Prospective Phase II Trial of Definitive Chemoradiation and Concurrent Nivolumab in Locally Advanced p16+ Oropharynx Cancer.

Purpose: We conducted a prospective, single-institution phase II trial to test the hypothesis that the addition of nivolumab to definitive chemoradiation would improve the progression-free survival (PFS) among patients with high-risk p16+ oropharyngeal squamous cell carcinoma (OPSCC).

Methods And Materials: Patients with previously-untreated locoregionally advanced, p16+ OPSCC (clinical T4/N3, matted lymph nodes, and/or retropharyngeal lymphadenopathy) were enrolled. Patients received a priming dose of nivolumab, concurrent nivolumab and chemoradiation (70 Gy to PTVhigh, 56 Gy to PTVlow, weekly carboplatin/paclitaxel), and 4 cycles of adjuvant nivolumab over 12 weeks.

Two-team approaches in modern head and neck oncologic and reconstructive surgery: ablative considerations.

Purpose Of Review: Two-team approaches to head and neck cancer ablation and free flap reconstruction now occur concurrently in most centers. While the functional outcomes after head and neck ablation and reconstruction are typically examined through the lens of the reconstructive surgeon, optimizing the patient's functional outcome requires careful considerations of the entire surgical team. This review summarizes important intraoperative considerations for decision making by the surgical team, with a particular emphasis on ablative considerations, to optimize reconstructive outcomes after tumor extirpation.

Next generation of head and neck free flap reconstruction: the future of innovation and refinement.

Purpose Of Review: We briefly review the history of surgical innovation in free flap reconstruction of the head and neck. With a specific focus on maximizing patient QoL by prioritizing a 'precision reconstruction', we then posit novel avenues for surgical refinement to usher in the next generation of head and neck free flap reconstruction.

Recent Findings: Patients undergoing free flap reconstruction of the head and neck increasingly co-prioritize preservation of quality-of-life (QoL) alongside the desire to survive their diagnosis.

Tumor Hypoxia and CD8 T-Cell Infiltration in Patients With Advanced Laryngeal Cancer.

Objective: We assessed correlations between tumor carbonic anhydrase IX (CAIX) staining, as a marker of tumor hypoxia, and CD8 T-cell infiltration in a cohort of patients with advanced laryngeal squamous cell carcinoma undergoing a bioselection approach for definitive treatment.

Study Design: Retrospective cohort study.

Setting: Tertiary care hospital.

Parotidectomy Trends Toward Outpatient for Benign Disease.

Objective: We evaluate the safety of outpatient parotidectomy. We evaluate factors that lead to planned admission and compare costs. We evaluate trends toward outpatient, and the outcomes of switching admission status, total versus superficial approach, and ambulatory versus hospital site.

Hypothyroidism Predicts Fistula Development Following Salvage Oropharyngectomy.

Importance: Previous work demonstrated postoperative hypothyroidism adversely affects wound healing in salvage laryngectomy. Currently, no studies have evaluated the association between wound healing and hypothyroidism in patients undergoing salvage oropharyngectomy.

Objective: The primary objective was studying hypothyroidism and other factors associated with oropharyngocutaneous fistula development and fistula requiring reoperation within 30 days after salvage oropharyngectomy.

Patient-Initiated Communication After Parotidectomy.

Objectives: We sought to study the incidence of patient-initiated communication after parotidectomy, identify patient and surgical factors associated with patient-initiated communication, and evaluate trends and possible areas for improvement.

Methods: A retrospective cohort study of patients who underwent parotidectomy without combined procedures from 2018 to 2022 in a single tertiary-care institution was performed. We reviewed all patient communications documented within the electronic medical record within 30 days of discharge.

Oral cavity obliteration is a novel predictor of functional outcomes after glossectomy reconstruction.

Objectives: The primary goal for reconstruction of oral tongue defects is to improve speech and swallowing. The purpose of this study is to present a new reconstructive metric that uses volume displacement to measure oral cavity obliteration and correlate this metric to outcomes of speech and swallowing.

Methods: 47 patients underwent resection and primary closure or free-tissue reconstruction of oral tongue defects.

Endoscope-Assisted Transcervical Resection of Parapharyngeal Space Tumors.

Objective: We describe a novel technique for endoscope-assisted (EA) transcervical (TC) approach for resection of parapharyngeal space (PPS) tumors and compare perioperative outcomes of this approach to standard TC approaches.

Study Design: Retrospective chart review.

Setting: Single tertiary care center.

Utility of bioselection with neoadjuvant chemotherapy for organ preservation in patients with T4 laryngeal cancer.

Background: Neoadjuvant chemotherapy for induction selection of definitive treatment (IS) protocols have shown excellent outcomes for organ preservation and survival in patients with T3 laryngeal squamous cell carcinoma (LSCC). We seek to evaluate survival and organ preservation outcomes in T4 LSCC patients treated with IS protocols.

