Otolaryngology Commons^™

Deployment Of Cisplatin In Veterans With Oropharyngeal Cancer: Toxicity And Impact On Oncologic Outcomes, Ola Soliman, David C Wilde, Jan O Kemnade, Anita L Sabichi, George Chen, Albert Chen, Samantha N Little, Andrew T Huang, David J Hernandez, Vlad C Sandulache

Faculty, Staff and Students Publications

OBJECTIVE: Cisplatin forms the backbone of systemic chemotherapy treatment for oropharyngeal squamous cell carcinoma (OPSCC). The ideal cisplatin dosing regimen remains yet to be fully defined for achieving optimal efficacy and toxicity profiles in patients with comorbidity.

METHODS: We retrospectively reviewed oncologic and toxicity data for patients with OPSCC treated at the Michael E. DeBakey Veterans Affairs Medical Center between 2000 and 2020 who initiated curative intent, definitive chemo-radiation with one of three single agent regimens: high dose (HD) cisplatin, low dose (LD) cisplatin or cetuximab.

RESULTS: Patients with HPV-associated tumors and nonsmokers demonstrated improved overall and disease-free survival along …

Development And Validation Of An Automated Image-Based Deep Learning Platform For Sarcopenia Assessment In Head And Neck Cancer, Zezhong Ye, Anurag Saraf, Yashwanth Ravipati, Frank Hoebers, Paul J Catalano, Yining Zha, Anna Zapaishchykova, Jirapat Likitlersuang, Christian Guthier, Roy B Tishler, Jonathan D Schoenfeld, Danielle N Margalit, Robert I Haddad, Raymond H Mak, Mohamed Naser, Kareem A Wahid, Jaakko Sahlsten, Joel Jaskari, Kimmo Kaski, Antti A Mäkitie, Clifton D Fuller, Hugo J W L Aerts, Benjamin H Kann

Faculty, Staff and Student Publications

Importance: Sarcopenia is an established prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC); the quantification of sarcopenia assessed by imaging is typically achieved through the skeletal muscle index (SMI), which can be derived from cervical skeletal muscle segmentation and cross-sectional area. However, manual muscle segmentation is labor intensive, prone to interobserver variability, and impractical for large-scale clinical use.

Objective: To develop and externally validate a fully automated image-based deep learning platform for cervical vertebral muscle segmentation and SMI calculation and evaluate associations with survival and treatment toxicity outcomes.

Design, setting, and participants: For this prognostic study, …

Machine Learning Driven Index Of Tumor Multinucleation Correlates With Survival And Suppressed Anti-Tumor Immunity In Head And Neck Squamous Cell Carcinoma Patients, Can F Koyuncu, Mitchell J Frederick, Lester D R Thompson, Germán Corredor, Sirvan Khalighi, Zelin Zhang, Bolin Song, Cheng Lu, Reetoja Nag, Vidya Sankar Viswanathan, Michael Gilkey, Kailin Yang, Shlomo A Koyfman, Deborah J Chute, Patricia Castro, James S Lewis, Anant Madabhushi, Vlad C Sandulache

Faculty, Staff and Students Publications

OBJECTIVES: Matching treatment intensity to tumor biology is critical to precision oncology for head and neck squamous cell carcinoma (HNSCC) patients. We sought to identify biological features of tumor cell multinucleation, previously shown by us to correlate with survival in oropharyngeal (OP) SCC using a machine learning approach.

MATERIALS AND METHODS: Hematoxylin and eosin images from an institutional OPSCC cohort formed the training set (D

RESULTS: MuNI correlated with overall survival. A multivariable nomogram that included MuNI, age, race, sex, T/N stage, and smoking status yielded a C-index of 0.65, and MuNI was prognostic of overall survival (2.25, 1.07-4.71, 0.03), …

Longitudinal Diffusion And Volumetric Kinetics Of Head And Neck Cancer Magnetic Resonance On A 15 T Mr-Linear Accelerator Hybrid System: A Prospective R-Ideal Stage 2a Imaging Biomarker Characterization/Pre-Qualification Study, Joint Head And Neck Radiation Therapy-Mri Development Cooperative, Mr-Linac Consortium Head And Neck Tumor Site Group

Faculty, Staff and Student Publications

Objectives: We aim to characterize the serial quantitative apparent diffusion coefficient (ADC) changes of the target disease volume using diffusion-weighted imaging (DWI) acquired weekly during radiation therapy (RT) on a 1.5 T MR-Linac and correlate these changes with tumor response and oncologic outcomes for head and neck squamous cell carcinoma (HNSCC) patients as part of a programmatic R-IDEAL biomarker characterization effort.

