Oral Oncology

A new CT dynamic maneuver "Mouth Opened with Tongue Extended" can improve the clinical TNM staging of oral cavity and oropharynx squamous cell carcinomas Publication date: July 2019 Source: Oral Oncology, Volume 94 Author(s): Guillaume Bron, Ugo Scemama, Virginie Villes, Nicolas Fakhry, Sebastien Salas, Christophe Chagnaud, David Bendahan, Arthur Varoquaux Abstract Objectives Cross sectional imaging is mandatory for oral cavity and oropharynx head and neck squamous cell carcinoma's (ooSCC) local extension and TNM staging. However a complex anatomy and frequent dental metallic artifacts make it difficult. This study assesses the clinical benefit of "Mouth Open with Tongue Extended" dynamic maneuver at CT (CTmote) as compared to the conventional CT (CTconv) and MRI. Material Retrospectively, 58 patients with histologically proven ooSCC (oral cavity: 34; oropharynx: 24) were included in the study. All had endoscopy with biopsies, MRI, CTconv and an CTmote acquisitions. Data were splitted in 3 datasets and 2 independent radiologists performed readings blindly. Gold standard was pTNM in 31% of cases; otherwise cTNM obtained at multidisciplinary team meeting with endoscopy and mapping biopsies were used. Results CTmote was feasible for all patients including those already treated by surgery or radiotherapy. Exact TNM staging was obtained in 68%, 83%, 83% for CTconv, CTmote and MRI respectively. The best exam ratings at paired wise comparisons were 3%, 47%, 50% for CTconv, CTmote and MRI respectively. CTmote and MRI observer agreements, image quality and confidence ratings, were comparable and higher compared to CTconv (p < 0.001). Conclusions CTmote improves oral cavity and oropharynx tumour stage assessment compared to CTconv with performances close to those of MRI examination. In clinical practice, combining both CT with MOTE maneuver and MRI seems to be the optimal imaging strategy for local staging. Graphical abstract

Comparisons of clinical and functional outcomes of different reconstructive methods for the hypopharyngeal defect Publication date: July 2019 Source: Oral Oncology, Volume 94 Author(s): Song I. Park, Sung Yong Choi, Chung-Hwan Baek, Young-Ik Son, Han-Sin Jeong, Man Ki Chung Abstract Background To compare clinical and functional outcomes of different reconstructive options for a hypopharyngeal defect after head and neck cancer surgery. Methods We retrospectively analyzed 127 cases who had undergone hypopharyngeal reconstruction, as either pedicled (25 cases), fasciocutaneous free flap (FCFF) (41 cases) or visceral flap (61 cases). Results Overall incidence of flap compromise was 10.2% (13 cases), and there were no statistically significant factors associated with flap compromise. Fistula or stenosis occurred in 36.2% (46 patients) and 23.6% (30 patients), respectively. Salvage surgery increased the risk of fistula formation (OR 2.93, 95% CI 1.32–6.52, p < 0.01), whereas FCFF showed a protective effect for stenosis, compared to pedicled flap (OR 0.09, 95% CI 0.01–0.47, p < 0.01). Conclusion Outcomes of hypopharynx reconstruction can be successful if different flap options are used appropriately according to the type of defect and previous treatment history of the patient.

Novel application of the Clavien-Dindo classification system and the comprehensive complications index® in microvascular free tissue transfer to the head and neck Publication date: July 2019 Source: Oral Oncology, Volume 94 Author(s): Julian Jakob Ebner, Tarun Mehra, Thomas Gander, Paul Schumann, Harald Essig, Daniel Zweifel, Martin Rücker, Ksenjia Slankamenac, Martin Lanzer

