In-Chul Nam

Preoperative 18F-FDG PET/CT and high-risk HPV in patients with oropharyngeal squamous cell carcinoma.

To evaluate the association of 18F‐fluorodeoxyglucose‐positron emission tomography (18F‐FDG PET/CT) and high‐risk human papillomavirus (HPV) status and to establish the histologic correlates in oropharyngeal cancer (OPSCC).

Characteristics and Prognostic Implications of High-Risk HPV-Associated Hypopharyngeal Cancers

Background High-risk human papillomavirus (HPV) is an oncogenic virus that causes oropharyngeal cancers, and it has a favorable outcome after the treatment. Unlike in oropharyngeal cancer, the prevalence and role of high-risk HPV in the etiology of hypopharyngeal squamous cell carcinoma (HPSCC) is uncertain. Objective The aim of the present study was to evaluate the effect and prognostic significance of high-risk HPV in patients with HPSCC. Methods The study included 64 subjects with HPSCC who underwent radical surgery with or without radiation-based adjuvant therapy. Primary tumor sites were the pyriform sinus in 42 patients, posterior pharyngeal wall in 19 patients, and postcricoid area in 3 patients. High-risk HPV in situ hybridization was performed to detect HPV infection. Results The positive rate of high-risk HPV in situ hybridization was 10.9% (7/64). There was a significant difference in the fraction of positive high-risk HPV among pyriform sinus cancer (16.7%), posterior pharyngeal wall cancer (0%), and postcricoid area cancer (0%) (p = 0.042). The laryngoscopic examination revealed a granulomatous and exophytic appearance in 85.7% (6/7) of patients with high-risk HPV-positive pyriform sinus cancer, but in only 31.4% (11/35) of patients with high-risk HPV-negative pyriform sinus cancer (p = 0.012). Significant correlations were found between positive high-risk HPV and younger age (p = 0.050) and non-smoking status (p = 0.017). HPV-positive patients had a significantly better disease-free survival (p = 0.026) and disease-specific survival (p = 0.047) than HPV-negative patients. Conclusions High-risk HPV infection is significantly related to pyriform sinus cancer in patients with HPSCC.

Role of larynx-preserving partial hypopharyngectomy with and without postoperative radiotherapy for squamous cell carcinoma of the hypopharynx

The purpose of this study was to examine the treatment outcomes of larynx-preserving partial hypopharyngectomies for hypopharyngeal carcinoma. Forty-three patients underwent partial hypopharyngectomy and reconstruction using faciocutaneous free flaps with and without postoperative radiotherapy between 1998 and 2009. Primary tumor sites were pyriform sinus in 35 and posterior pharyngeal wall in 8 patients. Thirty patients received postoperative radiotherapy. The 5-year overall and disease-specific survival rates were 63% and 67%, respectively. A significant positive correlation was found between pathologic N stage and primary site and disease-specific survival rates (N0/N1 stage; 93% vs. N2/N3 stage; 43%, p<0.001 and pyriform sinus; 80% vs. posterior pharyngeal wall; 29%, p=0.012, respectively). Recurrences occurred in 15 (35%) patients. Among them, two patients were successfully rescued. Primary partial hypopharyngectomy with laryngeal preservation can be achieved with favorable oncologic outcomes. Factors that affected prognosis were advanced stage neck disease and posterior pharyngeal wall carcinoma.

Extracapsular spread in hypopharyngeal squamous cell carcinoma: Diagnostic value of FDG PET/CT

The purpose of this study was to evaluate the use of fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for the identification of extracapsular spread (ECS) with supporting histologic correlation in hypopharyngeal cancer.

Factors influencing the outcomes of primary surgery with postoperative radiotherapy for pN2 oropharyneal squamous cell carcinoma.