Methods:Thirty patients with HNSCC who received curative-intent RT at MD Anderson Cancer Center, were included. Baseline and weekly MRI were obtained, and various ADC parameters were extracted from the regions of interest (ROIs). Baseline and weekly ADC parameters were …

Systemic Inflammation Is Associated With Disease Extent And Survival In Oral Cavity Squamous Cell Carcinoma, Brendan Coutu, Dallin N. Christensen, Evan Ryan, Elizabeth Bradford Bell, Weining Zhen, Zafar Sayed

Graduate Medical Education Research Journal

Background: Although systemic immune-inflammation index (SII) correlates with patient survival in various solid malignancies limited information is available in the setting of oral cavity squamous cell carcinoma (OCSCC).

Methods: We retrospectively reviewed 222 patients who underwent a resection of curative intent for patients with OCSCC. SII was determined prior to surgical resection as platelet count × neutrophil count/lymphocyte count.

Results: At a median follow-up of 30.6 months, 2-year disease-free survival (DFS) and overall survival (OS) rates were 63.9% and 76.4%, respectively. A high SII (>1047) was associated with poor performance status and disease extent. A low SII was independently …

Efficacy Of Systemic Chemotherapy In Patients With Low-Grade Mucinous Appendiceal Adenocarcinoma: A Randomized Crossover Trial, John Paul Shen, Abdelrahman M Yousef, Fadl A Zeineddine, Mohammad A Zeineddine, Rebecca S Tidwell, Karen A Beaty, Lisa C Scofield, Safia Rafeeq, Nicholas Hornstein, Elizabeth Lano, Cathy Eng, Aurelio Matamoros, Wai Chin Foo, Abhineet Uppal, Christopher Scally, Paul Mansfield, Melissa Taggart, Kanwal P Raghav, Michael J Overman, Keith Fournier

Faculty, Staff and Student Publications

IMPORTANCE: Appendiceal adenocarcinoma is a rare tumor, and given the inherent difficulties in performing prospective trials in such a rare disease, there are currently minimal high-quality data to guide treatment decisions, highlighting the need for more preclinical and clinical investigation for this disease.

OBJECTIVE: To prospectively evaluate the effectiveness of fluoropyrimidine-based systemic chemotherapy in patients with inoperable low-grade mucinous appendiceal adenocarcinoma.

DESIGN, SETTING, AND PARTICIPANTS: This open-label randomized crossover trial recruited patients at a single tertiary care comprehensive cancer center from September 2013 to January 2021. The data collection cutoff was May 2022. Enrollment of up to 30 patients was …

Survival Outcomes Of Patients With Mycosis Fungoides Involving The External Ear And Ear Canal, Alex J Wilkinson, Marc-Elie Nader, Dianna Roberts, Madeleine Duvic, Jillian R Gunther, Bouthaina S Dabaja, Paul W Gidley

Faculty, Staff and Student Publications

OBJECTIVES/HYPOTHESIS: Mycosis Fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma. Disease involvement of specific locations may be more significant than simply the symptoms associated with that site; it is possible that involvement of certain sites could be associated with poor prognosis. We aimed to evaluate the outcomes of patients with MF with documented involvement of the EAC and external ear.

STUDY DESIGN: Retrospective analysis.

METHODS: We retrospectively reviewed 40 patients with MF that were treated by otologists between 2012 and 2021.

RESULTS: We report the largest series of patients with MF involving the external ear and EAC. …

Cost-Effective Microscopic Draping: Covid-19 Umbrella, Yusif Hajiyev, Ronald J Vilela

Faculty, Staff and Students Publications

We describe a cost-effective solution to limit aerosol transmission to the surgeon and other personnel in the operating room during otologic surgery.

Improving Surgeon-Patient Communication In Thyroid Cancer Diagnosis And Treatment Discussions: A Narrative Review, Lauren Schlegel, Roberta S. Perry, Elizabeth Cottrill

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Background and Objective: Patient experience is greatly influenced by physician-patient communication. Yet, unmet communication needs continue to be well documented in patients with thyroid cancer. This review discusses factors that may impact this communication and presents communication interventions that are currently being used with thyroid cancer patients.

