Mark A. Varvares

Oral cancer in vivo gene expression profiling assisted by laser capture microdissection and microarray analysis.

Large scale gene expression profiling was carried out on laser capture microdissected (LCM) tumor and normal oral epithelial cells and analysed on high-density oligonucleotide microarrays. About 600 genes were found to be oral cancer associated. These oral cancer associated genes include oncogenes, tumor suppressors, transcription factors, xenobiotic enzymes, metastatic proteins, differentiation markers, and genes that have not been implicated in oral cancer. The database created provides a verifiable global profile of gene expression during oral carcinogenesis, revealing the potential role of known genes as well as genes that have not been previously implicated in oral cancer.

Evaluation of chemotherapy response in patients with advanced head and neck cancer using [F-18]fluorodeoxyglucose positron emission tomography

[F‐18]Fluorodeoxyglucose (FDG)‐positron emission tomography (PET) can measure the metabolic activity of tissues; FDG‐PET may be able to predict response to chemotherapy by identifying changes in tumor metabolism. Measurement of response to treatment may help improve survival in the management of advanced head and neck cancer. We evaluated this particular use of FDG‐PET in patients participating in a neoadjuvant organ‐preservation protocol using taxol and carboplatin and compared pathologic response after chemotherapy with changes in tumor metabolism measured by FDG‐PET.

SURGICAL MARGIN DETERMINATION IN HEAD AND NECK ONCOLOGY: CURRENT CLINICAL PRACTICE. THE RESULTS OF AN INTERNATIONAL AMERICAN HEAD AND NECK SOCIETY MEMBER SURVEY

Our aim was to investigate the ways in which surgeons who perform head and neck ablative procedures on a regular basis define margins, how they use frozen sections to evaluate margins, and the effect of chemoradiation on determining tumor margins.

Tumor-Infiltrating γδ T Lymphocytes Predict Clinical Outcome in Human Breast Cancer

Understanding and dissecting the role of different subsets of regulatory tumor-infiltrating lymphocytes (TILs) in the immunopathogenesis of individual cancer is a challenge for anti-tumor immunotherapy. High levels of γδ regulatory T cells have been discovered in breast TILs. However, the clinical relevance of these intratumoral γδ T cells is unknown. In this study, γδ T cell populations were analyzed by performing immunohistochemical staining in primary breast cancer tissues from patients with different stages of cancer progression. Retrospective multivariate analyses of the correlations between γδ T cell levels and other prognostic factors and clinical outcomes were completed. We found that γδ T cell infiltration and accumulation in breast tumor sites was a general feature in breast cancer patients. Intratumoral γδ T cell numbers were positively correlated with advanced tumor stages, HER2 expression status, and high lymph node metastasis but inversely correlated with relapse-free survival and overall survival of breast cancer patients. Multivariate and univariate analyses of tumor-infiltrating γδ T cells and other prognostic factors further suggested that intratumoral γδ T cells represented the most significant independent prognostic factor for assessing severity of breast cancer compared with the other known factors. Intratumoral γδ T cells were positively correlated with FOXP3+ cells and CD4+ T cells but negatively correlated with CD8+ T cells in breast cancer tissues. These findings suggest that intratumoral γδ T cells may serve as a valuable and independent prognostic biomarker, as well as a potential therapeutic target for human breast cancer.

Thyroplasty: A New Approach

A new type of thyroplasty implant (prosthesis) has been designed to be used as part of a surgical operation that accomplishes medial displacement of a paralyzed vocal cord. The implant is inserted through a rectangular window fashioned in the thyroid lamina on the side of the vocal cord paralysis. Instruments for measuring the location and outline of the window in the thyroid lamina are presented. A thyroplasty saw blade is introduced. By using this blade, a window of precise measurement can be constructed without injury to the underlying perichondrium. The implant is constructed from a biocompatible, medical-grade polymer. Four sizes each are available for the male and female larynges. The proper-size implant can be selected with a measuring device. It is not necessary to alter the implant at the time of surgery; it snaps into place and suturing is not necessary. Once the implant is inserted, its medial or lateral displacement is not possible; on the other hand, the implant can be easily removed if vocal cord function returns, or if a change to a different-size implant is indicated. The design of the implant will close the posterior commissure.

Effects of Aspirin and Low‐Dose Heparin in Head and Neck Reconstruction using Microvascular Free Flaps

Objective: The success of microvascular free‐tissue transfer to the head and neck has been greatly increased secondary to increased experience, yet postoperative anticoagulation continues to be routinely used to prevent pedicle thrombosis. However, there is currently no consensus as to what the ideal regimen, if any, is recommended for postoperative anticoagulation. This study reviews the outcome and incidence of perioperative complications in patients undergoing free flaps for head and neck reconstruction, using a simple postoperative anticoagulation regimen of aspirin and subcutaneous heparin (SQH).

Use of the radial forearm fasciocutaneous free flap and Montgomery salivary bypass tube for pharyngoesophageal reconstruction

Head and neck reconstructive surgeons involved in pharyngoesophageal reconstruction have several options available to repair the defect after partial or total laryngopharyngectomy. There is no uniform agreement among head and neck surgeons as to which of the most frequently used techniques offers the best results.

Teflon Granuloma of the Larynx: Etiology, Pathophysiology, and Management

Intralaryngeal Teflon injection for correction of unilateral vocal cord paralysis is known to produce a foreign body giant cell reaction. In our practice, we have seen increasing numbers of patients who had developed dysphonia related to Teflon injection. This patient series was reviewed, as were the surgical technique to correct this condition, voice results, and acoustic analysis of a subset of the patient series. We conclude that dysphonia, secondary to Teflon injection, can be either from overinjection of Teflon or inappropriate injection, or from the proliferative granulomatous response of the larynx to the Teflon. Our technique of laser incision into the superior aspect of the Teflon implant, followed by vaporization and preservation of a margin of mucosa of the cord medially, resulted in improved voice in 8 of 11 patients treated in this manner. Acoustic and aerodynamic analyses reveal significant deficits in vocal function that may persist after procedures used to correct this condition.

Relationship between psychological status and compliance in a sample of patients treated for cancer of the head and neck.

The psychological status of patients treated for advanced head and neck cancer is an area of patient care that has not received sufficient attention from caregivers and can be influential in terms of patient outcomes.

Histological pattern of mandibular invasion by oral squamous cell carcinoma.

Objective: Mandibular invasion by oral squamous cell carcinoma may progress by either an infiltrative or an erosive histological pattern. The infiltrative pattern is marked by nests and cords of tumor cells along an irregular tumor front, and the erosive pattern exhibits a broad, pushing tumor front. The objectives of this study were 1) to define the characteristics associated with each histological pattern of mandibular invasion, 2) to assess the relationship between pattern of invasion and clinical outcome as measured by death with disease and disease presence at last follow‐up, and 3) to determine whether the cell cycle markers cyclin D1 and Ki‐67 are associated with the histological pattern of invasion or are predictive of outcome.