and of occipital nerve decompression surgery in chronic head and neck pain. 14. Estimating PTV margins in head and neck stereotactic ablative radiation therapy (SABR) through target site analysis of positioning and intrafractional accuracy. Science.gov (United States) Mesko, Shane; Wang, He; Tung, Samuel; Wang, Congjun; Pasalic, Dario; Chapman, Bhavana V; Moreno, Amy C; Reddy, Jay P; Garden, Adam S; Rosenthal, David I; Gunn, G Brandon; Frank, Steven J; Fuller, Clifton D; Morrison, William; Phan, Jack 2019-09-30  PubMed DOI: 10.1016/j.ijrobp.2019.09.010  ISSN: 0360-3016 Recurrent and/or previously irradiated head and neck cancers (HNC) are therapeutically challenging and may benefit from high-dose, highly accurate radiation techniques, such as stereotactic ablative radiation therapy (SABR). Here, we compare set-up and positioning accuracy across HNC subsites to further optimize the treatment process and PTV margin recommendations for HN-SABR. We prospectively collected data on 405 treatment fractions across 79 patients treated with SABR for recurrent/previously irradiated HNC. First, interfractional error was determined by comparing ExacTrac x-ray to the treatment plan. Patients were then shifted and residual error measured with repeat x-ray. Next, cone-beam-CT (CBCT) was compared to ExacTrac for positioning agreement and final shifts were applied. Lastly, intrafractional error was measured with x-ray before each arc. Results were stratified by treatment site into skull base, neck/parotid, and mucosal. Most patients (66.7%) were treated to 45Gy/5 fractions (range: 21-47.5Gy, 3-5 fractions). The initial mean±SD interfractional errors were -0.2±1.4mm (A/P), 0.2±1.8mm (C/C) and -0.1±1.7mm (L/R). Interfractional 3D-vector error was 2.48±1.44, with skull base significantly lower than other sites (2.22 vs. 2.77, P=0.0016). All interfractional errors were corrected to within 1.3mm and 1.8°. CBCT agreed with ExacTrac to within 3.6mm and 3.4°. CBCT disagreements and intrafractional errors of >1mm or >1° occurred at significantly lower rates in skull base sites (CBCT: 16.4% vs. 50.0% neck; 52.0% mucosal; Pneck/parotid), and 1.8mm (mucosal). HN-SABR PTV margins should be optimized by target site. PTV margins of 1.5-2mm may be sufficient in the skull base, while 2-2.5mm may be necessary for neck and mucosal targets. When using ExacTrac, skull base sites show significantly fewer uncertainties throughout the treatment process, while neck/mucosal targets may require the addition of CBCT to account for positioning errors and internal organ motion. Copyright © 2019. Published by Elsevier Inc. 15. The role of single-nucleotide polymorphism (SNPs) in toxicity of induction chemotherapy based on cisplatin and paclitaxel in patients with advanced head and neck cancer. Science.gov (United States) De Marchi, Pedro; Melendez, Matias E; Laus, Ana C; Kuhlmann, Pamela A; de Carvalho, Ana Carolina; Arantes, Lidia Maria R B; Evangelista, Adriane F; Andrade, Edilene S; de Castro, Gilberto; Reis, Rui M; Carvalho, André Lopes; de Souza Viana, Luciano 2019-09-17  PubMed DOI: 10.1016/j.oraloncology.2019.09.013  ISSN: 1368-8375  Volume: 98  Pages: 48-52 Keywords: Head and neck cancer, Induction chemotherapy, LAHNSCC, Pharmacogenomic, SNP, Toxicity Induction chemotherapy in locally-advanced head and neck squamous cell carcinoma (LAHNSCC) patients is potentially associated to serious adverse events. Biomarkers associated with toxicity could tailor its indication. This study evaluated the association between single-nucleotide polymorphisms (SNPs) in metabolic genes and toxicity to induction chemotherapy. 