Methods: A narrative review of articles on the physician-patient relationship and communication in thyroid cancer published between 1985 and 2022 was conducted through PubMed and Google. An additional review of the articles referenced in the bibliography of the included articles was performed.

Key Content and Findings: This review discusses communication components impacting the …

Risk Factors For Head And Neck Cancer In More And Less Developed Countries: Analysis From The Inhance Consortium, Neerav Goyal, Max Hennessy, Erik Lehman, Wenxue Lin, Antonio Agudo, Wolfgang Ahrens, Stefania Boccia, Paul Brennan, Hermann Brenner, Gabriella Cadoni, Cristina Canova, Chu Chen, David Conway, Maria Paula Curado, Luigino Dal Maso, Alexander W Daudt, Valeria Edefonti, Eleonora Fabianova, Leticia Fernandez, Silvia Franceschi, Werner Garavello, Maura Gillison, Richard B Hayes, Claire Healy, Rolando Herrero, Ivana Holcatova, Jossy L Kanda, Karl Kelsey, Bo T Hansen, Rosalina Koifman, Pagona Lagiou, Carlo La Vecchia, Fabio Levi, Guojun Li, Jolanta Lissowska, Rossana Mendoza López, Danièle Luce, Gary Macfarlane, Dana Mates, Keitaro Matsuo, Michael Mcclean, Ana Menezes, Gwenn Menvielle, Hal Morgenstern, Kirsten Moysich, Eva Negri, Andrew F Olshan, Tamas Pandics, Jerry Polesel, Mark Purdue, Loredana Radoi, Heribert Ramroth, Lorenzo Richiardi, Stimson Schantz, Stephen M Schwartz, Diego Serraino, Oxana Shangina, Elaine Smith, Erich M Sturgis, Beata Świątkowska, Peter Thomson, Thomas L Vaughan, Marta Vilensky, Deborah M Winn, Victor Wunsch-Filho, Guo-Pei Yu, Jose P Zevallos, Zuo-Feng Zhang, Tongzhang Zheng, Ariana Znaor, Paolo Boffetta, Mia Hashibe, Yuan-Chin A Lee, Joshua E Muscat

Faculty, Staff and Students Publications

Objective: We analyzed the pooled case-control data from the International Head and Neck Cancer Epidemiology (INHANCE) consortium to compare cigarette smoking and alcohol consumption risk factors for head and neck cancer between less developed and more developed countries.

Subjects and methods: The location of each study was categorized as either a less developed or more developed country. We compared the risk of overall head and neck cancer and cancer of specific anatomic subsites associated with cigarette smoking and alcohol consumption. Additionally, age and sex distribution between categories was compared.

Results: The odds ratios for head and neck cancer sites associated …

Association Of Suppressive Myeloid Cell Enrichment With Aggressive Oropharynx Squamous Cell Carcinoma, Changlin Yang, Rekha Garg, Kristanna Fredenburg, Frances Weidert, Hector Mendez-Gomez, Robert Amdur, Ji-Hyun Lee, Jamie Ku, Jesse Kresak, Stephanie Staras, Andrew G Sikora, Lily Wang, Daniel Mcgrail, Duane Mitchell, Elias Sayour, Natalie Silver

Faculty, Staff and Student Publications

BACKGROUND: While immune-cell infiltrated tumors, such as human papillomavirus positive (HPV+) ororpharyngeal squamous cell carcinomas (OPSCC) have been associated with an improved clinical prognosis, there is evidence to suggest that OPSCCs are also subjected to increased immunoregulatory influence. The objective of this study was to assess whether patients with clinically aggressive OPSCC have a distinct immunosuppressive immune signature in the primary tumor.

