R. Rezaee

Phase II study of bevacizumab in combination with docetaxel and radiation in locally advanced squamous cell carcinoma of the head and neck

The purpose of this study was to establish the efficacy and toxicities of concurrent bevacizumab and docetaxel with radiation for locally advanced head and neck squamous cell carcinoma (HNSCC).

Utility of SPECT/CT for periparotid sentinel lymph node mapping in the surgical management of head and neck melanoma

PURPOSE Sentinel lymph node (SLN) biopsy is instrumental in staging and treatment of cutaneous melanoma. SPECT/CT, single-photon emission computed tomography (SPECT) integrated with computed tomography (CT), increases the accuracy of SLN mapping to improve surgical planning. SPECT/CT can correct for signal scatter to prevent masking, which is especially common in the head and neck. For periparotid lymph nodes SPECT/CT may improve localization of SLNs compared to lymphoscintigraphy. MATERIALS/METHODS Hospital charts were reviewed for 14 patients with melanoma and suspected lymphatic drainage to the parotid region who received lymphoscintigraphy followed by SPECT/CT prior to surgical excision and SLN. RESULTS Overall, SPECT/CT provided data, which changed management in 57% of patients. CONCLUSIONS Fifty-seven percent of our patients benefited from use of SPECT/CT. The distinction between level II and parotid sentinel lymph nodes was clearly identified through SPECT/CT images. We believe that patients with melanoma draining to the parotid region would benefit from SPECT/CT SLN mapping.

Time-Resolved and Bolus-Chase MR Angiography of the Leg: Branching Pattern Analysis and Identification of Septocutaneous Perforators

OBJECTIVE The goal of this study was to compare time-resolved MR angiography (MRA) and bolus-chase MRA in the identification of peroneal artery septocutaneous perforators and for classification of the branching pattern of the arterial tree in the leg in a cohort of candidates for fibular free flap transfer operations. MATERIALS AND METHODS Retrospective analysis was performed on imaging data from 53 legs of 27 patients (age range, 27-88 years) who underwent time-resolved MRA (FLASH; TR/TE, 2.5/1.0; flip angle, 22°; voxel dimensions, 1.54 × 1.25 × 1.5 mm; acquisition time, 2.27 s/frame) and bolus-chase MRA (FLASH; 3.2/1.2; flip angle, 25°; voxel dimensions, 0.94 × 0.89 × 1 mm) at 3 T with gadobenate dimeglumine administered at 0.05 and 0.10 mmol/kg, respectively. The branching pattern was analyzed; the total number of septocutaneous perforators for each leg was calculated from the time-resolved and bolus-chase MRA data; and the results were combined. The total and average number of septocutaneous perforators per leg and the frequency of various branching patterns were calculated. The techniques were compared in terms of branching pattern and number of visible septocutaneous perforators. RESULTS A total of 84 septocutaneous perforators (1.58 ± 1.05 [SD] per leg) were identified. Pattern 1A was found in 42 legs; 1B, two legs; 2A, one leg; 2B, one; 3A, four; 3B, one; and 3D, two legs. Classification with time-resolved MRA was successful for 53 legs and with boluschase MRA for 51 legs (Z = 0.713, p = 0.24, one-tailed, not significant). Twenty-two septocutaneous perforators were identified with time-resolved MRA and 82 with bolus-chase MRA. CONCLUSION MRA of the leg can be used to investigate the branching pattern and identify septocutaneous perforators in a single step. With the imaging parameters and contrast dose used in this study, septocutaneous perforators can be better identified with boluschase MRA, although this result may be partially related to the higher gadolinium dose used in this technique.

Multi-institutional investigation of the prognostic value of lymph nodel yield in advanced-stage oral cavity squamous cell carcinoma

Although existing literature provides surgical recommendations for treating occult disease (cN0) in early‐stage oral cavity squamous cell carcinoma (SCC), a focus on late‐stage oral cavity SCC is less pervasive.

Randomized phase III study of 2 cisplatin-based chemoradiation regimens in locally advanced head and neck squamous cell carcinoma: Impact of changing disease epidemiology on contemporary trial design

Chemoradiotherapy results in excellent outcomes in locally advanced head and neck squamous cell carcinoma (HNSCC). This trial compared 2 chemoradiotherapy regimens.

