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Increased Survival in HPV Positive Oropharyngeal SCCa
Scientific Oral Presentations
Incidence of Micropapillary Carcinoma in Total Thyroidectomy Michael Navid Pakdaman, BS (presenter); Michael P Hier, MD; Michael Tamilia, MD, FRCP; Martin J Black, FRCS(C); Richard J Payne, MD, MSc, FRCS OBJECTIVE: (1) Compare prognostic factors in thyroid micropapillary carcinoma (MPC) ⬍5 mm versus ⬎⫽5 mm. (2) To compare MPC characteristics in patients with pre-existing thyroid carcinoma to patients with no other thyroid carcinoma. METHODS: Pathology results were reviewed for consecutive total thyroidectomy patients between 2002 and 2007 (n⫽835). Hemithyroidectomies and completion thyroidectomies were excluded. Statistical significance of the difference in incidences was calculated using Fisher’s exact test and chi-squared analysis. RESULTS: MPC was found in 50.2% of total cases. Where the size was ⬍5mm (64%), 9.3% extended beyond the thyroid capsule, 51.7% were multifocal, and 27.5% were bilateral. In MPCs ⬎⫽5 mm (36%), the data showed 25.2%, 70.9%, 51%, respectively (p-value always ⬍ 0.05). In the 314 patients with no other thyroid malignancy, MPC was found in 47.1% of cases. 14.9% had capsular extension; 50% were multifocal, of which 56.8% were bilateral. In the 521 patients with malignant disease, the data showed 52.1%, 15.1%, 63.2%, and 63.3%,
respectively, with p-values via Fisher’s exact test .22, .112, .003, and .07. CONCLUSIONS: In this study, MPC was found in 50.2% of patients. MPC’s ⬎⫽5 mm carried an increased risk for extracapsular spread, multifocality, and bilaterality. While patients with malignancies of the thyroid (aside from MPC) more commonly have multifocal MPCs, there was no significant difference in bilaterality, size, or extracapsular spread in MPCs in the presence of malignant vs. benign disease. Increased Survival in HPV Positive Oropharyngeal SCCa Anthony C. Nichols, MD (presenter); William Faquin, MD, PhD; Shanaz Begum, MD, PhD; William H Westra, MD; John Clark MD; James W Rocco, MD, PhD OBJECTIVE: To determine if HPV16 infection is associated with improved survival in advanced oropharyngeal squamous cell carcinoma (OPSCC) treated with chemoradiation. METHODS: A retrospective chart review was performed in 44 patients with stage III and IV OPSCC who were treated with curative intent using chemoradiation. Tumor specimens were evaluated for the presence of HPV16 DNA with the in-situ hybridization-catalyzed signal amplification method applied to pre-treatment archival tumor specimens. Tumors were scored as HPV positive if a signal specific to tumor nuclei was detected. Progression-free survival was estimated by KaplanMeier analysis. Outcome analyses were performed in the subsets of those with documented local, regional or distant relapse, and in disease-free patients, with a minimum of 2 years for follow-up. RESULTS: The incidence of HPV16 positive tumors in this patient population was 59%. Overall progression-free survival independent of HPV status was 62%, while survival for patients with HPV16 positive tumors was 78%. Survival of patients with HPV negative tumors was considerably less at 40%. Only HPV status was associated with response to chemoradiation (p⫽0.006). Patient age, performance status, and tumor stage were not predictive of response. Patients with a history of smoking and heavy alcohol use had an inverse association with HPV status and lower survival in response to chemoradiation (p⫽.00015). CONCLUSIONS: Patients with OPSCC tumors resulting from HPV16 infection are more likely to respond to platinum-based concurrent chemoradiation, than HPV negative patients with traditional risk factors for oropharyngeal head and neck cancer. Lymph Node Clustering in Head and Neck Squamous Cell Cancer Kimberly J. Lee, MD (presenter); Claudia Kirsch, MD; James William Sayre, PhD; Sunita Bhuta, MD; Elliot Abemayor, MD, PhD
SCI. ORALS
cele occurs at a higher incidence with a partial superficial parotidectomy compared to a near complete parotidectomy; both with facial nerve dissection. (2)To determine if needle aspiration vs. observation yields more persistant sialoceles beyond 4 weeks. METHODS: Retrospective, single surgeon, single institution study comparing 100 consecutive partial superficial parotidectomy procedures and 20 consecutive near-total parotidectomy procedures for formation of post-operative sialocele. Study period 2004-2007. The first 18 sialoceles were treated with one or more needle aspirations. The last 21 sialoceles were treated with observation and no needle aspiration. Antibiotics were not used beyond the first week of surgery in either group. Chi Square analysis was performed. RESULTS: There were 39 sialoceles in the partial superficial parotidecotomy group (39/100-39%) and none in the near-total parotidectomy group (0/20-0%). (p⬍0.05). All sialoceles resolved by the end of the fourth post-operative week whether aspirated or not aspirated. CONCLUSIONS: Sialoceles are common post-partial superficial parotidectomy and did not occur after near-total parotidectomy. Patients should be advised in the pre-operative counseling period of this possible event after partial superficial parotidectomy. Sialoceles after parotidectomy can generally be treated by observation. Needle aspiration and antibiotics are optional.
