Jason H. Franklin

Detection of circulating tumor cells in advanced head and neck cancer using the cellsearch system

Early detection of circulating tumor cells (CTCs) offers the possibility of improved outcome for patients with head and neck squamous cell cancer (HNSCC).

Randomized, controlled, study of absorbable nasal packing on outcomes of surgical treatment of rhinosinusitis with polyposis.

Background The aim of this study was to establish the effect of absorbable dressing on postoperative discomfort and mucosal healing after sinus surgery. A prospective, randomized, controlled, blinded study was performed. Methods Patients 18–80 years old undergoing sinus surgery were enrolled in the study. Each patients ethmoid cavities were randomized to receive either absorbable dressing or the standard nonabsorbable sinus packs. Therefore, patients served as their own control. Preoperative CT scan and intraoperative endoscopic photographs were used for staging within the Lund-Mackay system. The procedure was performed as indicated by extent of disease. The remaining absorbable dressing was removed at 2 weeks by endoscopic suctioning in the clinic. Patients completed questionnaires regarding sinus symptoms and discomfort. Postoperative endoscopic appearance was graded by a single rhinologist. Length of follow-up was 6 months. Results Thirty-five patients were randomized. There were no significant adverse events in either group. Patients’ symptom scores improved at 2 weeks and at 1 and 3 months when compared with preoperation. Both groups had similar preoperative grade of disease and extent of surgery. Endoscopic appearance of the absorbable cavity showed a trend toward improvement at 2 weeks (p < 0.05). Endoscopic appearance showed a similar trend toward improvement at 1, 3, and 6 months in the absorbable group (NS). Twenty-seven patients had a strong preference for a particular nasal packing of which 16 of 27 (59.3%) patients preferred the absorbable dressing. Conclusion The absorbable dressing showed a trend toward positive effect on early wound healing and in late results. Strong patient preference was indicated for the absorbable dressing over standard sponges.

The epidemic of human papillomavirus and oropharyngeal cancer in a Canadian population

BACKGROUNDnSexually transmitted infection with the human papillomavirus (hpv) is responsible for a significant burden of human cancers involving the cervix, anogenital tract, and oropharynx. Studies in the United States and Europe have demonstrated an alarming increase in the frequency of hpv-positive oropharyngeal cancer, but the same direct evidence does not exist in Canada.nnnMETHODSnUsing the London Health Sciences Centre pathology database, we identified tonsillar cancers diagnosed between 1993 and 2011. Real-time polymerase chain reaction was then used on pre-treatment primary-site biopsy samples to test for dna from the high-risk hpv types 16 and 18. The study cohort was divided into three time periods: 1993-1999, 2000-2005, and 2006-2011.nnnRESULTSnOf 160 tumour samples identified, 91 (57%) were positive for hpv 16. The total number of tonsillar cancers significantly increased from 1993-1999 to 2006-2011 (32 vs. 68), and the proportion of cases that were hpv-positive substantially increased (25% vs. 62%, p < 0.002). Those changes were associated with a marked improvement in 5-year overall survival (39% in 1993-1999 vs. 84% in 2006-2011, p < 0.001). When all factors were included in a multivariable model, only hpv status predicted treatment outcome.nnnINTERPRETATIONnThe present study is the first to provide direct evidence that hpv-related oropharyngeal cancer is increasing in incidence in a Canadian population. Given the long lag time between hpv infection and clinically apparent malignancy, oropharyngeal cancer will be a significant clinical problem for the foreseeable future despite vaccination efforts.

Accuracy of technetium‐99m SPECT‐CT hybrid images in predicting the precise intraoperative anatomical location of parathyroid adenomas

This study evaluated the accuracy of single photon emission computed tomography (SPECT)‐CT imaging for the preoperative localization of parathyroid adenomas.

