•Hypopharyngeal squamous cell carcinoma has a reported 5-year overall survival rate of approximately 30–35%.•Nearly 50% of patients exhibitrecurrence within the first year after diagnosis.•Laryngeal ...preservation strategies are well supported although long term toxicity is significant.•Salvage surgery a common occurrence.•Future directions will focus on immunotherapy/targeted therapies to improve survival outcomes.
Cancer of the hypopharynx is relatively rare and accounts for roughly 3% of all head and neck cancers. Unfortunately, hypopharyngeal carcinoma has one of the worst prognosis of all head and neck cancers with a reported 5-year overall survival rate of approximately 30–35%. Toxicity related to therapy, and the need for surgical salvage continue to dominate the landscape in this disease. In this article, we set out to discuss a comprehensive overview of the current management principles, recent literature and evidence based therapeutic options surrounding treatment for hypopharyngeal squamous cell carcinoma, with a special focus on the evolution of an organ sparing paradigm.
Background
Hypopharyngeal carcinoma is relatively rare, representing approximately 3% of all head and neck malignancies. It also is characterized by having one of the worst prognoses at time of ...diagnosis. This is largely due to its tendency for late presentation.
Methods
This article will review current literature including as well as the National Comprehensive NCCN Guidelines Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) for the treatment of hypopharyngeal cancer.
Results
Hypopharyngeal cancer often presents in an advanced stage and its prognosis is notoriously poor. Treatment goals are similar to other carcinomas of the head and neck and treatment typically involves multiple modalities including surgery, radiation, and chemotherapy. Organ sparing nonsurgical therapy has shown comparable survival outcomes to surgery in early stage hypopharyngeal cancer.
Conclusion
Treating hypopharyngeal cancer remains a challenging prospect for the head and neck oncologist. A multidisciplinary approach is essential due to the necessity of combined therapy treatment protocols. There is opportunity for novel treatments and prospective trials to improve outcomes in hypopharyngeal carcinoma. Disease prevention by targeting environmental risk factors is likely to have the greatest impact in this disease.
Objective: Little is known about what may distinguish effective and ineffective group interventions. Group motivational interviewing (MI) is a promising intervention for adolescent alcohol and other ...drug use; however, the mechanisms of change for group MI are unknown. One potential mechanism is change talk, which is client speech arguing for change. The present study describes the group process in adolescent group MI and effects of group-level change talk on individual alcohol and marijuana outcomes. Method: We analyzed 129 group session audio recordings from a randomized clinical trial of adolescent group MI. Sequential coding was performed with the Motivational Interviewing Skill Code (MISC) and the CASAA Application for Coding Treatment Interactions software application. Outcomes included past-month intentions, frequency, and consequences of alcohol and marijuana use; motivation to change; and positive expectancies. Results: Sequential analysis indicated that facilitator open-ended questions and reflections of change talk increased group change talk. Group change talk was then followed by more change talk. Multilevel models accounting for rolling group enrollment revealed group change talk was associated with decreased alcohol intentions, alcohol use, and heavy drinking 3 months later; group sustain talk was associated with decreased motivation to change, increased intentions to use marijuana, and increased positive alcohol and marijuana expectancies. Conclusions: Facilitator speech and peer responses each had effects on change and sustain talk in the group setting, which were then associated with individual changes. Selective reflection of change talk in adolescent group MI is suggested as a strategy to manage group dynamics and increase behavioral change.
In motivational interviewing groups focusing on adolescent alcohol and drug use, use of open-ended questions and reflections of change talk by the facilitator were associated with increased change talk in the group and with positive outcomes at 3 months. Use of motivational interviewing in groups may help adolescents change their substance use.
Objectives/Hypothesis
To demonstrate the comparative effectiveness of transoral robotic surgery (TORS) to intensity modulated radiotherapy (IMRT) for early T‐stage oropharyngeal cancer.
Data Sources
...The search included MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, and bibliographies of relevant studies through September 2012.
Methods
Studies included patients treated for early T‐stage oropharynx cancer with TORS or IMRT. Study retrieval and data extraction were conducted in duplicate and resolved by consensus. Treatment‐ specific details, as well as recurrence, survival, and adverse events, were collected. Methodologic quality for each study was appraised.
Results
Twenty case series, including eight IMRT studies (1,287 patients) and 12 TORS studies (772 patients), were included. Patients receiving definitive IMRT also received chemotherapy (43%) or neck dissections for persistent disease (30%), whereas patients receiving TORS required adjuvant radiotherapy (26%) or chemoradiotherapy (41%). Two‐year overall survival estimates ranged from 84% to 96% for IMRT and from 82% to 94% for TORS. Adverse events for IMRT included esophageal stenosis (4.8%), osteoradionecrosis (2.6%), and gastrostomy tubes (43%)—and adverse events for TORS included hemorrhage (2.4%), fistula (2.5%), and gastrostomy tubes at the time of surgery (1.4%) or during adjuvant treatment (30%). Tracheostomy tubes were needed in 12% of patients at the time of surgery, but most were decannulated prior to discharge.