METHODS: This retrospective case-control study analyzed 37 pre-treatment tissue samples from HPV+ and HPV-negative OPSCC patients treated at a single institution. The cases were patients with known disease recurrence and the controls were patients without disease recurrence. An …

Pembrolizumab And Cabozantinib In Recurrent Metastatic Head And Neck Squamous Cell Carcinoma: A Phase 2 Trial, Nabil F Saba, Conor E Steuer, Asari Ekpenyong, Ashley Mccook-Veal, Kelly Magliocca, Mihir Patel, Nicole C Schmitt, William Stokes, James E Bates, Soumon Rudra, Jill Remick, Mark Mcdonald, Marin Abousaud, Aik Choon Tan, Muhammad Zaki Hidayatullah Fadlullah, Ritu Chaudhary, Jameel Muzaffar, Kedar Kirtane, Yuan Liu, Georgia Z Chen, Dong M Shin, Yong Teng, Christine H Chung

Faculty, Staff and Student Publications

Anti-programmed cell death protein 1 (PD-1) therapy is a standard of care in recurrent metastatic head and neck squamous cell carcinoma (RMHNSCC). Vascular endothelial growth factor inhibitors, including tyrosine kinase inhibitors, have immunomodulatory properties and have offered promising results when combined with anti-PD-1 agents. We conducted a phase 2, multicenter, single-arm trial of pembrolizumab and cabozantinib in patients with RMHNSCC who had Response Evaluation Criteria in Solid Tumors v.1.1 measurable disease and no contraindications to either agent. We assessed the primary end points of tolerability and overall response rate to the combination with secondary end points of progression-free survival and …

Spatial Pd-L1, Immune-Cell Microenvironment, And Genomic Copy-Number Alteration Patterns And Drivers Of Invasive-Disease Transition In Prospective Oral Precancer Cohort, William N William, Jianjun Zhang, Xin Zhao, Edwin R Parra, Naohiro Uraoka, Heather Y Lin, S Andrew Peng, Adel K El-Naggar, Jaime Rodriguez-Canales, Jaejoon Song, Ann M Gillenwater, Ignacio I Wistuba, Jeffrey N Myers, Kathryn A Gold, Renata Ferrarotto, Patrick Hwu, Teresa Davoli, J Jack Lee, John V Heymach, Vassiliki A Papadimitrakopoulou, Scott M Lippman

Faculty, Staff and Student Publications

BACKGROUND: Studies of the immune landscape led to breakthrough trials of programmed death-1 (PD-1) inhibitors for recurrent/metastatic head and neck squamous cell carcinoma therapy. This study investigated the timing, influence of somatic copy-number alterations (SCNAs), and clinical implications of PD-L1 and immune-cell patterns in oral precancer (OPC).

METHODS: The authors evaluated spatial CD3, CD3/8, and CD68 density (cells/mm

RESULTS: Epithelial, but not CD68 immune-cell, PD-L1 expression was detected in 28% of OPCs, correlated with immune-cell infiltration, 9p21.3 loss of heterozygosity (LOH), and inferior oral cancer-free survival (OCFS), notably in OPCs with low CD3/8 cell density, dysplasia, and/or 9p21.3 LOH. High …

Lingual Alveolar Soft Part Sarcoma In A 78-Year-Old Woman: A Case Report And Comprehensive Review Of The Literature From 1952 To 2022, Aliaksandr Aksionau, Nestor Enriquez Dela Cruz, Andrew T Meram, Hugo Cuellar-Saenz, Jillian R Aveni, Hidehiro Takei

Faculty, Staff and Student Publications

BACKGROUND: Alveolar soft part sarcoma (ASPS) is a rare translocation-related soft tissue sarcoma, occurring mainly in the limbs and trunk in young adults and adolescents. ASPS is rarely seen in the head and neck and one fourth of those cases described are tongue primary. Given its nonspecific symptoms, clinical findings, and rarity in this location, lingual ASPS (L-ASPS) has been reported to be commonly misdiagnosed as various benign tumors, leading to adverse outcomes.

METHODS: We report a case of L-ASPS occurring in the oldest (78 years) female patient published to date and comprehensively review the literature from 1952 to 2022. …

Ninety-Day Mortality Following Transoral Robotic Surgery Or Radiation At Commission On Cancer-Accredited Facilities, James R Janopaul-Naylor, Manali Rupji, Rachel A Tobillo, Joshua W Lorenz, Jeffrey M Switchenko, Sibo Tian, Azeem S Kaka, David C Qian, Ashley J Schlafstein, Conor E Steuer, Jill S Remick, Soumon Rudra, Mark W Mcdonald, Nabil F Saba, William A Stokes, Mihir R Patel, James E Bates

Faculty, Staff and Student Publications

BACKGROUND: Postoperative mortality for oropharynx squamous cell carcinoma (OPSCC) with transoral robotic surgery (TORS) varies from 0.2% to 6.5% on trials; the real-world rate is unknown.

