Hiang Khoon Tan

SALVAGE SURGERY AFTER CONCOMITANT CHEMORADIATION IN HEAD AND NECK SQUAMOUS CELL CARCINOMAS—STRATIFICATION FOR POSTSALVAGE SURVIVAL

Salvage surgery after concomitant chemoradiation therapy (CCRT) for patients with head and neck squamous cell carcinomas (HNSCC) is challenging because of its associated morbidity/mortality and the poor prognoses of these patients.

Amplification and overexpression of PPFIA1, a putative 11q13 invasion suppressor gene, in head and neck squamous cell carcinoma.

Chromosomal amplifications of the 11q13 genomic region are frequent in head and neck squamous cell carcinoma (HNSCC). To identify novel 11q13 amplification targets, we integrated high‐resolution array‐based comparative genomic hybridization and Affymetrix gene‐expression profiling of eight HNSCC cell lines. We found that PPFIA1 was the highest upregulated gene in the 11q13 amplicon of HNSCC cell lines when compared with HNSCC lines without 11q13 amplification and confirmed the upregulation of PPFIA1 in primary HNSCCs by real‐time PCR. Using siRNA knockdown, we investigated PPFIA1 function in three HNSCC lines using both in vitro invasion assays and wound‐healing assays. Surprisingly, we found that cancer cells become more invasive when the PPFIA1 protein levels were reduced, suggesting that PPFIA1 may act as an invasion inhibitor in HNSCC. This unexpected result suggests that the 11q13 amplicon may comprise both positive and negative regulators involved in HNSCC. Our study is the first to evaluate the role of PPFIA1 in head and neck carcinogenesis and suggests a potential link between PPFIA1 activity and cell‐extracellular matrix interactions. This article contains supplementary material available via the Internet at http://www.interscience.wiley.com/jpages/1045‐2257/suppmat.

Prognostic Significance of Invasion Depth in Oral Tongue Squamous Cell Carcinoma

Purpose: Staging for tongue carcinoma does not consider its depth of invasion. We aim to determine the prognostic significance of invasion depth in tongue cancer. Materials and Methods: Retrospective review of patients with tongue carcinoma who underwent curative surgery between 2002 and 2005; 67 patients were analyzed. Tumors were divided into 2 groups: group A = invasion depth <4 mm; group B = invasion depth ≥4 mm. Recurrence and survival rates were calculated for each group and compared. Results: The local recurrence rate in group B was significantly higher (10 vs. 29.7%, p = 0.048). Group A patients had a superior 5-year overall survival (68.8 vs. 41.6%, p = 0.012), disease-specific survival (67.1 vs. 41.1%, p = 0.026) and local recurrence-free survival (89.5 vs. 65.4%, p = 0.035). Five-year regional recurrence, locoregional recurrence and distant recurrence-free survival rates were not significantly different between the 2 groups (p = 0.390, p = 0.173 and p = 0.207). The impact of invasion depth on survival was maintained on multivariate analysis (p = 0.031). Conclusion: Invasion depth is an important prognostic indicator in tongue cancer.

Management of orocutaneous fistulas using a vacuum-assisted closure system.

The vacuum‐assisted closure (VAC) system has been used to manage complicated wounds. The purpose of this study was to describe a novel technique in using the VAC system for orocutaneous fistulas.

Serglycin expression: An independent marker of distant metastases in nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) has a high propensity for metastasis. The purpose of this study was for us to determine whether serglycin expression can be used to predict distant metastases.

Outcomes and Prognostic Factors of Radiation-Induced and De Novo Head and Neck Squamous Cell Carcinomas.

Objective We sought to compare clinical outcomes, pathological features, treatment patterns, and survival outcomes between radiation-induced squamous cell carcinoma (RISCC) and de novo SCC (DNSCC) of the head and neck, as well as identify prognostic factors in these patients. Study Design Case-control study. Setting Tertiary medical center. Subjects and Methods Retrospective case-control analysis of 34 RISCCs and 136 DNSCCs matched by age at diagnosis, sex, smoking status, and primary tumor site. Results Median latency of RISCC development was 13 years. Radiation-induced squamous cell carcinomas were more likely to present with node-negative disease than DNSCCs (70.6% vs 42.9%; P = .024). A greater proportion of DNSCCs was treated with curative intent (92.6% vs 79.4%; P = .048) and achieved no residual disease posttreatment (82.2% vs 41.2%; P < .001) compared with RISCCs. Patients with RISCC had poorer overall survival (OS) (median, 1.67 vs 5.03 years; P = .018) and disease-specific survival (DSS) (median, 1.67 vs 8.65 years; P = .001) than those with DNSCC. Among patients who underwent curative treatment with no residual disease after treatment, there were, however, no survival differences between RISCC and DNSCC. Conclusion In our cohort, RISCCs have a poorer prognosis than DNSCCs. However, those able to undergo curative treatment and have no residual disease after treatment have comparable survival outcomes. Locoregional control of these tumors appears paramount in achieving the best outcomes for patients with RISCC.

Metastasectomy for metachronous pulmonary and hepatic metastases from nasopharyngeal carcinoma: Report of 6 cases and review of the literature.

Metastatic nasopharyngeal carcinoma (NPC) is commonly treated with palliative chemotherapy. The purpose of this study was to review the feasibility of metastasectomy for metachronous pulmonary and hepatic metastases from NPC.

Novel technique of creating a seal for the vacuum‐assisted closure system application in complex head and neck wounds

Achieving a good seal for the application of the vacuum‐assisted closure (VAC) system in complex head and neck wounds is difficult.

Subcutaneous injection is a simple and reproducible option to restore parathyroid function after total parathyroidectomy in patients with secondary hyperparathyroidism

BACKGROUND Secondary hyperparathyroidism is a common clinical problem seen in patients with end-stage renal disease (ESRD) undergoing hemodialysis. In patients with severe persistent hyperparathyroidism, parathyroidectomies are often required. OBJECTIVES We sought to evaluate the feasibility and efficacy of total parathyroidectomy followed by subcutaneous injection of parathyroid autograft compared with surgical implantation. METHODS We conducted a retrospective study of 132 patients with confirmed diagnoses of ESRD treated with hemodialysis or peritoneal dialysis, with secondary hyperparathyroidism who had undergone total parathyroidectomies. Clinical and biochemical characteristics, including preoperative and postoperative intact parathyroid hormone levels were recorded and compared between patients who had undergone subcutaneous injection or surgical implantation of autograft. RESULTS From February 2005 to February 2012, 132 patients who had undergone total parathyroidectomies were included in our study. To compare the techniques of subcutaneous injection and surgical implantation, pre- and postoperative biochemistry was recorded and analyzed. Preoperative biochemistry was comparable in both groups. However, autograft recovery was significantly faster in the group with subcutaneous injection compared with surgical implantation (P = .03). Median time to parathyroid recovery was 2 months for injection compared with 9 months for implantation. There was no remarkable difference in the recurrence rates between the 2 groups. CONCLUSION Subcutaneous injection of parathyroid tissue is a feasible and simple alternative to the more commonly used method of surgical implantation.

Diagnostic pitfall: Adenoid cystic carcinoma of the tongue presenting as an isolated hypoglossal nerve palsy, case report and literature review

Highlights • Adenoid Cystic Carcinoma is a malignant neoplasm originating in both major and minor salivary glands.• It is characterized by slow progression, local invasiveness and perineural invasion.• It may present as a hypoglossal nerve palsy.• When the diagnosis is in doubt, we suggest examination under anasthesia and deep biopsy.