The purpose of this study was to examine treatment outcomes and define factors that influence survival in patients with pN2 oropharyngeal carcinoma. Fifty-five patients underwent primary surgery with postoperative radiotherapy between 1994 and 2009. Primary tumor sites were 36 tonsil, 13 base of tongue, 3 soft palate, and three posterior pharyngeal wall. There were 15, 26, 5, and 9 patients with stage T1 to T4 cancers, respectively. The N stage were 5 N2a, 37 N2b, and 13 N2c. The 5-year disease-specific survival rates were 66%. A significant positive correlation was found between high risk HPV status and extracapsular spread and disease-specific survival rates (HPV (+); 93% vs. HPV (-); 56%, p=0.031 and extracapsular spread (-); 93% vs. extracapsular spread (+); 50%, p=0.008, respectively). Primary surgery with postoperative radiotherapy can be achieved with favorable oncologic outcomes for pN2 oropharyngeal carcinoma. Factors that affected prognosis were HPV status and extracapsular spread.

The Effectiveness of Pregabalin for Post-Tonsillectomy Pain Control: A Randomized Controlled Trial

Background Although various analgesics have been used, postoperative pain remains one of the most troublesome aspects of tonsillectomy for patients. Objective The aim of the present study was to evaluate the effectiveness of premedication using pregabalin compared with placebo (diazepam) on postoperative pain control in patients undergoing tonsillectomy. Methods Forty-eight adult patients were randomly divided into a control group and a pregabalin group. Preoperatively, patients in the control group received 4 mg diazepam orally as placebo, whereas those in the pregabalin group received 300 mg pregabalin orally. All participants were provided with patient-controlled analgesia using fentanyl for 24 hours after surgery. Postoperative pain treatment included acetaminophen 650 mg three times daily for 8 postoperative days. The primary outcome measure was the total amount of patient-controlled fentanyl consumption after tonsillectomy. Secondary outcome measures were the number of injections of ketorolac tromethamine (each 30 mg) requested by patients, pain scores, overall satisfaction scores, drowsiness, nausea, dizziness, headache, and vomiting after the surgery. P < 0.05 was considered statistically significant. Results The total amount of fentanyl demanded decreased significantly in the pregabalin group (P < 0.001). There were no significant differences in the number of ketorolac tromethamine injections, pain scores, overall satisfaction scores, drowsiness, nausea, dizziness, headache, and vomiting between the two groups. Conclusion Administration of 300 mg pregabalin prior to tonsillectomy decreases fentanyl consumption compared with that after 4 mg diazepam, without an increased incidence of adverse effects. Trial Registration KCT0001215

Standardized Uptake Value and Resection Margin Involvement Predict Outcomes in pN0 Head and Neck Cancer

Objective The aim of this study was to evaluate the prognostic factors of patients with pathologically negative lymph node (pN0) head and neck cancer. Study Design Case series with chart review. Setting College medical center. Subjects and Methods The medical records of 120 patients were reviewed. Primary tumor sites included 46 larynx, 45 oral cavity, 17 oropharynx, and 12 hypopharynx. Results The recurrence rate was 14% (17/120) over a mean observation period of 33 months. Median 18F-fluorodeoxyglucose (FDG)–positron emission tomography (PET)/computed tomography (CT) maximal standardized uptake value (SUVmax; using 8.5 as a cutoff; P = .001), positive surgical margins (P = .005), and pathologic T stage (P = .012) were found to be associated with recurrence. The 5-year disease-specific survival rate (DSSR) in our cohort was 86%. Patients with an SUVmax value higher than 8.5 and positive surgical margins had significantly decreased 5-year DSSR based on Kaplan-Meier survival curves. Multivariate Cox regression analysis confirmed the significant association between median SUVmax (using 8.5 as a cutoff; hazard ratio [HR], 6.13; 95% confidence interval [CI], 1.79-20.93; P = .004) and margin involvement (HR, 4.98; 95% CI, 1.42-17.47; P = .012). Conclusion A median 18F-FDG PET/CT SUVmax cutoff values of 8.5 or greater and positive surgical margins were associated with adverse outcomes in patients with pN0 head and neck cancer.