59 LAHNSCC phase II clinical trial patients (NCT00959387) were assessed regarding 47 metabolic genes (366 SNPs). Toxicities were graded (CTCAE 3.0) and statistical analysis was performed. The SNPs rs8187710 (ABCC2) and rs1801131 (MTHFR) were associated to increased risk of gastrointestinal toxicity, whereas the SNPs rs3788007 (ABCG1) and rs4148943 (CHST3) were associated to decreased risk. Two other SNPs, rs2301159 (SLC10A2) and rs2470890 (CYP1A2), were associated with increased risk of hematological toxicity. Nevertheless, these SNPs did not remain significant after adjusting for multiple comparisons. This study could not demonstrate relationship between SNPs and toxicity to induction chemotherapy in LAHNSCC patients. The small number of patients may have affected the results. Copyright © 2019 Elsevier Ltd. All rights reserved. 16. Pretreatment Dietary Patterns Are Associated with the Presence of Nutrition Impact Symptoms 1 Year after Diagnosis in Patients with Head and Neck Cancer. Science.gov (United States) Crowder, Sylvia L; Sarma, Kalika P; Mondul, Alison M; Chen, Yi Tang; Li, Zonggui; Pepino, M Yanina; Zarins, Katie R; Wolf, Gregory T; Rozek, Laura S; Arthur, Anna E 2019-10-01  PubMed DOI: 10.1158/1055-9965.EPI-19-0128  ISSN: 1055-9965  Volume: 28  Issue: 10  Pages: 1652-1659 Dietary inflammatory potential could impact the presence and severity of chronic adverse treatment effects among patients with head and neck cancer. The objective of this study was to determine whether pretreatment dietary patterns are associated with nutrition impact symptoms (NIS) as self-reported 1 year after diagnosis. This was a longitudinal study of 336 patients with newly diagnosed head and neck cancer enrolled in the University of Michigan Head and Neck Specialized Program of Research Excellence. Principal component analysis was utilized to derive pretreatment dietary patterns from food frequency questionnaire data. Burden of seven NIS was self-reported 1 year after diagnosis. Associations between pretreatment dietary patterns and individual symptoms and a composite NIS summary score were examined with multivariable logistic regression models. The two dietary patterns that emerged were prudent and Western. After adjusting for age, smoking status, body mass index, tumor site, cancer stage, calories, and human papillomavirus status, significant inverse associations were observed between the prudent pattern and difficulty chewing [OR 0.44; 95% confidence interval (CI), 0.21-0.93; P = 0.03], dysphagia of liquids (OR 0.38; 95% CI, 0.18-0.79; P = 0.009), dysphagia of solid foods (OR 0.46; 95% CI, 0.22-0.96; P = 0.03), mucositis (OR 0.48; 95% CI, 0.24-0.96; P = 0.03), and the NIS summary score (OR 0.45; 95% CI, 0.22-0.94; P = 0.03). No significant associations were observed between the Western pattern and NIS. Consumption of a prudent diet before treatment may help reduce the risk of chronic NIS burden among head and neck cancer survivors. Dietary interventions are needed to test whether consumption of a prudent dietary pattern before and during head and neck cancer treatment results in reduced NIS burden. ©2019 American Association for Cancer Research. 17. Paragangliomas of the Head and Neck: Local Control and Functional Outcome Following Fractionated Stereotactic Radiotherapy. Science.gov (United States) Weissmann, Thomas; Lettmaier, Sebastian; Roesch, Johannes; Mengling, Veit; Bert, Christoph; Iro, Heinrich; Hornung, Joachim; Janka, Rolf; Semrau, Sabine; Fietkau, Rainer; Putz, Florian 2019-10-04  PubMed DOI: 10.1097/COC.0000000000000614  ISSN: 0277-3732 To investigate local control and functional outcome following state-of-the-art fractionated stereotactic radiotherapy (FSRT) for paragangliomas of the head and neck. In total, 40 consecutive patients with paragangliomas of the head and neck received conventionally FSRT from 2003 to 2016 at the Department of Radiation Oncology of the University Hospital Erlangen. Local control, toxicities, and functional outcome were examined during follow-up. In