Keith E. Matheny

Predictors of Weight Loss During Radiation Therapy

OBJECTIVE: To define risk factors for weight loss or dehydration during radiation therapy (RT). STUDY DESIGN AND SETTING: Retrospective chart review, academic tertiary care center. RESULTS: The incidence of severe weight loss during RT was 32.7%, the incidence of dehydration was 10.9%, and the rate of prophylactic feeding gas-trostomy tube placement was 32%. The patients most likely to suffer severe weight loss included patients with tumor sites of nasopharynx and base of tongue, those treated with chemoradiation, and patients with severe pretreatment weight loss. Prophylactic feeding gastrostomy tube placement before RT significantly reduced the incidence of severe weight loss and hospitalization during RT. CONCLUSION: Severe weight loss and dehydration during RT for head and neck cancer is common. Prophylactic feeding gastrostomy tubes significantly reduce the incidence of severe weight loss and hospitalization for dehydration during RT when placed before onset of RT. Patients at risk for severe weight loss include those with severe pretreatment weight loss, tumors of the nasopharynx and base of tongue, or treatment with chemoradiation.

Dominant negative p63 isoform expression in head and neck squamous cell carcinoma.

Objectives/Hypothesis: p63, a member of the p53 family of genes, is vital for normal epithelial development and may play a critical role in epithelial tumor formation. Although p63 has been identified in various head and neck malignancies, a detailed analysis of which of the six isoforms of the p63 gene is present in normal mucosa and head and neck malignancies has not yet been performed. The study analyzed p63 isoform expression on the RNA and protein level in normal, diseased, and malignant mucosa of the head and neck to examine the differential expression of p63 isoforms in head and neck tumors versus adjacent nonmalignant tissue and to identify the predominant p63 isoform expressed in head and neck squamous cell carcinoma (HNSCC).

Inhibition of epidermal growth factor receptor signaling decreases p63 expression in head and neck squamous carcinoma cells.

Objectives/Hypothesis Both the epidermal growth factor receptor (EGFR) and the p53 homologue p63 are overexpressed in a significant number of cases of head and neck squamous cell carcinoma (HNSCC). Epidermal growth factor receptor and p63 both possess oncogenic properties, including the potential to increase cell proliferation and antagonize apoptosis. ZD1839 (“Iressa”) is an adenosine triphosphate–competitive inhibitor specific to the EGFR tyrosine kinase currently under evaluation as a chemotherapeutic agent in HNSCC. The objective was to investigate whether p63 expression is decreased after treatment of HNSCC cells with ZD1839. Downregulation of p63 by ZD1839 would identify a potential molecular relationship between EGFR signaling and p63 and could provide insight into the mechanism of action of ZD1839.

Contemporary indications for the Caldwell-Luc procedure.

The Caldwell-Luc operation was first described in the late 19th century as a technique to remove infection and diseased mucosa from the maxillary sinus via the canine fossa, while creating intranasal counterdrainage through the inferior meatus. This operation has been performed countless times over the past century, but it has come under increased scrutiny within the past 20 years. This criticism is multifactorial. Medical management of allergic and infectious sinus disease has continued to improve, and endoscopic sinus surgery techniques have proven to be safe and effective in the vast majority of patients requiring surgical management. Additionally, several retrospective studies have shown high complication rates with the operation. Recent studies have illustrated both the histologic benefit of complete removal of diseased mucosa, as well as better patient outcomes with minimal morbidity when a safer operative technique is used. Overall, the Caldwell-Luc procedure is safe and effective as described, and should remain in the repertoire of surgeons managing the maxillary sinus.

Expression of p63 and 14-3-3σ in normal and hyperdifferentiated mucosa of the upper aerodigestive tract

OBJECTIVE: Our goal was to analyze p63 and 14-3-3σ expression in normal and hyperdifferentiated head and neck mucosa. STUDY DESIGN: Compare the in vivo expression of p63 and 14-3-3σ by immunohistochemistry in normal mucosa and oral lichen planus, a benign mucosal lesion marked by hyperdifferentiation and apoptosis. RESULTS AND CONCLUSION: p63 is underexpressed and 14-3-3σ is overexpressed in lichen planus on immunohistochemical analysis. SIGNIFICANCE: The findings support the hypothesis that p63 plays an antidifferentiation role, whereas 14-3-3σ plays a prodifferentiation role in the upper aerodigestive tract epithelium. Lichen planus is a valuable model for the study of p63, 14-3-3σ, and mucosal differentiation. p63 and 14-3-3σ may be molecular markers for oral lichen planus.

Safety, feasibility, and efficacy of placement of steroid-eluting bioabsorbable sinus implants in the office setting: a prospective case series.

The outcomes of endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) can be compromised by postoperative inflammation, recurrent polyposis, middle turbinate lateralization, and synechiae, often requiring subsequent interventions. A bioabsorbable steroid‐eluting sinus implant placed in the operating room following ESS has been proven safe and effective in 2 randomized controlled trials and a subsequent meta‐analysis, for its ability to preserve sinus patency, and reduce medical and surgical interventions. This trial sought to evaluate the safety, feasibility, and outcomes of implants placed in the office after achieving hemostasis.