The high stakes of head and neck surgery following radiation and chemotherapy – An assessment of complications and survival Publication date: July 2019 Source: Oral Oncology, Volume 94 Author(s): Ramez Philips, Nolan Seim, Anna Marcinow, James Rocco, Amit Agrawal, Enver Ozer, Ricardo Carrau, Stephen Kang, Matthew Old Abstract Objectives To investigate variables that predict medical and surgical complications in patients undergoing salvage surgery after primary organ-preserving therapy for head and neck cancer and to investigate the effect of complications on 5-year overall survival. Materials and methods A retrospective study was conducted on patients undergoing salvage surgery after primary organ-preserving therapy for head and neck cancer at a tertiary institution from 2006 to 2011. Multivariable regression analysis was used to assess association between independent variables and medical and surgical complications. A Kaplan-Meier survival curve was plotted to assess effect of surgical and medical complications on 5-year overall survival. Results One hundred thirty-six patients undergoing salvage surgery after primary organ-preservation surgery met inclusion criteria. Surgical complications occurred in 68/136 (50.0%) of patients. After adjusting for confounders, young age and history of hypothyroidism were significant predictors of surgical complications (p < 0.05). Medical complications occurred in 37/136 (27.2%) of patients. After adjusting for confounders, older age and history of hepatic disease were significant predictors of having a medical complication (p < 0.05). Patients with no complications had better overall survival than patients with medical complications (p = 0.009). There was no difference in overall survival between patients without complications and patients with surgical complications only (p = 0.259). Conclusion Risk factors for medical and surgical complications include history of hypothyroidism, liver disease, and age. Survival outcomes are not affected by surgical complications but are significantly affected by medical complications highlighting the importance of personalized patient care and medical co-management.

Time to recurrence and patient survival in recurrent oral squamous cell carcinoma Publication date: July 2019 Source: Oral Oncology, Volume 94 Author(s): Annelies Weckx, Maximilian Riekert, Andrea Grandoch, Volker Schick, Joachim E. Zöller, Matthias Kreppel Abstract Objectives Tumour relapse remains one of the major problems in managing oral squamous cell carcinoma (OSCC) with mortality rates of up to 92%. Early recurrences have a worse prognosis than late relapses. However, few has been written about the influence of clinicopathological parameters on the timing of recurrence and the patient survival. Materials and methods Retrospective chart review of 159 patients with an OSCC recurrent disease. Exclusion criteria were neoadjuvant chemoradiotherapy, follow-up <6 weeks, perioperative death, second primaries and inadequate information on clinicopathological parameters. Statistical analysis was performed using univariate and multivariate analysis. Results A significant correlation was found in the χ2-analysis between the timing of recurrence and the margin status (p = 0.020), lymph node ratio (p = 0.030) and grading (p = 0.003) of the primary tumour. In the multivariate survival analysis, the timing of recurrence (p < 0.001), margin status of the primary tumour (p = 0.023), presence of extracapsular spread in the primary tumour (p = 0.003) and performance of a salvage treatment (p < 0.001) were shown to be independent risk factors for overall survival. Conclusion For patients with a recurrent OSCC, the time to recurrence, margin status, extracapsular spread and the performance of a salvage treatment are independent prognostic factors for overall survival. Furthermore, a significant association exists between the moment of recurrence and the lymph node ratio, the margin status and grading of the primary tumour. This knowledge can allow for the development of individualised surveillance programs and like this, an earlier diagnosis and better second treatment chance in the case of a recurrence.