Cisplatin otoprotection using transtympanic L-N-acetylcysteine: A pilot randomized study in head and neck cancer patients

To evaluate the feasibility and efficacy of transtympanic L‐N‐Acetylcysteine (L‐NAC) administration in patients receiving cisplatin chemotherapy for head and neck cancer.

Transoral robotic total laryngectomy: Report of 3 cases

Because of the significant toxicity of chemoradiation regimens, there has been a resurgence of interest in the primary surgical management of head and neck cancer and, in particular, the use of minimally invasive surgery. One such technique is transoral robotic surgery (TORS). We aim to discuss the potential role of TORS in patients requiring total laryngectomy (TL).

Voice‐related quality of life (V‐RQOL) outcomes in laryngectomees

Laryngeal cancer has a significant impact on patients. This study compared the Voice‐Related Quality of Life (V‐RQOL) outcomes specific to 3 different postlaryngectomy voice rehabilitation methods.

Does HPV type affect outcome in oropharyngeal cancer

BackgroundAn epidemic of human papillomavirus (HPV)-related oropharyngeal squamous cell cancer (OPSCC) has been reported worldwide largely due to oral infection with HPV type-16, which is responsible for approximately 90% of HPV-positive cases. The purpose of this study was to determine the rate of HPV-positive oropharyngeal cancer in Southwestern Ontario, Canada.MethodsA retrospective search identified ninety-five patients diagnosed with OPSCC. Pre-treatment biopsy specimens were tested for p16 expression using immunohistochemistry and for HPV-16, HPV-18 and other high-risk subtypes, including 31,33,35,39,45,51,52,56,58,59,67,68, by real-time qPCR.ResultsFifty-nine tumours (62%) were positive for p16 expression and fifty (53%) were positive for known high-risk HPV types. Of the latter, 45 tumors (90%) were identified as HPV-16 positive, and five tumors (10%) were positive for other high-risk HPV types (HPV-18 (2), HPV-67 (2), HPV-33 (1)). HPV status by qPCR and p16 expression were extremely tightly correlated (pu2009<u20090.001, Fishers exact test). Patients with HPV-positive tumors had improved 3-year overall (OS) and disease-free survival (DFS) compared to patients with HPV-negative tumors (90% vs 65%, pu2009=u20090.001; and 85% vs 49%, pu2009=u20090.005; respectively). HPV-16 related OPSCC presented with cervical metastases more frequently than other high-risk HPV types (pu2009=u20090.005) and poorer disease-free survival was observed, although this was not statistically significant.ConclusionHPV-16 infection is responsible for a significant proportion of OPSCC in Southwestern Ontario. Other high-risk subtypes are responsible for a smaller subset of OPSCC that present less frequently with cervical metastases and may have a different prognosis.

A descriptive analysis of the relationship between quality of life and distress in individuals with head and neck cancer.

PurposeBoth short- and long-term outcomes for individuals with head and neck cancer (HNCa) may be influenced by multiple factors. Identification of distress in those with HNCa may provide a critical dimension that influences quality of life (QoL). Consequently, this investigation assessed distress and QoL in those with HNCa.MethodsThis study utilized a cross-sectional, self-report survey design. Participants included 49 adults diagnosed with HNCa. Upon assessment, post-diagnosis time ranged between 3–12xa0months. All participants completed a validated distress screening measure, the Brief Symptom Inventory 18 (BSI-18), and the EORTC general QoL assessment tool (EORTC-QLQ-C30) and HNCa module (EORTC-QLQ-H&N35).ResultsApproximately 22% of participants demonstrated clinically significant distress. Additionally, distress was significantly related to QoL status and specific symptoms.ConclusionsScreening for distress in those with HNCa may permit early identification of problems that influence QoL outcomes. The ability to identify distress early may also facilitate timely intervention to reduce distress and optimize QoL.

A new angle to mandibular reconstruction: the scapular tip free flap.

The purpose of this study was to review our experience with the scapular tip free flap for mandibular reconstruction, describe the surgical approach, and highlight specific clinical applications.