Clinical significance of orthostatic dizziness in the diagnosis of benign paroxysmal positional vertigo and orthostatic intolerance

PURPOSE Orthostatic dizziness (OD) and positional dizziness (PD) are considerably common conditions in dizziness clinic, whereas those two conditions are not clearly separated. We aimed to evaluate the clinical significance of simple OD and OD combined with PD for the diagnosis of benign paroxysmal positional vertigo (BPPV) and orthostatic intolerance (OI). PATIENTS AND METHODS Patients presenting with OD (n=102) were divided into two groups according to their symptoms: group PO, presenting with PD as well as OD; group O, presenting with OD. A thorough medical history, physical examination, and vestibular function tests were performed to identify the etiology of the dizziness. Orthostatic vital sign measurement (OVSM) was used to diagnose OI. RESULTS The majority of patients were in group PO (87.3%). BPPV was the most common cause of OD for entire patients (36.3%) and group PO (37.1%), while OI was most common etiology for group O (38.5%). Total of 17 (16.7%) OI patients were identified by OVSM test. Orthostatic hypotension (n=10) was most frequently found, followed by orthostatic hypertension (n=5), and orthostatic tachycardia (n=2). Group O showed significantly higher percentage (38.5%) of OI than group PO (13.5%) (P=0.039). CONCLUSION It is suggested that orthostatic testing such as OVSM or head-up tilt table test should be performed as an initial work up for the patients with simple OD. Positional tests for BPPV should be considered as an essential diagnostic test for patients with OD, even though their dizziness is not associated with PD.

Relationship between extracapsular spread and FDG PET/CT in oropharyngeal squamous cell carcinoma

Abstract Conclusion: Median maximum standardized uptake (SUVmax) cut-off values of FDG PET/CT higher than 3.85 were found to be associated with a greater risk cervical lymph node metastasis with extracapsular spread (ECS) in patients with oropharyngeal squamous cell carcinoma (OPSCC). Objectives: The purpose of this study was to evaluate the use of FDG PET/CT for the identification of ECS and to establish its histologic correlates in OPSCC. Methods: The medical records of 78 patients who underwent FDG PET/CT for OPSCC before surgery were reviewed. Results: ECS was present in 42% (42/69) of dissected necks and in 51% (54/106) of dissected cervical levels. The SUVmax values of cervical lymph nodes with and without ECS were found to be significantly different (6.73 ± 3.78 vs 3.02 ± 2.24, p < 0.001). The SUVmax cut-off value for differentiating necks with ECS from those without ECS was 3.85. The presence of ECS (p = 0.036) and median SUVmax (using 3.85 as a cut-off) (p = 0.037) were found to have a significant adverse effect on 5-year disease-specific survival by univariate analysis. The multivariate analysis showed a significant association of 5-year disease-specific survival with ECS (hazard ratio (HR) = 32.3 in cervical metastasis with ECS, p = 0.012; and HR = 19.6 in cervical metastasis without ECS, p = 0.024).

High-risk human papillomavirus and lymph node size in patients with single node metastasis of oral and oropharyngeal cancer

Abstract Conclusion: High-risk human papillomavirus (HPV) infection was significantly related to lymph node size in patients with single node metastasis of oral and oropharyngeal cancer. Objective: The purpose of this study was to examine the relationship between high-risk HPV infection and lymph node size in patients with single node metastasis of oral and oropharyngeal carcinoma. Methods: This study included 48 patients with oral and oropharyngeal carcinoma. Pathologic lymph node stages comprised 36 N1 and 12 N2a. Results: High-risk HPV in situ hybridization was positive in 29% of patients (14/48). Of those patients with high-risk HPV, there was a significant difference (p = 0.008) between oral (9.5%) and oropharyngeal (44.4%) cancers. Average lymph node diameter was 20.7 ± 12.6 mm (range 5–54 mm). We found a positive correlation between high-risk HPV status and lymph node size (p = 0.018). Mean lymph node diameter in high-risk HPV-positive cases was 27.3 ± 13.1 mm and 18.0 ± 11.5 mm in high-risk HPV-negative cases. Extracapsular spread (p = 0.030) and cystic nodal metastases (p = 0.019) were also significantly related to lymph node size. High-risk HPV negative status (p = 0.043), advanced tumor stage (p = 0.009), and extracapsular spread (p = 0.038) all had significant adverse effects on 5-year disease-specific survival.