METHODS: NCDB study from 2010 to 2017 for patients with cT1-2N0-2M0 OPSCC with Charleson-Deyo score 0-1. Ninety-day mortality assessed from start and end of treatment at Commission on Cancer-accredited facilities.

RESULTS: 3639 patients were treated with TORS and 1937 with radiotherapy. TORS cohort had more women and higher income, was younger, more often treated at academic centers, and more likely to have private insurance (all p < 0.05). Ninety-day mortality was 1.3% with TORS and 0.7% or 1.4% from start or end of radiotherapy, respectively. From end of therapy, there was no significant difference on MVA between treatment modality.

CONCLUSIONS: There is minimal difference between 90-day mortality …

A Scoping Review Of Randomized Clinical Trials For Pain Management In Pediatric Tonsillectomy And Adenotonsillectomy, Michael C Shih, Barry D Long, Phayvanh P Pecha, David R White, Yi-Chun C Liu, Emily Brennan, Mariam I Nguyen, Clarice S Clemmens

Faculty, Staff and Students Publications

OBJECTIVES: To examine the volume, topics, and reporting trends in the published literature of randomized clinical trials for pharmacologic pain management of pediatric tonsillectomy and adenotonsillectomy and to identify areas requiring further research.

DATA SOURCES: PubMed (National Library of Medicine and National Institutes of Health), Scopus (Elsevier), CINAHL (EBSCO), and Cochrane Library (Wiley).

METHODS: A systematic search of four databases was conducted. Only randomized controlled or comparison trials examining pain improvement with a pharmacologic intervention in pediatric tonsillectomy or adenotonsillectomy were included. Data collected included demographics, pain-related outcomes, sedation scores, nausea/vomiting, postoperative bleeding, types of drug comparisons, modes of administration, …

Molecular Diagnostics In The Evaluation Of Thyroid Nodules: Current Use And Prospective Opportunities, Jena Patel, Joshua Klopper, Elizabeth E. Cottrill

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Thyroid cancer is the most common endocrine malignancy with an estimated 43,800 new cases to be diagnosed in 2022 and representing the 7th most common cancer in women. While thyroid nodules are very common, being identified in over 60% of randomly selected adults, only 5-15% of thyroid nodules harbor thyroid malignancy. Therefore, it is incumbent upon physicians to detect and treat thyroid malignancies as is clinically appropriate and avoid unnecessary invasive procedures in patients with benign asymptomatic lesions. Over the last 15-20 years, rapid advances have been made in cytomolecular testing to aid in thyroid nodule management. Initially, indeterminate thyroid …

Evofosfamide For The Treatment Of Human Papillomavirus-Negative Head And Neck Squamous Cell Carcinoma, Stephen Mf Jamieson, Peter Tsai, Maria K Kondratyev, Pratha Budhani, Arthur Liu, Neil N Senzer, E Gabriela Chiorean, Shadia I Jalal, John J Nemunaitis, Dennis Kee, Avik Shome, Way W Wong, Dan Li, Nooriyah Poonawala-Lohani, Purvi M Kakadia, Nicholas S Knowlton, Courtney Rh Lynch, Cho R Hong, Tet Woo Lee, Reidar A Grénman, Laura Caporiccio, Trevor D Mckee, Mark Zaidi, Sehrish Butt, Andrew Mj Macann, Nicholas P Mcivor, John M Chaplin, Kevin O Hicks, Stefan K Bohlander, Bradly G Wouters, Charles P Hart, Cristin G Print, William R Wilson, Michael A Curran, Francis W Hunter

Faculty, Staff and Student Publications

Evofosfamide (TH-302) is a clinical-stage hypoxia-activated prodrug of a DNA-crosslinking nitrogen mustard that has potential utility for human papillomavirus (HPV) negative head and neck squamous cell carcinoma (HNSCC), in which tumor hypoxia limits treatment outcome. We report the preclinical efficacy, target engagement, preliminary predictive biomarkers and initial clinical activity of evofosfamide for HPV-negative HNSCC. Evofosfamide was assessed in 22 genomically characterized cell lines and 7 cell line–derived xenograft (CDX), patient-derived xenograft (PDX), orthotopic, and syngeneic tumor models. Biomarker analysis used RNA sequencing, whole-exome sequencing, and whole-genome CRISPR knockout screens. Five advanced/metastatic HNSCC patients received evofosfamide monotherapy (480 mg/m2 qw × …

