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Including Surgical Resection in the Multimodal Management of Very Locally Advanced Sinonasal Cancer

Karp, Jerome M; Hu, Kenneth S; Persky, Michael; Persky, Mark; Jacobson, Adam; Tran, Theresa; Li, Zujun; Givi, Babak; Tam, Moses M
OBJECTIVE:Sinonasal cancer often presents as locoregionally advanced disease. National guidelines recommend management of stage T4b tumors with systemic therapy and radiotherapy, but recent studies suggest that including surgical resection in the multimodal treatment of these tumors may improve local control and survival. We queried the National Cancer Database to examine patterns of care and outcomes in T4b sinonasal squamous cell carcinoma (SCC). STUDY DESIGN/METHODS:Prospectively gathered data. SETTING/METHODS:National Cancer Database. METHODS:Patients with T4b N0-3 M0 sinonasal squamous cell carcinoma diagnosed in 2004 to 2016 were stratified between those who received chemoradiotherapy and those who underwent surgical resection with neoadjuvant or adjuvant treatment. The overall survival of each cohort was assessed via Kaplan-Meier analysis and Cox proportional hazard models, with repeat analysis after reweighting of data via inverse probability of treatment weighting. RESULTS:= .004]). CONCLUSION/CONCLUSIONS:Surgical treatment with neoadjuvant or adjuvant treatment for stage T4b sinonasal SCC was associated with promising survival outcomes, suggesting a role for incorporating surgery in treatment of select T4b SCC, particularly when removal of all macroscopic disease is feasible.
PMID: 34962843
ISSN: 1097-6817
CID: 5108122

Improving Quality and Safety of Thyroidectomy [Meeting Abstract]

Papazian, M; Roland, J T; Shao, Q; Vaezi, A; DeLacure, M; Tran, T; Persky, M J; Persky, M S; Jacobson, A; Givi, B
Introduction: Thyroidectomy is commonly performed in otolaryngology. Complications such as recurrent laryngeal nerve (RLN) injury and severe hypocalcemia have reported incidences in national studies as high as 3% and 8%, respectively. Narcotic pain medications are commonly used for postoperative pain management. Here, we present the long-term results of a thyroidectomy quality and safety improvement program, with an emphasis on reducing narcotic use.
Method(s): All surgeons who perform thyroidectomy established standards for antibiotic administration, postoperative calcium management, and narcotics use. The program was established in 2018 and data on adverse events, length of stay, antibiotic and narcotic use were recorded prospectively from June 2018 to January 2021. Data trends were analyzed throughout the course of the study.
Result(s): During the study period, 542 thyroidectomies were performed by 14 surgeons. The average length of stay was less than 24 hours. Five (0.9%) adverse events were recorded: 1 (0.2%) temporary RLN dysfunction, 3 (0.6%) hematomas, 1 (0.2%) surgical site infection, and 1 (0.2%) temporary hypocalcemia. The average number of narcotics prescribed declined from 18 doses (95%CI: 16.8-18.5) in 2019 to 9 in 2020 (95%CI: 8.5-9.6) (p<0.0001), without an increase in need for refills. No instances of permanent hypocalcemia or permanent RLN injury were identified.
Conclusion(s): By implementing a thyroidectomy quality improvement program, we achieved extremely low rates of adverse events and significantly reduced the use of narcotics without adverse effects. These data can inform practitioners and the public about expected outcomes of thyroid surgery, and establish benchmarks for quality and safety.
ISSN: 1879-1190
CID: 5024602

Trimodality Treatment of Very Locally Advanced Sinonasal Cancer: A National Cancer Database Analysis [Meeting Abstract]

Karp, J. M.; Hu, K. S.; Persky, M.; Jacobson, A.; Tran, T.; Li, Z.; Givi, B.; Tam, M.
ISSN: 0360-3016
CID: 4686342

De-escalation with Definitive Unilateral Neck Radiation for T3 or N2b/N3 p16+Tonsil Squamous Cell Carcinoma Using Prospectively Defined Criteria [Meeting Abstract]

Yan, S. X.; Mojica, J.; Barbee, D.; Harrison, L. B.; Gamez, M. E.; Tam, M.; Concert, C. M.; Li, Z.; Culliney, B.; Jacobson, A.; Persky, M.; DeLacure, M.; Persky, M.; Tran, T.; Givi, B.; Hu, K. S.
ISSN: 0360-3016
CID: 4688592

Resection Margin Distance in Extra-Hepatic Cholangiocarcinoma: How Much Is Enough? [Meeting Abstract]

