2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

ii. When to do neck dissection for SCCA, role for sentinel node in SCCA Harris BN, Bayoumi A, Rao S, et al. Factors associated with recurrence and regional adenopathy for head and neck cutaneous squamous cell carcinoma. Otolaryngol Head Neck Surg . 2017; 156(5):863-869. EBM level 4.......................................................................................................86-92 Summary : The subset of patients who present with advanced disease are not well represented by the AJCC 7th edition. This paper examined 212 patients with advanced disease, such as recurrent tumors, perineural invasion (PNI), and depth of invasion > 2 mm, features found in < 5% of patients with cutaneous SCC of the head and neck. In this study, PNI was an independent predictor for recurrence (hazard ratio = 2.62; p = 0.028), and these patients were 2.74 times more likely to present with nodal disease. On multivariate analysis, the poorly differentiated histology was associated with a 2.34 times greater risk for recurrence, and previous treatment was associated with a 2.21 times greater risk for recurrence. Additionally, patients with a primary tumor site on the ear, cheek, temple, or lip were more likely to present with regional metastatic disease. i. Deintensification of therapy Barney CL, Walston S, Zamora P, et al. Clinical outcomes and prognostic factors in cisplatin versus cetuximab chemoradiation for locally advanced p16 positive oropharyngeal carcinoma. Oral Oncol . 2018; 79:9-14. EBM level 3....................................................................................93-98 Summary : Current trends towards using cetuximab over cisplatin to deintensify oropharyngeal cancer treatment occurred prior to the randomized control trial data evaluating these agents. This study is a retrospective evaluation of patients who received either agent with radiotherapy. Cisplatin offered improved locoregional and overall survival compared with cetuximab. Chera BS, Amdur RJ, Tepper JE, et al. Mature results of a prospective study of deintensified chemoradiotherapy for low-risk human papillomavirus-associated oropharyngeal squamous cell carcinoma. Cancer . 2018; 124(11):2347-2354. EBM level 2..................................................99-106 Summary : This study is a prospective phase II trial for treatment of oropharyngeal squamous cell carcinoma with weekly low-dose cisplatin and 60-Gy radiotherapy. Three-year locoregional, disease-free, and overall survival rates were 100%, 100%, 95%, respectively. Quality-of-life and swallowing scores were good. No patients required permanent PEG tubes, though 39% of patients required PEG tubes during therapy. Sethia R, Yumusakhuylu AC, Ozbay I, et al. Quality of life outcomes of transoral robotic surgery with or without adjuvant therapy for oropharyngeal cancer. Laryngoscope . 2018; 128(2):403-411. EBM level 4...............................................................................................................................107-115 Summary : This study prospectively evaluated 111 patients undergoing transoral robotic surgery (TORS) management for oropharyngeal cancer with or without adjuvant therapy. Patients who underwent TORS alone maintained higher quality-of-life and functional scores than patients who received postoperative radiation or chemoradiation. There were no PEG tubes or tracheostomy in the surgery-only treatment cohort.

III. Upper Aerodigestive Tract A. Oropharynx