John M. Chaplin

Comparison of the use of endoscopic and radiologic gastrostomy in a single head and neck cancer unit.

Background:  Head and neck cancer patients frequently require gastrostomy feeding. Different insertion techniques have been described. The aim of the present study was to compare clinical results of percutaneous endoscopic and radiological gastrostomies in patients treated in a regional head and neck cancer unit.

EFFECT OF IMMUNOCOMPROMISE ON METASTATIC CUTANEOUS SQUAMOUS CELL CARCINOMA IN THE PAROTID AND NECK

Our aim was to examine the effect of a compromised immune state on the outcomes in patients treated for metastatic cutaneous squamous cell carcinoma (SCC).

Quality of life after parotid and temporal bone surgery for cancer.

Objectives The purposes of this study were to examine the quality of life (QL) of patients who received treatment for cancer of the parotid or temporal region, and to identify factors contributing to it. The relationships between clinician‐based measures of treatment outcome and the patient‐based counterparts were also evaluated.

Fungal laryngitis in immunocompetent patients

The diagnosis of fungal laryngitis is often overlooked in systemically immunocompetent patients because it is commonly considered a disease of the immunocompromised, and because it often mimics, clinically and histologically, more common and more serious conditions e.g. leukoplakia. A high index of suspicion is required to make the diagnosis, and should be considered in any immunocompetent patient with persistent or refractory laryngitis and factors predisposing to local mucosal barrier impairment e.g. gastropharyngeal reflux, smoking or inhaled steroid use. In such cases, demonstration of hyperkeratosis, particularly if associated with intraepithelial neutrophils, on biopsy should trigger a search for fungal elements using specialized stains. Prolonged treatment by systemic antimycotics is required. Treatment should also include the elimination of any predisposing factors, as failure to do so may result in difficulty with disease eradication or recurrence of the condition.

Endovascular treatment of epistaxis.

Aim:  Embolization of external carotid vessels in the treatment of intractable epistaxis is not well documented in Australasia. The aim of the present retrospective study was to audit our experience with the technique, and to compare it with other centres.

ACINIC CELL CARCINOMA OF THE PAROTID GLAND: AUCKLAND EXPERIENCE AND LITERATURE REVIEW

Acinic cell carcinoma is an uncommon malignancy of the salivary glands and as such it has been difficult to accurately delineate its natural history. The aim of this study is to assess the behaviour of acinic cell salivary cancer of the parotid gland presenting to a single head and neck surgical unit in Auckland. The study is a structured review of cases of acinic cell carcinoma of the parotid gland presenting from 2000 to 2006 to the Head and Neck Unit at Auckland Hospital, those identified from the pathology database and the Otobase head and neck database. Case records and pathology reports were reviewed. Fifteen patients were identified, 9 men and 6 women. The mean age was 67.2 years, with range 50–85 years. The mean follow up was 4.4 years and range 1.1–7 years. There was one case of local recurrence during study period and no deaths. Five of 15 patients received postoperative radiotherapy. Postoperative complications consisted of one wound haematoma and two cases of marginal mandibular weakness (one transient and one permanent). Current management strategies are obtaining appropriate rates of recurrence and postoperative complications within the Auckland population.

Parotid metastatic disease from cutaneous squamous cell carcinoma: Prognostic role of facial nerve sacrifice, lateral temporal bone resection, immune status and P-stage

Recognized prognostic indicators for metastatic cutaneous squamous cell carcinoma (SCC) of the head and neck include facial nerve involvement, immune status, and “parotid” staging system (P‐stage). We sought to examine the impact of lateral temporal bone resection (LTBR) on prognosis.

FACIAL PALSY AS THE PRESENTING COMPLAINT OF PERINEURAL SPREAD FROM CUTANEOUS SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK

Perineural spread (PNS) of squamous carcinoma of the skin of the head and neck is well recognized. Clinical evidence of such spread usually manifests as sensory changes or motor deficit in the presence of a history of a previously excised head and neck skin lesion. However, it is not commonly reported that an isolated facial palsy (FP) may be the first sign of perineural involvement and these patients can sometimes be misdiagnosed as having Bell’s palsy. We report a series of such cases to alert to this possibility and to the need to consider it in patients presenting with FP, especially in countries with a high incidence of cutaneous squamous cell carcinoma (SCC).

Where are we with clinical outcomes in head and neck cancer

In this review clinical outcomes are considered in terms of three categories: observer-based outcomes, measurementbased outcomes, and patient-based outcomes. Observerand measurement-based outcomes are important but do not necessarily reflect patients’ perceptions. Some false assumptions persist in this regard when reporting outcomes of surgery for head and neck cancer. Although it is important to measure and observe real differences in outcome, it still needs to be shown that these changes make a difference from the patients’ point of view. This paper examines these issues in relation to recent reports of treatment for laryngeal cancer, oral cancer, metastatic neck disease, and cancer of the parotid region. Curr

Evofosfamide for the treatment of human papillomavirus-negative head and neck squamous cell carcinoma

Evofosfamide (TH-302) is a clinical-stage hypoxia-activated prodrug of a DNA-crosslinking nitrogen mustard that has potential utility for human papillomavirus (HPV) negative head and neck squamous cell carcinoma (HNSCC), in which tumor hypoxia limits treatment outcome. We report the preclinical efficacy, target engagement, preliminary predictive biomarkers and initial clinical activity of evofosfamide for HPV-negative HNSCC. Evofosfamide was assessed in 22 genomically characterized cell lines and 7 cell line-derived xenograft (CDX), patient-derived xenograft (PDX), orthotopic, and syngeneic tumor models. Biomarker analysis used RNA sequencing, whole-exome sequencing, and whole-genome CRISPR knockout screens. Five advanced/metastatic HNSCC patients received evofosfamide monotherapy (480 mg/m2 qw × 3 each month) in a phase 2 study. Evofosfamide was potent and highly selective for hypoxic HNSCC cells. Proliferative rate was a predominant evofosfamide sensitivity determinant and a proliferation metagene correlated with activity in CDX models. Evofosfamide showed efficacy as monotherapy and with radiotherapy in PDX models, augmented CTLA-4 blockade in syngeneic tumors, and reduced hypoxia in nodes disseminated from an orthotopic model. Of 5 advanced HNSCC patients treated with evofosfamide, 2 showed partial responses while 3 had stable disease. In conclusion, evofosfamide shows promising efficacy in aggressive HPV-negative HNSCC, with predictive biomarkers in development to support further clinical evaluation in this indication.