total, 148 magnetic resonance imaging studies were subjected to longitudinal volumetric analysis using whole tumor segmentation in a subset of 22 patients. A total of 80.0% (32/40) of patients received radiotherapy as part of their primary treatment. In 20.0% (8/40) of patients, radiation was used as salvage treatment after tumor recurrence in patients initially treated with surgery alone. The median dose applied was 54.0 Gy (interdecile range, 50.4 to 56.0 Gy) in single doses of 1.8 or 2 Gy. Local control was 100% after a median imaging follow-up of 52.2 months (range, 0.8 to 152.9 mo). The volumetric analysis confirmed sustained tumor control in a subset of 22 patients and showed transient enlargement (range, 129.6% to 151.2%) in 13.6% of cases (3/22). After a median volumetric follow-up of 24.6 months mean tumor volume had diminished to 86.1% compared with initial volume. In total, 52.5% (21/40) of patients reported improved symptoms after radiotherapy, 40% (16/40) observed no subjective change with only 7.5% (3/40) reporting significant worsening. State-of-the-art FSRT provides excellent control and favorable functional outcome in patients with paragangliomas of the head and neck. The volumetric analysis provides improved evidence for sustained tumor control. 18. EORTC Quality of Life Questionnaire Head and Neck (H&N)-35 scores from H&N squamous cell carcinoma patients obtained at diagnosis and at 6, 9 and 12 months following diagnosis predict 10-year overall survival. Science.gov (United States) Aarstad, Hans Jørgen; Østhus, Arild Andrè; Aarstad, Helene Hersvik; Lybak, Stein; Aarstad, Anne Kari H 2019-09-16  PubMed DOI: 10.1007/s00405-019-05630-2  ISSN: 0937-4477 Keywords: Head and neck neoplasms, Human papilloma virus, Prognosis, Quality of life To study the 10-year overall survival predictions, and mechanisms behind, of head and neck (HN) quality of life (QoL) scores obtained at diagnosis and 6, 9, and 12 months following diagnosis in a cohort of HN squamous cell carcinoma (HNSCC) patients. Consecutive HNSCC patients (N = 109) subjected to standard workup and treatment self-reported their QoL measured by the EORTC Quality of Life Questionnaire (QLQ) H&N-35 between November 2002 and June 2005. Each QoL index was calculated and additionally aggregated to one sum score. The included patients were at diagnosis younger than 78 years, judged adequately cognitive functioning, and scheduled for curative treatment. Self-reported smoking, alcohol consumption, and socio-demographic information were registered. Twenty-two patients were high-risk (hr)-HPV DNA tumor positive. If the treatment goal was changed to palliative, no new QoL information was collected. All living patients were followed until 10 years after diagnosis. Median survival was 105 months. Significant overall survival predictions were found from the EORTC H&N-35 QLQ sum scores continuously measured at diagnosis (p = 0.006) and obtained at 6 (p = 0.02), 9 (p = 0.002) and 12 (p = 0.05) months. Lower QoL predicted lower overall survival. These sum score survival predictions were in part independent of TNM stage, hr-HPV status, gender, age, alcohol and smoking status. The indices "pain", "swallowing", "social eating", and "feeling ill" were predictive of survival at 3 out of 4 measuring points (diagnosis, 6, 9 and 12 months) in univariate analyses. EORTC H&N-35 QLQ scores at diagnosis and throughout the first year thereafter harbor prognostic power. 