Immunogenetic Determinants Of Susceptibility To Head And Neck Cancer In The Million Veteran Program Cohort, Yanhong Liu, Jennifer R Kramer, Vlad C Sandulache, Robert Yu, Guojun Li, Liang Chen, Zenab I Yusuf, Yunling Shi, Saiju Pyarajan, Spyros Tsavachidis, Li Jiao, Michelle L Mierzwa, Elizabeth Chiao, Yvonne M Mowery, Andrew Shuman, Sanjay Shete, Andrew G Sikora, Donna L White

Faculty, Staff and Student Publications

Increasing rates of human papillomavirus (HPV)-driven oropharyngeal cancer (OPC) have largely offset declines in tobacco-associated head and neck squamous cell carcinoma (HNSCC) at non-OPC sites. Host immunity is an important modulator of HPV infection, persistence, and clearance, and also of immune evasion in both virally- and nonvirally-driven cancers. However, the association between collective known cancer-related immune gene variants and HNSCC susceptibility has not been fully characterized. Here, we conducted a genetic association study in the multiethnic Veterans Affairs Million Veteran Program cohort, evaluating 16,050 variants in 1,576 immune genes in 4,012 HNSCC cases (OPC = 1,823; non-OPC = 2,189) and …

Expert Consensus Statement: Management Of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy, Stacey L Ishman, Stephen Maturo, Seth Schwartz, Margo Mckenna, Cristina M Baldassari, Mathieu Bergeron, Boris Chernobilsky, Zarmina Ehsan, Lisa Gagnon, Yi-Chun Carol Liu, David F Smith, Jeffrey Stanley, Habib Zalzal, Nui Dhepyasuwan

Faculty, Staff and Students Publications

OBJECTIVE: To develop an expert consensus statement regarding persistent pediatric obstructive sleep apnea (OSA) focused on quality improvement and clarification of controversies. Persistent OSA was defined as OSA after adenotonsillectomy or OSA after tonsillectomy when adenoids are not enlarged.

METHODS: An expert panel of clinicians, nominated by stakeholder organizations, used the published consensus statement methodology from the American Academy of Otolaryngology-Head and Neck Surgery to develop statements for a target population of children aged 2-18 years. A medical librarian systematically searched the literature used as a basis for the clinical statements. A modified Delphi method was used to distill expert …

Factors Affecting Adherence To Intranasal Treatment For Allergic Rhinitis: A Qualitative Study, Meha G Fox, Lauren M Cass, Kevin J Sykes, Emily L Cummings, Scott N Fassas, Rohit Nallani, Josh B Smith, Alexander G Chiu, Jennifer A Villwock

Faculty, Staff and Students Publications

OBJECTIVE: To determine the facilitators of and barriers to adherence to use of intranasal pharmacotherapy (daily intranasal corticosteroids and/or antihistamine, and nasal saline irrigation [NSI]), for allergic rhinitis (AR).

METHODS: Patients were recruited from an academic tertiary care rhinology and allergy clinic. Semi-structured interviews were conducted after the initial visit and/or 4-6 weeks following treatment. Transcribed interviews were analyzed using a grounded theory, inductive approach to elucidate themes regarding patient adherence to AR treatment.

RESULTS: A total of 32 patients (12 male, 20 female; age 22-78) participated (seven at initial visit, seven at follow-up visit, and 18 at both). Memory …

A Retrospective Study Of The Relationship Between Hypertension And Vestibular Disorders In Middle-Aged Women With And Without Hiv, Helen S Cohen, Michael W Plankey, Deanna Ware

Faculty, Staff and Students Publications

BACKGROUND: Patients often conflate the problem of lightheadedness from hypertension (HTN) and vertigo from a vestibular impairment, describing both problems as dizziness. The goal of the study was to learn if there is a relationship between measures of vestibular function and blood pressure.