Upfront PET/CT affects management decisions in patients with recurrent head and neck squamous cell carcinoma Publication date: July 2019 Source: Oral Oncology, Volume 94 Author(s): Max Rohde, Anne L. Nielsen, Jørgen Johansen, Jens A. Sørensen, Anabel Diaz, Manan Pareek, Jon T. Asmussen, Oke Gerke, Anders Thomassen, Niels Gyldenkerne, Helle Døssing, Kristine Bjørndal, Poul Flemming Høilund-Carlsen, Christian Godballe Abstract Purpose To compare multidisciplinary team conference (MDTC) decisions regarding treatment intent based on either chest X-ray + MRI of the head and neck (CXR/MRI) or 18F-FDG-PET/CT (PET/CT) in patients with recurrent head and neck squamous cell carcinoma (HNSCC). Methods Prospective blinded cohort study based on paired data. Consecutive patients with suspected recurrent HNSCC were invited to participate. All included patients underwent CXR/MRI and PET/CT before diagnostic biopsy. An ordinary MDTC using all available imaging data was conducted as per standard practice. After at least three months (to eliminate recall bias in the team), the first project MDTC, based on either CXR/MRI or PET/CT, was conducted, and the tumor board made conclusions regarding treatment. After an additional three months, a second project MDTC was conducted using the complementary imaging strategy. The separate treatment strategies were compared using McNemar's test. Results A total of 110 patients (90 males and 20 females, median age 66 years, range 40–87) were included. The initial primary tumor originated from the pharynx in 56 (51%) patients, oral cavity in 17 (15%) patients, and larynx in 37 (34%) patients. Based on CXR/MRI, 87 patients (79%) were recommended curative treatment and 23 (21%) palliative treatment. Based on PET/CT, the MDTC decided that 52 (47%) patients were suitable for curative treatment and 58 (53%) for palliative treatment. The absolute difference of 32% was statistically significant (95% CI: 22–42%, p < 0.001). Conclusions PET/CT affected MDTC decisions in patients with recurrent HNSCC towards less curative and more palliative treatment.

Gender disparities in head and neck cancer chemotherapy clinical trials participation and treatment Publication date: July 2019 Source: Oral Oncology, Volume 94 Author(s): Liliya Benchetrit, Sina J. Torabi, Janet P. Tate, Saral Mehra, Heather A. Osborn, Melissa R. Young, Barbara Burtness, Benjamin L. Judson Abstract Objectives To characterize the representation of women in clinical trials directing the National Comprehensive Cancer Network (NCCN) guidelines for chemotherapy use in head and neck squamous cell carcinoma (HNSCC), as well as the relationship between gender and chemotherapy administration in the definitive treatment of HNSCC in the United States. Methods A review of all HNSCC chemotherapy clinical trials cited by the 2018 NCCN guidelines was performed. Sex-based proportions were compared with the corresponding proportions in the general U.S. population of patients with HNSCC between 1985 and 2015, derived from the Surveillance, Epidemiology, and End Results (SEER) program. A second analysis using the National Cancer Database (NCDB), identified 63,544 adult patients diagnosed with stages III-IVB HNSCC between 2004 and 2014 and treated with definitive radiotherapy or chemoradiotherapy. Univariable and multivariable logistic regression analyses were used to identify predictors of chemotherapy administration. Results While women comprised 26.2% of U.S. patients with HNSCC between 1985 and 2015, they comprised only 17.0% of patients analyzed in U.S. NCCN-cited chemotherapy clinical trials between 1985 and 2017. On multivariable analysis, women had decreased odds of receiving chemotherapy (Odds Ratio [OR]: 0.875; 95% Confidence Interval [CI]: 0.821–0.931; p < 0.001). Conclusion Women are underrepresented in HNSCC chemotherapy clinical trials cited by the national guidelines. Additionally, women are less likely than men to receive definitive chemoradiotherapy as oppose to definitive radiotherapy. Reasons for these disparities warrant further investigation as well as re-evaluation of eligibility criteria and enrollment strategies, in order to improve relevance of clinical trials to women with HNSCC.

Corrigendum to "Utility of CD8 score by automated quantitative image analysis in head and neck squamous cell carcinoma" [Oral Oncol. 86 (2018) 278–287] Publication date: June 2019 Source: Oral Oncology, Volume 93 Author(s): D.J. Hartman, F.S. Ahmed, R.L. Ferris, D.L. Rimm, L. Pantanowitz

Concurrent oropharyngeal squamous cell carcinomas in couples Publication date: June 2019 Source: Oral Oncology, Volume 93 Author(s): Prashanth Panta, Mukund Seshadri

Human papillomavirus (HPV) vaccine and HPV-related head and neck cancer: What's next? Publication date: June 2019 Source: Oral Oncology, Volume 93 Author(s): F. De Felice, A. Polimeni, V. Tombolini

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