19. Multiple-CT optimization: An adaptive optimization method to account for anatomical changes in intensity-modulated proton therapy for head and neck cancers. Science.gov (United States) Yang, Zhiyong; Zhang, Xiaodong; Wang, Xianliang; Zhu, X Ronald; Gunn, Brandon; Frank, Steven J; Chang, Yu; Li, Qin; Yang, Kunyu; Wu, Gang; Liao, Li; Li, Yupeng; Chen, Mei; Li, Heng 2019-09-26  PubMed DOI: 10.1016/j.radonc.2019.09.010  ISSN: 0167-8140 Keywords: Adaptive planning, Head and neck cancer, Intensity-modulated proton therapy, Multiple CT optimization We aimed to determine whether multiple-CT (MCT) optimization of intensity-modulated proton therapy (IMPT) could improve plan robustness to anatomical changes and therefore reduce the additional need for adaptive planning. Ten patients with head and neck cancer who underwent IMPT were included in this retrospective study. Each patient had primary planning CT (PCT), a first adaptive planning CT (ACT1), and a second adaptive planning CT (ACT2). Selective robust IMPT plans were generated using each CT data set (PCT, ACT1, and ACT2). Moreover, a MCT optimized plan was generated using the PCT and ACT1 data sets together. Dose distributions optimized using each of the four plans (PCT, ACT1, ACT2, and MCT plans) were re-calculated on ACT2 data. The doses to the target and to organs at risk were compared between optimization strategies. MCT plans for all patients met all target dose and organs-at-risk criteria for all three CT data sets. Target dose and organs-at-risk dose for PCT and ACT1 plans re-calculated on ACT2 data set were compromised, indicating the need for adaptive planning on ACT2 if PCT or ACT1 plans were used. The D 98% of CTV1 and CTV3 of MCT plan re-calculated on ACT2 were both above the coverage criteria. The CTV2 coverage of the MCT plan re-calculated on ACT2 was worse than ACT2 plan. The MCT plan re-calculated on ACT2 data set had lower chiasm, esophagus, and larynx doses than did PCT, ACT1, or ACT2 plans re-calculated on ACT2 data set. MCT optimization can improve plan robustness toward anatomical change and may reduce the number of plan adaptation for head and neck cancers. Copyright © 2019 Elsevier B.V. All rights reserved. 20. A contemporary analysis of racial disparities in recommended and received treatment for head and neck cancer. Science.gov (United States) Nocon, Cheryl C; Ajmani, Gaurav S; Bhayani, Mihir K 2019-10-03  PubMed DOI: 10.1002/cncr.32342  ISSN: 0008-543X Keywords: head and neck neoplasms, health care disparities, race factors Racial disparities in squamous cell carcinoma of the head and neck (HNSCC) negatively affect non-Hispanic black (NHB) patients. This study was aimed at understanding how treatment is prescribed and received across all HNSCC subsites. With the National Cancer Database, patients from 2004 to 2014 with surgically resectable HNSCCs, including tumors of the oral cavity (OC), oropharynx (OP), hypopharynx (HP), and larynx (LX), were studied. The treatment received was either upfront surgery or nonsurgical treatment. Treatment patterns were compared according to race and subsite, and how these differences changed over time was evaluated. NHB patients were less likely than non-Hispanic white (NHW) patients to receive surgery across all subsites (relative risk [RR] for OC, 0.87; RR for OP, 0.75; RR for HP, 0.73; RR for LX, 0.87; all P values <.05). They were also more likely to refuse a recommended surgery (RR for OC, 1.50; RR for OP, 1.23; RR for HP, 1.23; RR for LX, 1.34), and this difference was significant except for HP. NHB patients were more likely to not be offered surgery across all subsites (RR for OC, 1.38; RR for OP, 1.07; RR for HP, 1.05; RR for LX, 1.03; all P values <.05). Rates of surgery increased and rates of not being offered surgery declined for both NHB and NHW patients from 2004 to 2014, but the absolute disparities persisted in 2014. Across all HNSCC subsites, NHB patients were less likely than NHW patients to be recommended for and receive surgery and were more likely to refuse surgery. These differences have closed over time but persist. Enhanced shared decision making may improve these disparities. © 2019 American Cancer Society.