David M. Cohan

Survival rates and prognostic factors for infiltrating salivary duct carcinoma: Analysis of 228 cases from the Surveillance, Epidemiology, and End Results database

The survival rates and prognostic factors for salivary duct carcinoma (SDC) are not clear.

Survival Differences between Organ Preservation Surgery and Definitive Radiotherapy in Early Supraglottic Squamous Cell Carcinoma

Objective Single-modality treatment, either with organ preservation surgery (OPS) or definitive radiation (RT), is the treatment of choice for patients with early supraglottic squamous cell carcinoma (SGC). However, studies comparing the effectiveness of these 2 techniques are lacking. This study compares the survival outcomes in early SGC patients treated with OPS versus RT. Study Design Secondary data analysis. Setting Surveillance, Epidemiology and End Results database. Subjects and Methods This study included adult patients with early-stage (T1N0, T2N0) SGC undergoing single-modality treatment with either OPS (with or without neck dissection [ND]) or RT between 1988 and 2008. Survival analysis was used to compare the overall survival (OS) and disease-specific survival (DSS) between patients treated with OPS+ND, OPS alone, and RT. Results A total of 2631 T1/T2 N0 SGC patients were identified, of whom 167 (6%) were treated with OPS+ND, 186 (7%) with OPS only, and 2278 patients (87%) with definitive RT only. In stage I (T1N0) SGC patients, a significantly better 5-year DSS was noted for both OPS+ND (81% vs 68%, hazard ratio [HR] = 0.61, P = .03) and OPS only (82% vs 68%, HR = 0.70, P = .05) when compared with definitive RT. For stage II (T2N0) patients, only OPS+ND resulted in a significantly better 5-year DSS (86% vs 60%, HR = 0.31, P < .001) when compared with patients treated with RT. Conclusions Patients with early SGC who underwent OPS+ND had better OS and DSS than patients undergoing RT alone. OPS+ND may be considered a viable and preferred treatment option in these patients.

Determining the protein drug release characteristics and cell adhesion to a PLLA or PLGA biodegradable polymer membrane

Biodegradable polymers are of interest for developing controlled protein drug delivery platforms. In this study, two poly (alpha-hydroxy) esters were formulated with Aerosol-OT, a surfactant stabilizer, to encapsulate the protein keratinocyte growth factor (KGF) for controlled release KGF is involved in a number of crucial biologic processes, most notably epithelial growth and repair. The concentration of KGF that caused a biological response in vitro was determined (optimally 10 ng/mL) and compared with the release of KGF from the two biodegradable polymer membrane formulations. Each polymer formulation released biologically relevant levels, 10 ng/mL of active KGF, although with different times release kinetics. The membrane composed of PLGA/AOT/KGF exhibited a faster release rate of KGF into solution after 120 h of degradation time than the release rate of the PLLA/AOT/KGF matrices. Cell seeding assays showed that both polymer matrices, when formulated with AOT, sustained cell growth. Time of Flight Secondary Ion Mass Spectrometry (ToF-SIMS) was used to characterize the distribution of AOT and KGF through the polymer membrane. (c) 2010 Wiley Periodicals, Inc. J Biomed Mater Res, 2010.

Smoking cessation is associated with improved survival in oropharynx cancer treated by chemoradiation.

The effect of smoking and human papillomavirus (HPV) on overall survival (OS) of oropharyngeal squamous cell carcinoma (OPSCC) patients undergoing concurrent chemotherapy (CCRT) remains unclear.

Combined surgery and radiation improves survival of tonsil squamous cell cancers

Objective The study evaluated the addition of surgery (S) to radiation (RT) on survival of squamous cell carcinomas (SCC) of tonsillar-fossa (TF) in a modern cohort with similar epidemiology and treatment as current patients. Study Design Retrospective analysis utilizing Surveillance, Epidemiology, and End Results (SEER) Program data. Results For all stages combined TF patients who received S+RT had superior OS (p < 0.01) and DSS (p < 0.01). For each stage OS and DSS was superior for S+RT (p < 0.05). In multivariate analysis, HRs for OS were statistically significantly higher for TF patients (stage 2, 3, and 4) receiving RT alone (p < 0.001). Materials and Methods TF SCC patients treated with either S+RT or RT alone between 2004 and 2011 were examined (n = 6,476). Primary outcome measures included overall survival (OS) and disease specific survival (DSS). Cox proportional hazard ratios (HR) were estimated for patients treated with S+RT compared to RT alone. Conclusions OS and DSS were superior for all stages combined and for stages 2, 3, and 4 in TF patients who received S+RT compared to RT alone.

Clinical Evaluation and Staging of Oral Cancer

The identification and evaluation of the patient with oral cavity cancer is an inherently multidisciplinary proposition. For most patients, the initial identification and evaluation of an oral lesion is undertaken by a primary healthcare giver—dentists, primary care physicians, oral surgeons, and general practitioners—before referring to a tertiary care center. Accurate diagnosis and staging at the initial visit is vital to appropriate decision-making and treatment planning. It is critical that the first examination of the oral cancer patient be comprehensive. Equally important is that the history taken is complete and elicits pertinent details that will give the oncologic care providers information that will be relevant to the care of the patient. Initial evaluation of the oral cavity cancer patient will not only result in tumor staging but also provide information about the most appropriate interventions and identify comorbidities that may influence treatment choices. Attempt also should be made to elicit social support network the patient has to facilitate treatment and surveillance.

Subsite variation in survival of oropharyngeal squamous cell carcinomas 2004 to 2011.

To evaluate subsite‐specific differences in survival between squamous cell carcinomas of the base of tongue and tonsillar fossa in a modern cohort likely to have been treated with intensity‐modulated radiation therapy, chemotherapy for stage III and IV, and have had a high incidence of human papillomavirus–associated tumors.

Response to "Comparison between Organ Preservation Surgery and Radiation in Early Supraglottic Carcinoma Is Limited by Bias".

We read with interest the article by Arshad et al comparing survival for early supraglottic cancer between definitive radiation and organ preservation surgery (OPS) using the Survival, Epidemiology, and End Results (SEER) database. The authors report significantly improved disease-specific survival (DSS) for stage I and II supraglottic cancers treated with OPS + neck dissection (ND) vs radiation, with 5-year DSS for stage II patients of 86% vs 60% (hazard ratio, 0.31; P < .001), respectively. This result is remarkable and would have great importance for management decisions in early supraglottic cancer, if true. However, we are concerned that the comparison is made between dissimilar groups of patients in relation to neck metastases and that the subsequent bias is not adequately taken into account in the interpretation of the results. Based on the methods described, the authors excluded from the analysis all patients with node-positive (N+) disease. Since in the SEER database, staging represents a “best stage,” taking all available clinical and pathologic information into account, the primary-radiation group in this study was clinically N–, and the OPS + ND group was pathologically N–. The radiation group would have included patients with occult nodal metastases, but the OPS + ND group would have excluded them. Based on the reported rate for occult metastases for T1 and T2 supraglottic cancer identified by elective neck dissection, we would expect that 30% of the patients in the radiation group had occult nodal metastases. Since the presence of nodal metastases is a powerful negative prognostic factor for survival and signifies a more aggressive behavior of the disease, the exclusion of these patients from the OPS + ND group would be expected to have a significant positive effect on the survival outcome and is a significant source of bias in the study. We appreciate the role that epidemiologic studies such as this can have in provoking further investigation, but the biased results reported by Arshad et al are unlikely to lead to a useful hypothesis and should not be used to guide clinical decision making.