Recurrent pleomorphic adenoma of the parotid gland

Otolaryngology– Head and Neck Surgery Volume 131 Number 2

9:08 AM Genes Predictive of Chemoradiotherapy Response in Laryngopharyngeal Carcinoma Ian Ganly, MD PhD (presenter); Simon Talbot, MD; Ellie G. Maghami, MD; Agnes Viale; Adam Olshen, MD; Jatin P Shah, MD; Nicholas Socci, MD; Bhuvanesh Singh, MD New York NY; New York NY; New York NY; New York NY; New York NY; New York NY; New York NY; New York NY

Objectives: To identify angiogenesis/metastasis related genes that are predictive of locoregional failure in patients undergoing chemoradiotherapy (CRT) treatment. Methods: Tumor tissue was collected and snap-frozen from 35 sequential patients with histologically confirmed laryngopharyngeal cancer being treated with CRT. Gene expression analysis was performed on all cases using a novel cDNA array consisting of 277 genes functionally associated with angiogenesis (n ⫽ 152) and/or metastasis (n ⫽ 125). A total of 1152 randomly selected genes were used for inter-

sample normalization. RNA was extracted from freshly frozen pretreatment biopsies, reverse transcribed, labelled using cy3 and cy5, and then hybridized onto the micro array slide. Image capture and analysis was performed using GenePix Pro 3.0. Locoregional failure was correlated to the gene expression profiles to identify genes predictive for locoregional failure. Genes were validated and quantified using real time RT-PCR. Results: Of 35 patients, locoregional failure occurred in 9. Seventeen genes correlated with locoregional failure (2 sample t test P ⬍ 0.05). Seven genes were chosen for further analysis based on the availability of commercially available antibodies for immunohistochemistry. Of these 7 genes, real time RT-PCR validated 4 genes (mdm2, VCAM-1, ERBB2 and HRAS) (Wilcoxen rank sum test; 0.008, 0.024, 0.041 and 0.035, respectively). The predictive value of these genes was further validated by immunohistochemistry on an independent set of paraffin embedded LPC from patients treated CRT. Conclusions: Genomic screening and real-time RT-PCR analyses identified and validated 4 genes predictive for locoregional failure in LPC patients treated by CRT. The role of these genes in treatment selection and the functional basis for their activity in CRT response merits further consideration.

9:16 AM Recurrent Pleomorphic Adenoma of the Parotid Gland John P Leonetti, MD (presenter); Sam J Marzo, Petruzzelli, MD MBA PhD Maywood IL; Maywood IL; Maywood IL

MD;

Guy J

Objectives: To assess the long-term results in the management of 42 patients with recurrent pleomorphic adenoma of the parotid gland. Methods: A retrospective analysis of 42 patients who underwent parotidectomy for recurrent pleomorphic adenoma was performed to study presenting clinicoradiographic features, surgical technique, facial nerve management, and longterm recurrence incidence. Results: All 42 patients presented with multifocal, nontender, recurrent nodules following 1 to 4 prior surgical procedures and 6 patients underwent prior radiotherapy. Surgical procedures included subtotal parotidectomy in 12 patients, total parotidectomy in 28 patients, parotidectomy with facial nerve resection in 7 cases, and subtotal petrosectomy with facial nerve resection in 5 individuals. Two tumors were carcinoma ex-pleomorphic adenoma and the rest were pleomorphic adenomas. Patient follow-up ranged from 2 years to 13 years with a mean follow-up of 7.2 years. The 2 patients with malignant transformation died of dissemenated lung and bone metastasis. Twenty-nine of the remaining 40 patients have no recurrent disease. Seven patients developed local

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Objectives: The modified barium swallow (MBS) is frequently used to evaluate dysphagia in the head and neck cancer population. The relationship between MBS findings and dysphagia symptoms, however, is not well understood. The present study seeks to determine whether an association exists between MBS parameters and the M.D. Anderson Dysphagia Inventory (MDADI), a dysphagia-specific quality of life (QOL) measure. Methods: Cross-sectional study of adult subjects (n ⫽ 42) with no evidence of disease 12 months or more after treatment of a stage III or IV squamous cell carcinoma of the oropharynx or larynx. All subjects completed the MDADI followed by MBS. The MBS examinations were scored for the nonlaryngectomy group (n ⫽ 28) using the validated Pentration-Aspiration Scale (PAS). Additional MBS parameters assessed include tongue base retraction, maximal hyoid excursion, maximal laryngeal excursion, and maximal pharyngo-esophageal segment opening. Results: There were no significant differences in MDADI scores between subjects with penetration and/or aspiration on MBS when compared to subjects with no penetration and/or aspiration. The penetration-aspiration group demonstrated a trend (P ⫽ 0.09) toward worse scores on the functional subscale of the MDADI which may indicate greater difficulty when eating in public and with food preparation. Conclusions: The presence of penetration or aspiration on MBS does not predict the degree to which dysphagia effects quality of life. Some patients with penetration and aspiration have few dysphagia-related symptoms, whereas others without penetration or aspiration are greatly impaired. The identification of MBS parameters that are more predictive of dysphagia-related quality of life may help to improve the validity and reliability of the MBS.