METHODS: This retrospective study consisted of women who participated in a longitudinal study of the human immunodeficiency virus (HIV) and a control cohort of age-matched women without HIV. We used data from the point in time when participants were tested for vestibular functions with bi-thermal caloric tests and cervical vestibular evoked myogenic potentials; the data also included …

Effect Of Nodule Size And Stiffness On Phonation Threshold And Collision Pressures In A Synthetic Hemilaryngeal Vocal Fold Model, Mohsen Motie-Shirazi, Matías Zañartu, Sean D Peterson, Daryush D Mehta, Robert E Hillman, Byron D Erath

Faculty, Staff and Student Publications

Synthetic vocal fold (VF) replicas were used to explore the role of nodule size and stiffness on kinematic, aerodynamic, and acoustic measures of voiced speech production. Emphasis was placed on determining how changes in collision pressure may contribute to the development of phonotrauma. This was performed by adding spherical beads with different sizes and moduli of elasticity at the middle of the medial surface of synthetic silicone VF models, representing nodules of varying size and stiffness. The VF models were incorporated into a hemilaryngeal flow facility. For each case, self-sustained oscillations were investigated at the phonation threshold pressure. It was …

Children Then, Adults Now: Long-Term Outcomes-Performance At 15, 20, And 25 Years Of Cochlear Implant Use, João Elói Moura, Jorge Humberto Martins, Marisa Alves, Graça Oliveira, Daniela Ramos, Helena Alves, Ricardo Caiado, António Teixeira, Luís Filipe Silva, Jorge Migueis

Faculty, Staff and Student Publications

MOTIVATION: Severe to profound sensorineural hearing loss interferes with a child's development at the cognitive, linguistic, academic, and social levels. Since the beginning of the pediatric auditory rehabilitation program through cochlear implantation in the Ear, Nose, and Throat (ENT) Service of the Coimbra Hospital and University Center (CHUC), Portugal, its mentors defended the early diagnosis of hearing loss followed by timely intervention, and this was considered the starting point to optimize (re)habilitation through this method. Three decades or so later, recently we conducted this study to evaluate the performance of patients implanted in the initial phase of the cochlear implantation …

Role Of Sentinel Lymph Node Biopsy For Oral Squamous Cell Carcinoma: Current Evidence And Future Challenges, Sophie S Jang, Morgan E Davis, David R Vera, Stephen Y Lai, Theresa W Guo

Faculty, Staff and Student Publications

Sentinel lymph node biopsy (SLNB) has been used across oncological specialties for prognostication, staging, and identification of occult nodal metastasis. Recent studies demonstrated the potential clinical utility of SLNB in oral cavity squamous cell carcinoma (OCSCC). Elective neck dissection is the current standard of care in early management of OCSCC with depth of invasion greater than 2-4 mm; however, majority of patients ultimately do not have nodal disease on final pathology. SLNB is an alternative procedure widely adopted in early cancer management in many oncological subspecialities. Several considerations such as depth of invasion, nodal mapping, histopathology methods, operator variability, postoperative …

Multi-Organ Spatial Stratification Of 3-D Dose Distributions Improves Risk Prediction Of Long-Term Self-Reported Severe Symptoms In Oropharyngeal Cancer Patients Receiving Radiotherapy: Development Of A Pre-Treatment Decision Support Tool, Andrew Wentzel, Abdallah S R Mohamed, Mohamed A Naser, Lisanne V Van Dijk, Katherine Hutcheson, Amy M Moreno, Clifton D Fuller, Guadalupe Canahuate, G Elisabeta Marai

Faculty, Staff and Student Publications

Purpose: Identify Oropharyngeal cancer (OPC) patients at high-risk of developing long-term severe radiation-associated symptoms using dose volume histograms for organs-at-risk, via unsupervised clustering.

Material and methods: All patients were treated using radiation therapy for OPC. Dose-volume histograms of organs-at-risk were extracted from patients' treatment plans. Symptom ratings were collected via the MD Anderson Symptom Inventory (MDASI) given weekly during, and 6 months post-treatment. Drymouth, trouble swallowing, mucus, and vocal dysfunction were selected for analysis in this study. Patient stratifications were obtained by applying Bayesian Mixture Models with three components to patient's dose histograms for relevant organs. The clusters with the …

