R. Bryan Bell

Cytoreductive surgery for head and neck squamous cell carcinoma in the new age of immunotherapy.

Cytoreductive surgery is an approach to cancer treatment that aims to reduce the number of cancer cells via resection of primary tumor or metastatic deposits, in an effort to minimize a potentially immunosuppressive tumor burden, palliate symptoms, and prevent complications. Furthermore, it provides a platform for investigation of biomarkers with the goal of optimizing immunotherapy to reverse the immunosuppressive tumor microenvironment and enhance adaptive immune responses. Ultimately, our group aims to exploit the concept that successful cancer therapy is dependent upon an effective immune response. Surgery will remain an integral part of head and neck squamous cell carcinoma (HNSCC) treatment in the future, even as checkpoint inhibitors, co-stimulatory molecules, vaccines, adoptive T cell therapy and other novel agents enter clinical routine. Cytoreductive resection may provide an effective platform for immunotherapy and biomarker directed interventions to improve outcomes for patients with HNSCC.

Margin Analysis: Squamous Cell Carcinoma of the Oropharynx

Because of the common shared risk factors of smoking and heavy alcohol consumption, literature involving oropharyngeal squamous cell carcinoma (OPSCC) is often combined with oral squamous cell carcinoma. Human papilloma virus is now confirmed to be a major risk factor of OPSCC with its distinct epidemiology and favorable treatment outcome. The impact of adjuvant chemoradiation in the setting of positive surgical margins remains unclear but is likely influenced by tumor biology. This article reviews the tumor biology of OPSCC and summarizes recent findings on outcomes following surgical treatment of OPSCC.

Infinite cornucopia: The future of education and training in oral and maxillofacial surgery

The modern version of the specialty of oral and maxillofacial surgery (OMS) in the United States emerged through the vision of early oral surgeons desiring to improve the specialty and the care of their patients. Advances in scope and relevance were reflected in changing professional societies, as the American Society of Exodontists became the American Association of Exodontists and Oral Surgeons, followed by the American Association of Oral Surgeons, and finally the American Association of Oral and Maxillofacial Surgeons (AAOMS). Facilitating these changes were several milestone achievements, which include the establishment of the American Board of Oral (and Maxillofacial) Surgery following World War II, the decision on the part of AAOMS and its Committee on Resident Education and Training (CRET) to mandate 3year integrated hospital programs, the development of full-time faculty training models, the creation of dualdegreed programs, and the fostering of accredited fellowship programs in head and neck oncologic surgery, reconstructive microvascular surgery, pediatric craniofacial surgery, and cosmetic surgery. Despite these successes, a number of issues currently surrounding OMS resident education must be settled if the specialty is to be well prepared for a changing health care environment and if the public need for hospital-based OMS services is to be met. The most important of these, in my opinion, is overcoming a serious dichotomy in major maxillofacial surgery experience and volume among United States training programs.

Erratum to ‘Cytoreductive surgery for head and neck squamous cell carcinoma in the new age of immunotherapy’ [Oral Oncol. 61 (2016) 166–176]

http://dx.doi.org/10.1016/j.oraloncology.2017.02.001 1368-8375/ 2017 Elsevier Ltd. All rights reserved. DOI of original article: http://dx.doi.org/10.1016/j.oraloncology.2016.08.020 ⇑ Corresponding author at: Providence Oral, Head and Neck Cancer Program and Clinic, Earle A. Chiles Research Institute at Providence Cancer Center, Providence Medical Center, 4805 NE Glisan St. Suite 2N35, Portland, OR 97213, United States. E-mail address: Richard.bell@providence.org (R.B. Bell).

Immunotherapy in Head and Neck Cancers

Despite tremendous advances in our molecular understanding of carcinogenesis, the worldwide incidence of head and neck squamous cell carcinoma (HNSCC) remains unacceptably high with approximately 664,000 new diagnoses per year. Although roughly one-third of HNSCC patients will reside in developed countries with advanced medical resources, they will be faced with 5-year survival rates that remain quagmired at less than 50 %. Although advances in chemotherapy and radiation continue, cures for HNSCC remain in the surgeon’s purview. Oftentimes surgery leads to disfigurement and the need for adjunctive care for speech, nutrition, and breathing. This chapter will discuss how head and neck cancers avoid immune detection and several novel approaches undergoing clinical evaluation to make them “reappear.” Our discussion will focus on approaches with small molecules, antibodies and antibody drug conjugates (ABCs), and cytokines and a detailed discussion presenting the current and future applications of adoptive (autologous) tumor-specific T-cell therapies and HNSCC tumor vaccines. Abstract and Key Words are contributed by the Editor, AMF.

Towards improving oral health care education and delivery

The Surgeon General of the United States issued the first report on Oral Health America in 2000 and a subsequent National Call to Action in 2003, in which numerous disparities that exist in oral health and disease patterns, oral health care delivery, and oral health education were defined. These disparities are particularly manifested in adults and children entering our nation’s emergency departments and trauma systems, in patients undergoing cancer therapy, organ transplant or cardiac surgery, and those who are unable to afford or obtain access to specialized dental services. According to the National Institute of Dental and Craniofacial Research, there were 936,482 emergency department visits related to dental conditions in 2009. It has been estimated that as many as 15% of the most severely injured patients evaluated at U.S. trauma centers have significant facial injuries, of which half have catastrophic dental injuries that will require complex reconstruction and prosthetic rehabilitation. Of the roughly 1.6 million new cancer cases diagnosed in the United States each year, approximately 400,000 patients will develop oral complications annually. Dental assessment and rehabilitation is a critical component of comprehensive oncologic care in general and the oral, head and neck cancer patient in particular. Dental clearance is also critical to patients undergoing transplant or cardiac surgery. Physician access to acute dental care for their critically ill patients is an ongoing challenge. Thus, the societal impact of oral diseases in the context of hospitals is substantial. This burden is made more complicated by a separation of dentistry from medicine by virtue of having disparate and fundamentally isolated delivery models. While preventative and restorative dental services are important for healthrelated quality of life, they are typically elective, fee-for-service procedures (unless accompanied by pathology or infection) that are provided by officebased private practitioners. Most practicing dentists have opted out of Medicare/Medicaid programs, as well as most medical insurance programs, in order to maintain a reasonable level of reimbursement. This has resulted in a much-celebrated economic model of health care delivery, but it has also produced significant access to care issues that are just now being widely identified. Political pressure has resulted in federal and state governmental sanctions of mid-level providers to provide dental care for underserved populations with high rates of oral disease. At the same time, dentistry has effectively removed itself from the

Adoptive TIL in HPV-negative oral scca

Meeting abstracts A 22 year old male was diagnosed with clinical T2 squamous cell carcinoma of the lateral oral tongue. He underwent partial glossectomy with elective neck dissection of ipsilateral cervical nodes levels I-IV. Pathology showed a 2.1cm primary tumor with clear margins to 5mm, 1.6cm