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Scientific Session—Monday

parotid bed or cutaneous recurrent disease, 2 patients died of unrelated causes, and 2 patients were lost to follow-up. Conclusions: Tumor recurrence was found in 7 of 42 patients following our surgical resection. All seven of these patients underwent subtotal parotidectomy with “negative” surgical margins. Total parotidectomy or sub-

total petrosectomy with facial nerve resection in selected cases may reduce the risk of multiple episodes of pleomorphic adenoma recurrence. Two of 42 patients were found to have carcinoma ex-pleomorphic adenoma; both of these patients underwent prior radiotherapy, and both died of metastatic disease.

8:00 AM to 9:30 AM Room JJCC 1A12

middle ear reconstruction. Prolonged stable fixation may translate into long term improvements in hearing.

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Scientific Session: Otology/Neurotology Moderators: Karen J. Doyle, Driscoll, MD

MD, PhD,

Colin L. W.

8:08 AM Should Ossicular Reconstruction Be Staged after Tympanomastoidectomy?

8:00 AM Use of Hydroxyapatite Bone Cement for Difficult Ossicular Reconstruction Joel A Goebel, MD; Abraham Jacob, MD (presenter) St Louis MO; St Louis MO

Objectives: Conventional ossiculoplasty relies on favorable anatomy, surface tension, and packing to hold the reconstruction in its desired position. This can be frustrating when faced with difficult ossicular chain abnormalities that need a more stable fixation. We describe the use of Mimix™, a rapidly setting, nontoxic hydroxyapatite bone cement for the repair of complex ossicular problems in patients undergoing tympanomastoidectomy or stapedotomy. Methods: Mimix™ was used to cement partial ossicular replacement prostheses into position, repair incudostapedial joint separation and incus necrosis, repair incus necrosis during revision stapedotomy, augment the tapered incus during primary stapedotomy, and rebuild a total tympanic membrane perforation with a tympanic membrane/malleus head homograft. Preoperative and serial postoperative audiograms were examined for 4-tone pure tone average (PTA), speech reception thresholds (SRT), and word recognition scores (WRS) in 14 patients with up to 18 months follow-up. Results: The average improvement for PTA, SRT, and WRS approximated 22dB, 23dB, and ⫹6%. Most patients demonstrated a significant closure of their air-bone gap. There was 1 case of unexplained delayed mixed hearing loss 7 months after surgery following successful air-bone gap closure. Conclusions: Even experienced otologists have desired some way to better fixate an ossicular repair into place during difficult cases. Our experience with Mimix™ hydroxyapatite bone cement suggests that such rigid fixation may now be available. Its paste-like consistency, rapid setting time, osteoconductivity, and lack of neurotoxicity make it ideal for

Harold Kim, MD (presenter); Robert A Battista, MD; Arvind Kumar, MD; Richard J Wiet, MD Chicago IL; Hinsdale IL; Hinsdale IL; Hinsdale IL

Objectives: To determine whether ossicular reconstruction concurrent with tympanomastoidectomy results in significantly different hearing results when compared to ossicular reconstruction performed in a deferred procedure following tympanomastoidectomy. Methods: All patients undergoing ossicular reconstruction within a 2-year period were identified at a tertiary referral otology practice. These patients were segregated into 2 groups. Group 1 comprised those who had ossicular reconstruction concurrent with a tympanomastoidectomy for otomastoiditis with or without cholesteatoma. Group 2 comprised those who had a deferred ossicular reconstruction following tympanomastoidectomy. Pure-tone thresholds obtained on the last postoperative visit were noted. The frequency by which an air-bone gap (ABG) of less than 20 dB and less than 30 dB resulted were determined as well as mean final ABG for both groups. Results: Ninety patients were identified with a mean age of 37.6 ⫾ 19.4 years. Forty-eight underwent ossicular reconstruction concurrent with tympanomastoidectomy while 42 underwent a staged ossicular reconstruction following tympanomastoidectomy. Within Group 1, 56.3% had a postoperative ABG⬍20 dB while a similar 54.8% of Group 2 had a postoperative ABG ⬍ 20 dB (P ⫽ 0.341). In Group 1, 81.3% had ABG ⬍ 30 dB, and 81% of Group 2 had a postoperative ABG ⬍ 30 dB (P ⫽ 0.353). Overall, Group 1 had a mean postoperative ABG of 20.8 dB while Group 2 had a similar mean postoperative ABG of 20.2 dB (P ⫽ 0.744). Conclusions: Ossicular reconstruction concurrent with tympanomastoidectomy does not compromise the extent of postoperative hearing gain when compared to those who

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Otolaryngology– Head and Neck Surgery August 2004