Dev P. Kamdar

Factors predictive of severity of osteoradionecrosis of the mandible

An analysis of risk factors predictive of severe mandibular osteoradionecrosis (ORN) is needed to aid prophylaxis and management of this condition.

Up-front neck dissection followed by concurrent chemoradiation in patients with regionally advanced head and neck cancer.

The appropriate management of the neck in patients with regionally advanced head and neck cancer remains controversial. The purpose of this study was to retrospectively analyze our institutional experience with up‐front neck dissection followed by definitive chemoradiotherapy.

Outcomes of nonsurgical management of locally advanced carcinomas of the sinonasal cavity

To determine the outcome of definitive concurrent chemoradiation with platinum for locally advanced sinonasal carcinomas.

Utility of Abdominal Computed Tomography in Head and Neck Cancer Patients

Objective: Assess the role of abdominal computed tomography (CT) imaging in the staging and surveillance of patients with head and neck squamous cell cancer (HNSCC) for distant metastatic disease (DMD) and second primary tumors (SPT). Method: Retrospective review of 172 HNSCC patients treated at an academic center who underwent abdominal CT imaging from 2003 to 2007. These scans were categorized as suspicious, positive, or negative for DMD or SPT. Charts of patients with suspicious or positive results were reviewed to determine resultant work-up and outcomes. Results: After consideration of exclusion criteria, 165 patients were included in this retrospective study. Normal abdominal CT scans were seen in 139 patients while the remaining 27 patients had abnormal abdominal CT findings. Of these 27, 16 patients (9.7%) were determined to have malignancy. Twelve patients had DMD, and 4 were diagnosed with SPT. Conclusion: Abdominal CT imaging identified DMD or SPT in 9.7% of patients resulting in significant alteration in their comprehensive oncologic care. This rate is not inconsequential and might justify the use of abdominal CT in managing HNSCC patients. Prospective trials might help determine the impact of abdominal CT findings on survival.

Factors Predictive of Severity of ORN of the Mandible

OBJECTIVES: 1) Determine risk factors associated with severe osteoradionecrosis (ORN) of the mandible. 2) Aid future ORN management and prophylaxis based on results of the study. METHODS: We retrospectively analyzed 40 ORN patients diagnosed between June 2002 and November 2008. Of those, 92.5% were squamous cell cancers, 85% were oral cavity or oropharyngeal tumors, and 92.5% had mandibular ORN. All received 3D conformal radiation therapy (RT) or intensitymodulated RT, with 60 Gy median dose. 22.5% and 77.5% received primary and postoperative RT respectively. 75% received chemotherapy (CT), mostly concurrent (97%) and platinum-based (95%). ORN was staged based on Store-Boysen scores of 0-3. 90% of patients received antibiotics, and 32.5% hyperbaric oxygen. Debridement, plate removal, flap repair and external fixation were done in 87.5%, 42.5%, 22.5% and 7.5% patients respectively. RESULTS: Median time to ORN was 7.5 months (range,183). All primary RT, 96% Stage IV and 94% T4a patients had Stage 2/3 ORN. Secondary infection predicted Stage 3 ORN significantly (p 0.0001). Differences between proportions of Stage 3 patients with greater than, vs less than, or equal to 40 pack-year smoking history; and those who had primary surgery versus none, were significant (p 0.00001, 0.004 respectively). No significant association existed between ORN severity and CT, RT modality and dose, primary site, dental extractions, and alcohol intake. At 37 months average follow-up, 5%, 27.5%, 5% and 7.5% patients developed new primaries, local, regional and distant relapse respectively. CONCLUSIONS: Secondary infection, smoking, primary RT, surgery, T and overall stage were predictive of severity, and can potentially guide prophylaxis and management of mandibular osteoradionecrosis.