Overview Of The Hecktor Challenge At Miccai 2022: Automatic Head And Neck Tumor Segmentation And Outcome Prediction In Pet/Ct, Vincent Andrearczyk, Valentin Oreiller, Moamen Abobakr, Azadeh Akhavanallaf, Panagiotis Balermpas, Sarah Boughdad, Leo Capriotti, Joel Castelli, Catherine Cheze Le Rest, Pierre Decazes, Ricardo Correia, Dina El-Habashy, Hesham Elhalawani, Clifton D Fuller, Mario Jreige, Yornna Khamis, Agustina La Greca, Abdallah Mohamed, Mohamed Naser, John O Prior, Su Ruan, Stephanie Tanadini-Lang, Olena Tankyevych, Yazdan Salimi, Martin Vallières, Pierre Vera, Dimitris Visvikis, Kareem Wahid, Habib Zaidi, Mathieu Hatt, Adrien Depeursinge

Faculty, Staff and Student Publications

This paper presents an overview of the third edition of the HEad and neCK TumOR segmentation and outcome prediction (HECKTOR) challenge, organized as a satellite event of the 25th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) 2022. The challenge comprises two tasks related to the automatic analysis of FDG-PET/CT images for patients with Head and Neck cancer (H&N), focusing on the oropharynx region. Task 1 is the fully automatic segmentation of H&N primary Gross Tumor Volume (GTVp) and metastatic lymph nodes (GTVn) from FDG-PET/CT images. Task 2 is the fully automatic prediction of Recurrence-Free Survival (RFS) …

Head And Neck Cancer Predictive Risk Estimator To Determine Control And Therapeutic Outcomes Of Radiotherapy (Hnc-Predictor): Development, International Multi-Institutional Validation, And Web Implementation Of Clinic-Ready Model-Based Risk Stratification For Head And Neck Cancer, Lisanne V Van Dijk, Abdallah Sr Mohamed, Sara Ahmed, Nafiul Nipu, G Elisabeta Marai, Kareem Wahid, Nanna M Sijtsema, Brandon Gunn, Adam S Garden, Amy Moreno, Andrew J Hope, Johannes A Langendijk, Clifton D Fuller

Faculty, Staff and Student Publications

Background: Personalised radiotherapy can improve treatment outcomes of patients with head and neck cancer (HNC), where currently a 'one-dose-fits-all' approach is the standard. The aim was to establish individualised outcome prediction based on multi-institutional international 'big-data' to facilitate risk-based stratification of patients with HNC.

Methods: The data of 4611 HNC radiotherapy patients from three academic cancer centres were split into four cohorts: a training (n = 2241), independent test (n = 786), and external validation cohorts 1 (n = 1087) and 2 (n = 497). Tumour- and patient-related clinical variables were considered in a machine learning pipeline to predict overall …

Diagnostic Challenges And Prognostic Implications Of Extranodal Extension In Head And Neck Cancer: A State Of The Art Review And Gap Analysis, Christina E Henson, Ahmad K Abou-Foul, Daniel J Morton, Lachlan Mcdowell, Sujith Baliga, James Bates, Anna Lee, Pierluigi Bonomo, Petr Szturz, Paul Nankivell, Shao Hui Huang, William M Lydiatt, Brian O'Sullivan, Hisham Mehanna

Faculty, Staff and Student Publications

Extranodal extension (ENE) is a pattern of cancer growth from within the lymph node (LN) outward into perinodal tissues, critically defined by disruption and penetration of the tumor through the entire thickness of the LN capsule. The presence of ENE is often associated with an aggressive cancer phenotype in various malignancies including head and neck squamous cell carcinoma (HNSCC). In HNSCC, ENE is associated with increased risk of distant metastasis and lower rates of locoregional control. ENE detected on histopathology (pathologic ENE; pENE) is now incorporated as a risk-stratification factor in human papillomavirus (HPV)-negative HNSCC in the eighth edition of …

Head And Neck Cancer Online Support Groups: Disparities In Participation And Impact On Patients, Benjamin Tam, Matthew Lin, Carlos Castellanos, Ruben Ulloa, Niels Kokot, Kevin Hur

Faculty, Staff and Student Publications

OBJECTIVE: To characterize the users of the head and neck cancer (HNC) online support group (OSG) and describe the perceived benefits of membership.

STUDY DESIGN: Cross-sectional.

SETTING: Online.

METHODS: An administered survey with questions asking about demographics, cancer history, treatment choices, and feelings about OSGs was posted on the 5 largest HNC OSGs on Facebook.

RESULTS: A total of 97 participants completed the survey. Mean age was 57.8 years old (standard deviation = 10.7 years). Most participants were female (50.5%) and Caucasian (92.8%). This cohort was well educated with 65.5% holding at least a college degree. Annual income was high …