Rahnemai-Azar, A.; Ronnekleiv-Kelly, S. M.; Abbott, D.; Ethun, C.; Poultsides, G.; Tran, T.; Fields, R.; Krasnick, B. A.; Martin, R.; Scoggins, C. R.; Idrees, K.; Isom, C. A.; Hatzaras, I.; Shenoy, R.; Shen, P.; Perkins, J. D.; Pawlik, T.; Maithel, S.; Weber, S.
ISSN: 1068-9265
CID: 3705512

Resection margin distance in extrahepatic cholangiocarcinoma: How much is enough? [Meeting Abstract]

Rahnemai-Azar, A A; Ronnekleiv-Kelly, S; Abbott, D; Ethun, C G; Poultsides, G A; Tran, T; Fields, R; Krasnick, B A; Martin, R C G; Scoggins, C R; Idrees, K; Isom, C A; Hatzaras, I; Shenoy, R; Shen, P; Perkins, J D; Pawlik, T M; Maithel, S K; Weber, S M
Background: Surgical resection is required for curative treatment of patients with extra-hepatic cholangiocarcinoma (EH-CCA). The objective of this study was to determine if the distance of surgical margin was associated with outcome.
Method(s): Patients who underwent curative-intent resection for EH-CCA between 2000 and 2015 at 10 hepatobiliary centers across the U.S. were evaluated using prospectively collected data. Cox proportional hazard model was utilized to evaluate the influence of the extent of the margin on outcome.
Result(s): 538 patients with EH-CCA who underwent curative-intent resection were included: 383 (71%) undergoing R0 resection, 153 (28%) undergoing R1 resection, and 2 with R2 resection. A negative surgical margin (R0) was associated with improved recurrence-free (RFS) and overall survival (OS) (RFS: 10.5% vs. 3.6% (R1) and OS: 25.8% vs. 9.3% (R1). Subsequently, further analysis on 161 patients with complete data on distance of resection margin, all undergoing R0 resection, was performed to assess the impact of extent of margin on outcome. On multi-variable analysis, the resection margin distance, analyzed as a continuous variable, was not associated with either improved RFS (RR 1.00, 95% CI 0.96-1.05; p 0.71) or OS (RR 0.99, 95% CI 0.96-1.01; p 0.49). Increasing age, increased tumor size, and LN metastasis were identified as independent predictors of OS; while RFS were mainly dependent on tumor size and LN metastasis (Table).
Conclusion(s): Achieving R0 resection is acceptable for EH-CCA tumors, and obtaining additional margin does not confer a benefit on overall survival. Increasing age, tumor size, and LN metastasis are independent predictors of RFS and OS, but increased margin width is not associated with improvement in either. Multivariable analysis of factors affecting OS of patients with extra-hepatic CCA who underwent surgical resection, with significant factors noted in bold
ISSN: 1527-7755
CID: 3811602

De-escalation in HPV Era: Definitive Unilateral Neck Radiation for T3 or N2b/N3 p16+Tonsil Squamous Cell Carcinoma Using Prospectively Defined Criteria [Meeting Abstract]

Yan, S. X.; Mojica, J.; Barbee, D.; Harrison, L. B.; Gamez, M. E.; Tam, M.; Concert, C. M.; Li, Z.; Culliney, B.; Jacobson, A.; Persky, M.; DeLacure, M.; Persky, M.; Tran, T.; Givi, B.; Hu, K. S.
ISSN: 0360-3016
CID: 4111372

Functional Swallowing Outcomes Using FEES Evaluation After Swallowing-Sparing IMRT in Unilateral Versus Bilateral Neck Radiation [Meeting Abstract]

Tam, M.; Mojica, J.; Kim, N. S.; No, D.; Li, Z.; Tran, T.; DeLacure, M.; Givi, B.; Jacobson, A.; Persky, M.; Hu, K. S.
ISSN: 0360-3016
CID: 3035552

Utilization of Immunotherapy in Head and Neck Cancers Pre-Food and Drug Administration Approval of Immune Checkpoint Inhibitors [Meeting Abstract]

Wu, S. P. P.; Tam, M.; Gerber, N. K.; Li, Z.; Schmidt, B.; Persky, M.; Sanfilippo, N. J.; Tran, T.; Jacobson, A.; DeLacure, M.; Hu, K. S.; Persky, M.; Schreiber, D. P.; Givi, B.
ISSN: 0360-3016
CID: 3035562

Acquired Vascular Tumors of the Head and Neck

Persky, Mark; Tran, Theresa
Vascular neoplasms of the head and neck present with a wide spectrum of signs and symptoms. Diagnosis requires a high index of suspicion and is usually made after tumors are large enough to be visually apparent or cause symptoms. This article discusses the most common acquired benign and malignant vascular tumors, with an emphasis on their evaluation and treatment.
PMID: 29106888
ISSN: 1557-8259
CID: 2773232