Diana N. Kirke

Role of adjuvant chemoradiotherapy in T4N0 stage IV head and neck cancer: A National Cancer Database analysis

The purpose of this study was to evaluate the role of postoperative adjuvant radiotherapy (surgery + adjuvant RT) versus adjuvant chemoradiotherapy (surgery + adjuvant CRT) in patients with T4N0M0, stage IV head and neck squamous cell carcinoma (HNSCC).

Comparison of facility type outcomes for oral cavity cancer: Analysis of the national cancer database

Determine whether facility type effects overall survival in patients with oral cavity cancer.

Adjuvant chemoradiation does not improve survival in elderly patients with high-risk resected head and neck cancer.

Randomized trials have demonstrated that adjuvant chemoradiotherapy (CRT) confers an overall survival (OS) benefit over adjuvant radiation therapy (RT) alone in patients with resected head and neck squamous cell carcinoma (HNSCC) with adverse pathologic features (positive surgical margins [SM+] and/or extracapsular extension [ECE]). Whether this OS benefit exists in an elderly population remains unknown.

Outcomes of head and neck cancer surgery in the geriatric population based on case volume at academic centers

Evaluate the impact of case volume and other variables on cost and mortality after head and neck oncologic surgery in the geriatric population.Objectives/Hypothesis Evaluate the impact of case volume and other variables on cost and mortality after head and neck oncologic surgery in the geriatric population. Study Design Cross-sectional study. Methods The Vizient database was accessed for data on geriatric patients (age ≥65 years) who underwent surgery for head and neck cancers (excluding thyroid and skin cancer) at full member academic medical centers between 2009 and 2012. Multivariate, linear regression analyses, χ2 tests, and analysis of variance were applied to evaluate significant associations between hospital case volume and independent variables including cost, cost index, mortality, mortality index, length of stay, length of stay index, and readmission rates. Results A total of 4,544 patients were included. Total length of stay was 6.72 days in high-volume hospitals, compared to 8.12 days and 7.91 days in moderate- and low-volume hospitals, respectively (P = .0144). Frequency of intensive care unit stays was 36.5% in high-volume hospitals, compared to 42.19% and 40.29% in moderate- and low-volume hospitals, respectively (P = .0048). Mortality (0.78%) and average cost per case (

Outcomes of head and neck cancer surgery in the geriatric population based on case volume at academic centers: Outcomes of Geriatric Head and Neck Cancer

21,834) was lower, but nonsignificant in high-volume hospitals. Using multiple regression analysis, major severity of disease was positively associated with complication rate (P < .0001) and length of stay (P = .0481). Conclusions After controlling for other factors, high-volume academic medical centers have a lower intensive care unit stay, but no difference in mortality or average cost per case when compared to low-volume hospitals. Level of Evidence 2b Laryngoscope, 2017

Patient education materials assessment tool for laryngectomy health information

Evaluate the impact of case volume and other variables on cost and mortality after head and neck oncologic surgery in the geriatric population.Objectives/Hypothesis Evaluate the impact of case volume and other variables on cost and mortality after head and neck oncologic surgery in the geriatric population. Study Design Cross-sectional study. Methods The Vizient database was accessed for data on geriatric patients (age ≥65 years) who underwent surgery for head and neck cancers (excluding thyroid and skin cancer) at full member academic medical centers between 2009 and 2012. Multivariate, linear regression analyses, χ2 tests, and analysis of variance were applied to evaluate significant associations between hospital case volume and independent variables including cost, cost index, mortality, mortality index, length of stay, length of stay index, and readmission rates. Results A total of 4,544 patients were included. Total length of stay was 6.72 days in high-volume hospitals, compared to 8.12 days and 7.91 days in moderate- and low-volume hospitals, respectively (P = .0144). Frequency of intensive care unit stays was 36.5% in high-volume hospitals, compared to 42.19% and 40.29% in moderate- and low-volume hospitals, respectively (P = .0048). Mortality (0.78%) and average cost per case (

Marital status as a predictor of survival in patients with human papilloma virus-positive oropharyngeal cancer.

21,834) was lower, but nonsignificant in high-volume hospitals. Using multiple regression analysis, major severity of disease was positively associated with complication rate (P < .0001) and length of stay (P = .0481). Conclusions After controlling for other factors, high-volume academic medical centers have a lower intensive care unit stay, but no difference in mortality or average cost per case when compared to low-volume hospitals. Level of Evidence 2b Laryngoscope, 2017

Adenoid cystic carcinoma of the base of tongue: A population-based study

The decision to undergo laryngectomy carries medical, social, and emotional consequences. This study evaluates the understandability and actionability of current laryngectomy information.

(P067) Survival Outcomes With Adjuvant Chemoradiation Versus Adjuvant Radiation Alone for Elderly Patients With Resected Head and Neck Squamous Cell Carcinoma With Positive Surgical Margins or Extra-Capsular Extension

PURPOSE Determine whether marital status is a significant predictor of survival in human papillomavirus-positive oropharyngeal cancer. MATERIALS AND METHODS A single center retrospective study included patients diagnosed with human papilloma virus-positive oropharyngeal cancer at Boston Medical Center between January 1, 2010 and December 30, 2015, and initiated treatment with curative intent at Boston Medical Center. Demographic data and tumor-related variables were recorded. Univariate analysis was performed using a two-sample t-test, chi-squared test, Fishers exact test, and Kaplan Meier curves with a log rank test. Multivariate survival analysis was performed using a Cox regression model. RESULTS A total of 65 patients were included in the study with 24 patients described as married and 41 patients described as single. There was no significant difference in most demographic variables or tumor related variables between the two study groups, except single patients were significantly more likely to have government insurance (p=0.0431). Furthermore, there was no significant difference in 3-year overall survival between married patients and single patients (married=91.67% vs single=87.80%; p=0.6532) or 3-year progression free survival (married=79.17% vs single=85.37%; p=0.8136). After adjusting for confounders including age, sex, race, insurance type, smoking status, treatment, and AJCC combined pathologic stage, marital status was not a significant predictor of survival [HR=0.903; 95% CI (0.126,6.489); p=0.9192]. CONCLUSIONS Although previous literature has demonstrated that married patients with head and neck cancer have a survival benefit compared to single patients with head and neck cancer, we were unable to demonstrate the same survival benefit in a cohort of patients with human papilloma virus-positive oropharyngeal cancer.

Comparison of Chemoradiation Versus Radiation Alone for Elderly Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma: An Analysis of the National Cancer Data Base

BACKGROUND The objective was to assess demographic and survival patterns in patients with adenoid cystic carcinoma of the base of tongue. METHODS Patients were extracted from the Surveillance, Epidemiology and End Results (SEER) database from 1973 through 2012 and were categorized by age, gender, race, historical stage A, and treatment. Incidence and survival were compared with Kaplan Meier curves and mortality hazard ratios. RESULTS A total of 216 patients were included. After adjusting for age, gender, race and tumor-directed treatment, patients over the age of 70years had a significantly increased mortality [HR=2.847, 95% CI (1.499, 5.404) p=0.0014]. Furthermore mortality among patients with distant disease was significantly increased [HR=2.474 95% CI (1.459, 4.195) p=0.00008]. CONCLUSION By examining the largest collection of patients we have demonstrated that there is a significant difference in mortality based on both the age at diagnosis and in the setting of distant disease.