Conclusion
This review suggests that survival estimates are similar between the two modalities and that the differences lie in adverse events. Laryngoscope, 124:2096–2102, 2014
Aims
We tested race/ethnic differences in alcohol and marijuana (AM) trajectories (comprising an intercept term, reflecting overall probability of use, and a slope term, reflecting change in ...probability of use) during adolescence, whether AM use trajectories predicted high school outcomes, and whether outcomes differed by race/ethnicity after controlling for trajectory of AM use.
Design
This longitudinal study involved 6509 youth from 16 middle schools in Southern California surveyed from age 11.5 (2008) to age 17 (2015) years; all surveys assessed AM use, and the final survey also examined high school outcomes.
Setting
Youth completed five surveys in middle school and two on‐line surveys in high school.
Participants
The sample was 50% male and 80% non‐white.
Measurements
Intercept (at 2.75 years post‐baseline) and slope of AM use were examined as outcomes for race/ethnic differences. AM use trajectories were examined as predictors of academic performance and unpreparedness, social functioning, mental and physical health and delinquency.
Findings
We found differences in trajectories of use by race/ethnicity, with white youth reporting a higher overall intercept of alcohol use compared to all other groups (versus Asian P < 0.001, black P = 0.001, multi‐ethnic P = 0.008). Overall, examination of trajectories of use showed that adolescents with a higher alcohol use intercept term reported greater academic unpreparedness (P < 0.001) and delinquency (P < 0.001) at wave 7 in high school. In addition, youth with a higher intercept for marijuana use reported greater academic unpreparedness (P < 0.001) and delinquency (P < 0.001), and poorer academic performance (P = 0.032) and mental health (P = 0.002) in high school. At wave 7, compared to white youth, Hispanic and multi‐ethnic youth reported poorer academic performance (P < 0.001 and P = 0.034, respectively); Asian, black and Hispanic youth reported higher academic unpreparedness (P < 0.001, P = 0.019, and P = 0.001); and Asian youth and multi‐ethnic youth reported poorer physical health (P = 0.012 and P = 0.018) controlling for AM use.
Conclusions
Greater AM use was associated with worse functioning in high school for all youth. After controlling for AM use, non‐white youth reported worse outcomes in high school for academics and health.
The development of surgical site infections (SSIs) can put the viability of free tissue transfer reconstructions at risk, often resulting in considerable postoperative morbidity and prolonged ...hospitalization. Current antibiotic prophylactic guidelines suggest a first- or second-generation cephalosporin with metronidazole for clean-contaminated cases and recommend clindamycin as an alternative choice in penicillin-allergic patients. This study was designed to examine the rates of postoperative infection associated with prophylactic antibiotic regimens, including patients receiving clindamycin as an alternative due to penicillin allergy.
Case series with chart review.
Tertiary academic medical center.
Patients undergoing major ablative head and neck resection involving the pharynx and oral cavity reconstructed via free tissue transfer.
The sample included patients (n = 266) who underwent free tissue transfer involving the oral cavity and pharynx from 2009 to 2014. Data included demographic data, medical comorbidities, anatomic tumor subsite and surgical procedure, and prophylactic antibiotic regimen. SSI data were examined up to 30 days after the initial surgical procedure. Multivariate logistic regression analysis was performed to determine the overall risk for SSI. Culture data were also reviewed.
The data indicated that clindamycin was associated with an approximate 4-fold increased risk for SSI (odds ratio, 3.784; 95% confidence interval: 1.367-10.470 P = .010) after controlling for possible confounding factors.
For patients with a true penicillin allergy, we recommend broader gram-negative coverage with alternative antibiotics, such as cefuroxime, when undergoing free tissue transfer in the head and neck.
Background
Virtual surgical planning (VSP), intraoperative cutting guides and stereolithographic models, provides the head and neck reconstructive surgeon with powerful tools for complex ...reconstruction planning. Despite its use in fibular osteocutaneous reconstruction, application to the scapular tip has not been as widely reported.
Methods
From 2013 to 2014, four cases of either mandibular or maxillary reconstruction were completed with the scapular tip osseous free flap. All four cases underwent preoperative VSP with patient‐specific guide design.
Results
Patient‐specific guides were generated for scapular tip harvest. Guide placement was improved using a stabilizing flange and bracket design. With minimal disruption of the overlying periosteum a wedge osteotomy was successfully implemented in one case.
Conclusions
Unlike the fibula and iliac crest donor sites, the scapular tip has overlying muscle attachments that make intraoperative osteotomies challenging. Attention to key aspects of scapular anatomy, including the fibrous tip and extensive overlying muscle, permits effective guide design.
Level of evidence
4
Abstract Group motivational interviewing (MI) interventions that target youth at-risk for alcohol and other drug (AOD) use may prevent future negative consequences. Youth in a teen court setting n = ...193; 67% male, 45% Hispanic; mean age 16.6 ( SD = 1.05) were randomized to receive either a group MI intervention, Free Talk , or usual care (UC). We examined client acceptance, and intervention feasibility and conducted a preliminary outcome evaluation. Free Talk teens reported higher quality and satisfaction ratings, and MI integrity scores were higher for Free Talk groups. AOD use and delinquency decreased for both groups at 3 months, and 12-month recidivism rates were lower but not significantly different for the Free Talk group compared to UC. Results contribute to emerging literature on MI in a group setting. A longer term follow-up is warranted.
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