Time-resolved MR angiography of the legs at 3 T using a low dose of gadolinium: Initial experience and contrast dynamics

OBJECTIVE This article describes our initial clinical experience with time-resolved MR angiography (MRA) of the legs using the time-resolved imaging with stochastic trajectories (TWIST) technique with a half dose of gadolinium. MATERIALS AND METHODS Thirty-four patients underwent a TWIST examination of the legs at 3 T. Thirty-three patients also underwent a bolus-chase MRA examination in the same setting. Times elapsed between the start of contrast injection and the appearance of contrast material (t(A)) and peak enhancement of the arteries in the legs (t(B)) were analyzed. The number of patients with examinations affected by venous contamination was determined. The differences in t(A) and t(B) between cases in which venous contamination was present or absent were evaluated using a two-tailed Student t test. RESULTS The TWIST technique using a half dose of gadolinium provided diagnostic-quality images of all patients. The mean t(A) was 35.5 ± 8.8 (SD) seconds (range, 17.8-60.4 seconds), and the mean t(B) was 59.1 ± 15.1 seconds (range, 31-98.8 seconds). Venous contamination was observed in bolus-chase MRA images of 52.9% of patients. The relationship between venous contamination and t(A) was not statistically significant (p = 0.13). The incidence of venous contamination was higher in patients with lower values of t(B) (p = 0.01). CONCLUSION The described low-dose clinical experience with TWIST and the contrast dynamics information gained from this study could aid radiologists in planning protocols for leg MRA examinations.

Subcutaneous emphysema after otologic surgery: A case report

Subcutaneous emphysema of the head and neck after otologic surgery is exceedingly rare. The mechanism relates to the intimate relationship of the temporomandibular joint to the external auditory canal. We present a rare case of subcutaneous emphysema after otologic surgery for ear disease. An astute clinical index of suspicion coupled with prompt treatment can help minimize morbidity and improve patient outcomes.

Incidence of facial nerve sacrifice in parotidectomy for primary and metastatic malignancies

INTRODUCTION The parotid gland may become involved by primary parotid malignancies and secondarily by metastases from other primary sites. Surgical resection of these tumors can be technically challenging due to the intimate relationship of the parotid gland and the facial nerve. The primary aim of this project was to determine the incidence of facial nerve sacrifice in parotidectomy for primary and secondary malignancies of the parotid. METHODS A retrospective chart review of was performed. Patients who received parotidectomy with final pathology consistent with a malignant neoplasm were included. The primary outcome studied was necessity for facial nerve sacrifice. Co-variates included preoperative facial nerve function, preoperative pain, superficial versus total parotidectomy and pathologic diagnosis. Univariate analysis was performed using student t-test to determine odds ratios. RESULTS We identified 75 patients who had a parotidectomy for a malignant process in our review. 30 patients had facial nerve sacrifice: 14 total and 16 partial sacrifices. Patients were more likely to require facial nerve sacrifice when they presented with preoperative facial nerve dysfunction [100% vs 19.6%, p=0.0006, OR 154.3, CI (8.66-2750.9)], pre-op pain [76.5% vs. 29.3%, p=0.001, OR 7.84, CI (2.23-27.50)], and required excision of both superficial and deep lobes of the parotid gland [64.9% vs 15.8%, p=0.0001, OR 9.85, CI (3.27-29.66)]. CONCLUSION Our data illustrates that many patients with normal facial nerve function, even in the setting of malignancy, can have their facial nerve preserved. Pain, deep lobe involvement and preoperative facial nerve dysfunction are associated with an increased risk of needing at least partial facial nerve sacrifice in the setting of parotid gland malignancies.

Clinical Significance of Sarcopenia among Patients with Advanced Oropharyngeal Cancer

Objectives We investigated the prevalence and impact of sarcopenia on disease-free survival (DFS) and overall survival (OS) in advanced oropharyngeal cancer. Study Design Retrospective study. Setting Single-institution tertiary cancer care center. Subjects and Methods We identified patients with advanced oropharyngeal cancer with pretreatment positron emission tomography–computed tomography scans for image analysis. Data were collected on the following variables: age, sex, smoking and alcohol status, stage (TNM and American Joint Committee on Cancer), human papillomavirus (HPV) status, body mass index (BMI), and treatment modality. Results Of 113 patients identified with oropharyngeal cancer, 32 had sarcopenia: these patients were older (63.5 vs 57.6 years, P = .01), were less likely to be male (53.1% vs 76.5%, P = .03), and had a lower mean BMI (24.5 vs 28.4 kg/m2, P = .009). Eighty-five subjects had HPV-positive disease, and they had a higher BMI (28.2 vs 24.2 kg/m2, P = .01) than that of patients without HPV. Twenty-one subjects who were HPV positive had less cancer recurrence (24.7% vs 48.1%, P = .04) than that of their HPV-negative counterparts. Log-rank testing showed no difference in DFS (P = .06) associated with sarcopenia but a significant difference in OS (P = .049). There were differences in DFS (P = .009) and OS (P = .023) based on HPV status. According to univariable and multivariable models, HPV positivity exhibited improved DFS and OS. Sarcopenia was not statistically significant in survival models; however, it was associated with increased mortality and recurrence. Conclusion Sarcopenia is a prognostic factor affecting OS independent of HPV status in advanced oropharyngeal cancer.

Laryngotracheal reconstruction with a prefabricated fasciocutaneous free flap for recurrent papillary thyroid carcinoma

Prefabricated composite free flaps have been described as a technique for reconstruction of laryngotracheal defects.