Methods: Retrospective cohort of advanced T3 and T4 LSCC patients who underwent IS protocols based upon potential for preserving a functional larynx.

Pharyngeal Mucosal Margin Vessel Counts Predict Pharyngocutaneous Fistula in Salvage Laryngectomy.

Objective: We evaluated vessel counts in the pharyngeal mucosal margins of patients who underwent salvage laryngectomy to establish whether mucosal vascularity might predict fistula risk.

Study Design: Retrospective cohort.

Setting: Tertiary Medical Center.

Phase II Clinical Trial of Intravenous Levothyroxine to Mitigate Pharyngocutaneous Fistula in Euthyroid Patients Undergoing Salvage Laryngectomy.

Purpose: Patients undergoing head and neck cancer surgery after prior radiation or chemoradiation are at high risk for wound complications. Hypothyroidism is a known risk factor for wound complications, especially fistulae after salvage total laryngectomy. The purpose of this phase II clinical trial is to investigate the effect of perioperative intravenous levothyroxine supplementation on wound complications in patients undergoing salvage total laryngectomy.

Follow-up for human papillomavirus-related oropharynx cancer concentrated on unequal symptom change (FOCUS): Prospective patient-reported outcome collection.

Background: Post-treatment surveillance recommendations for oropharyngeal cancer do not vary with p16 status despite the differences in outcomes. The optimal algorithm personalizing follow-up for these patients remains undefined. Here, we evaluate the feasibility and utility of incorporating electronic patient-reported outcomes (ePROs) and circulating tumor DNA (ctDNA) into routine surveillance for patients treated for p16+ oropharynx cancer.

Upfront Neck Dissection for Treatment Selection and Improvement in Quality of Life as a Novel Treatment Paradigm for Deintensification in HPV+ OPSCC.

Purpose: Locoregionally advanced HPV+ oropharyngeal squamous cell carcinoma (OPSCC) has excellent cure rates, although current treatment regimens are accompanied by acute and long-term toxicities. We designed a phase II deescalation trial for patients with HPV+ OPSCC to evaluate the feasibility of an upfront neck dissection to individualize definitive treatment selection to improve the quality of life without compromising survival.

Patients And Methods: Patients with T1-3, N0-2 HPV+ OPSCC underwent an upfront neck dissection with primary tumor biopsy.

Aspirin use and head and neck cancer survival and recurrence.

Background: Head and neck cancer (HNC) has low 5-year survival, and evidence-based recommendations for tertiary prevention are lacking. Aspirin improves outcomes for cancers at other sites, but its role in HNC tertiary prevention remains understudied.

Methods: HNC patients were recruited in the University of Michigan Head and Neck Cancer Specialized Program of Research Excellence (SPORE) from 2003 to 2014.

Team-Based Surgical Approach to Head and Neck Microvascular Free Flap Reconstruction.

Importance: Because microvascular free flap reconstruction is increasingly used to restore function in patients with head and neck cancer, there is a growing need for evidence-based perioperative care.

Objective: To assess the association of different team-based surgical approaches with intraoperative and postoperative outcomes for patients undergoing head and neck free flap reconstruction.

Design, Setting, And Participants: This retrospective cohort study of 733 patients was conducted at an academic tertiary care medical center.

Lymph node level ratio as a predictor of survival in oral cavity squamous cell carcinoma.

Objective: To evaluate whether nodal yields and ratios based on level serves as prognostic indicators in patients with oral cavity squamous cell carcinoma undergoing neck dissection.

Materials And Methods: A retrospective analysis of 342 patients with oral cavity squamous cell carcinoma treated surgically between 1998 and 2017 were included.Demographics and clinicopathologic data were collated.

Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury.

Background: Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection.

Methods: This was a single-center, retrospective, electronic health record review.

Tumor-Derived Exosomes and the Role of Liquid Biopsy in Human Papillomavirus Oropharyngeal Squamous Cell Carcinoma.

The global incidence of human papillomavirus-positive (HPV+) head and neck squamous cell carcinoma (HNSCC) has surged in recent decades, with HPV+ HNSCC accounting for >70% of oropharynx cancers in the United States. Its incidence in men has surpassed that of HPV+ cervical cancer in women, and reliable assays are needed for early detection and to monitor response to therapy. Human papillomavirus-positive OPSCC has a more favorable response to therapy and prognosis than HPV-negative (HPV-) HNSCC, motivating regimens to deintensify curative surgery or chemoradiotherapy protocols.

Color Match following Free Flap Surgery in Head and Neck Reconstruction: A Colorimetric and Aesthetic Analysis.

Background: Many options for free tissue transfer have been described for head and neck reconstruction. Although functional outcomes remain paramount, aesthetic considerations such as color match can be equally consequential for patient quality of life. It is important to understand differences in color match based on flap donor site for head and neck reconstruction.