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Incidence of Micropapillary Carcinoma in Total Thyroidectomy Michael Navid Pakdaman, BS (presenter); Michael P Hier, MD; Michael Tamilia, MD, FRCP; Martin J Black, FRCS(C); Richard J Payne, MD, MSc, FRCS OBJECTIVE: (1) Compare prognostic factors in thyroid micropapillary carcinoma (MPC) ⬍5 mm versus ⬎⫽5 mm. (2) To compare MPC characteristics in patients with pre-existing thyroid carcinoma to patients with no other thyroid carcinoma. METHODS: Pathology results were reviewed for consecutive total thyroidectomy patients between 2002 and 2007 (n⫽835). Hemithyroidectomies and completion thyroidectomies were excluded. Statistical significance of the difference in incidences was calculated using Fisher’s exact test and chi-squared analysis. RESULTS: MPC was found in 50.2% of total cases. Where the size was ⬍5mm (64%), 9.3% extended beyond the thyroid capsule, 51.7% were multifocal, and 27.5% were bilateral. In MPCs ⬎⫽5 mm (36%), the data showed 25.2%, 70.9%, 51%, respectively (p-value always ⬍ 0.05). In the 314 patients with no other thyroid malignancy, MPC was found in 47.1% of cases. 14.9% had capsular extension; 50% were multifocal, of which 56.8% were bilateral. In the 521 patients with malignant disease, the data showed 52.1%, 15.1%, 63.2%, and 63.3%,
respectively, with p-values via Fisher’s exact test .22, .112, .003, and .07. CONCLUSIONS: In this study, MPC was found in 50.2% of patients. MPC’s ⬎⫽5 mm carried an increased risk for extracapsular spread, multifocality, and bilaterality. While patients with malignancies of the thyroid (aside from MPC) more commonly have multifocal MPCs, there was no significant difference in bilaterality, size, or extracapsular spread in MPCs in the presence of malignant vs. benign disease. Increased Survival in HPV Positive Oropharyngeal SCCa Anthony C. Nichols, MD (presenter); William Faquin, MD, PhD; Shanaz Begum, MD, PhD; William H Westra, MD; John Clark MD; James W Rocco, MD, PhD OBJECTIVE: To determine if HPV16 infection is associated with improved survival in advanced oropharyngeal squamous cell carcinoma (OPSCC) treated with chemoradiation. METHODS: A retrospective chart review was performed in 44 patients with stage III and IV OPSCC who were treated with curative intent using chemoradiation. Tumor specimens were evaluated for the presence of HPV16 DNA with the in-situ hybridization-catalyzed signal amplification method applied to pre-treatment archival tumor specimens. Tumors were scored as HPV positive if a signal specific to tumor nuclei was detected. Progression-free survival was estimated by KaplanMeier analysis. Outcome analyses were performed in the subsets of those with documented local, regional or distant relapse, and in disease-free patients, with a minimum of 2 years for follow-up. RESULTS: The incidence of HPV16 positive tumors in this patient population was 59%. Overall progression-free survival independent of HPV status was 62%, while survival for patients with HPV16 positive tumors was 78%. Survival of patients with HPV negative tumors was considerably less at 40%. Only HPV status was associated with response to chemoradiation (p⫽0.006). Patient age, performance status, and tumor stage were not predictive of response. Patients with a history of smoking and heavy alcohol use had an inverse association with HPV status and lower survival in response to chemoradiation (p⫽.00015). CONCLUSIONS: Patients with OPSCC tumors resulting from HPV16 infection are more likely to respond to platinum-based concurrent chemoradiation, than HPV negative patients with traditional risk factors for oropharyngeal head and neck cancer. Lymph Node Clustering in Head and Neck Squamous Cell Cancer Kimberly J. Lee, MD (presenter); Claudia Kirsch, MD; James William Sayre, PhD; Sunita Bhuta, MD; Elliot Abemayor, MD, PhD
SCI. ORALS
cele occurs at a higher incidence with a partial superficial parotidectomy compared to a near complete parotidectomy; both with facial nerve dissection. (2)To determine if needle aspiration vs. observation yields more persistant sialoceles beyond 4 weeks. METHODS: Retrospective, single surgeon, single institution study comparing 100 consecutive partial superficial parotidectomy procedures and 20 consecutive near-total parotidectomy procedures for formation of post-operative sialocele. Study period 2004-2007. The first 18 sialoceles were treated with one or more needle aspirations. The last 21 sialoceles were treated with observation and no needle aspiration. Antibiotics were not used beyond the first week of surgery in either group. Chi Square analysis was performed. RESULTS: There were 39 sialoceles in the partial superficial parotidecotomy group (39/100-39%) and none in the near-total parotidectomy group (0/20-0%). (p⬍0.05). All sialoceles resolved by the end of the fourth post-operative week whether aspirated or not aspirated. CONCLUSIONS: Sialoceles are common post-partial superficial parotidectomy and did not occur after near-total parotidectomy. Patients should be advised in the pre-operative counseling period of this possible event after partial superficial parotidectomy. Sialoceles after parotidectomy can generally be treated by observation. Needle aspiration and antibiotics are optional.
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