RESOLVE: bioabsorbable steroid-eluting sinus implants for in-office treatment of recurrent sinonasal polyposis after sinus surgery: 6-month outcomes from a randomized, controlled, blinded study.

Patients with recurrent sinonasal polyposis after endoscopic sinus surgery (ESS) have limited treatment options. Safety and efficacy were previously reported for a bioabsorbable sinus implant that elutes mometasone furoate for 3 months. Here we summarize longer‐term outcomes.

Self-cross-linked hyaluronic acid hydrogel in ethmoidectomy: a randomized, controlled trial.

Background This study was designed to evaluate the safety and efficacy of a novel, self–cross-linked hyaluronic acid (HA) hydrogel compared with carboxymethylcellulose (CMC) viscous foam in promoting healing when applied after ethmoidectomy. A prospective, randomized, controlled, blinded clinical trial was performed. The study was performed by four surgeons operating in two community hospitals. Methods Thirty patients with bilateral chronic rhinosinusitis underwent bilateral total ethmoidectomy. Intraoperatively, each patient received 5 mL of HA hydrogel in one ethmoid cavity and 5 mL of CMC contralaterally. The material applied within each ethmoid cavity was randomly assigned before surgery. An independent surgeon, blinded to the material used to treat each ethmoid cavity, evaluated postoperative endoscopic video at 1 and 2 weeks for edema, crusting, and mucopurulence and at 6 and 12 weeks for remucosalization and scarring/synechiae. Twenty-item Sino-Nasal Outcome Test SNOT-20 data were collected at each visit. A small sample underwent endoscopic mucosal biopsy. Results Twenty-nine of 30 patients completed the protocol. The difference in edema, crusting, and mucopurulence at 1 and 2 weeks was not statistically significant; however, at 6 and 12 weeks, the HA hydrogel showed statistically significant reduction in both overall endoscopic grade (p < 0.05), as well as synechiae formation (p < 0.05), with a trend toward superiority in remucosalization (p = 08). Histological analysis of six subjects at 12 weeks showed a nonsignificant trend toward a greater amount of regenerated cilia present with the HA hydrogel (p = 0.23). SNOT-20 scores declined 78.8% from preoperative scores. Conclusion Self–cross-linked HA hydrogel provides superior wound healing to CMC after ethmoidectomy.

A phase 3 trial of mometasone furoate sinus implants for chronic sinusitis with recurrent nasal polyps: Steroid implants for recurrent nasal polyps

Topical intranasal corticosteroid sprays (INCSs) are standard treatment for nasal polyps (NPs), but their efficacy is reduced by poor patient compliance and impaired access of drug to the sinus mucosa. A corticosteroid‐eluting sinus implant was designed to address these limitations in patients with recurrent polyposis after sinus surgery by delivering 1350 μg of mometasone furoate (MF) directly to the ethmoid sinus mucosa over approximately 90 days.

Self-Crosslinked Hyaluronic Acid Hydrogel (PureRegen Gel Sinus) in Ethmoidectomy: A Randomized, Controlled Trial

Objectives: Evaluate the safety and efficacy of a novel, self-crosslinked hyaluronic acid (HA) hydrogel (PureRegen Gel Sinus) compared with carboxymethylcellulose (CMC) viscous foam (Stammberger SinuFoam) in promoting healing when applied following ethmoidectomy. Methods: Prospective, randomized, controlled, double-blinded clinical trial, with 4 surgeons operating in 2 community hospitals. Thirty patients with bilateral chronic rhinosinusitis underwent bilateral ethmoidectomy. Intraoperatively, each patient received 2 mL of HA hydrogel in one ethmoid cavity, and 2 mL of CMC contralaterally. The material applied within each ethmoid cavity was randomly assigned before surgery. A fifth independent surgeon, blinded to the material used to treat each ethmoid cavity, evaluated postoperative endoscopic video at 1 and 2 weeks for edema, crusting, and mucopurulence and at 6 and 12 weeks for re-mucosalization and scarring/synechiae. SinoNasal Outcome Test (SNOT-20) data were collected preoperatively and at each postoperative visit. A small sample of the cohort underwent endoscopic mucosal biopsy for histologic analysis. Results: Twenty-nine of 30 patients completed the protocol. The difference in edema, crusting, and mucopurulence at 1 and 2 weeks was not statistically significant; however, at 6 and 12 weeks, the HA hydrogel showed statistically significant reduction in synechiae formation (P < .05), with a trend toward superiority in re-mucosalization (P = .08). Histologic analysis of 6 subjects at 12 weeks also showed a trend toward a greater amount of regenerated cilia present in the HA hydrogel-treated ethmoid cavities (P = .22). The cohort showed a 75.18% improvement in SNOT-20 analysis. Conclusions: Self-crosslinked hyaluronic acid hydrogel provides superior wound healing to carboxymethylcellulose after ethmoidectomy.