Radiation therapy for patients with newly diagnosed metastatic head and neck squamous cell carcinoma

Abstract

Background

To assess the association between radiation therapy (RT) use and overall survival (OS) for patients with metastatic head and neck squamous cell carcinomas (HNSCC).

Methods

We analyzed the National Cancer Database to identify patients with newly diagnosed metastatic HNSCC from 2004 to 2013 who were treated with up‐front chemotherapy. Associations between the use of RT and OS were evaluated.

Results

We identified 3516 patients with metastatic HNSCC who were treated with chemotherapy; 2288 (65%) were also treated with RT. The addition of RT to chemotherapy was associated with prolonged survival (median: 13.6 vs 11.3 months, log‐rank P < .001). After adjusting for other prognostic factors in a multivariable Cox model, propensity score matching and landmark analyses limited to patients who survived at least 3, 6, and 12 months after diagnosis, the use of RT remained associated with prolonged survival.

Conclusion

The addition of RT to chemotherapy in the up‐front management of metastatic HNSCC was associated with prolonged OS in this study.

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Obituary

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A novel preservation solution containing a JNK inhibitory peptide efficiently improves islet yield for porcine islet isolation

Background For islet transplantation, pancreas preservation in UW solution is associated with disadvantages such as collagenase inhibition, resulting in poor islet yield and islets with poor viability. In this study, we evaluated a novel preservation solution, the extracellular-type c-Jun N-terminal kinase (JNK) inhibitor-containing (EJ) solution. Methods EJ solution has high sodium-low potassium composition with low viscosity compared to UW solution. Moreover, EJ solution contains a recently developed JNK inhibitor from our laboratory. Results We first compared the performance of EJ solution with that of UW solution. Islet yield before and after purification was significantly higher in the EJ group than in the UW group. Second, we compared the performance of EJ solution with that of EJ solution without the JNK inhibitor (EJ-J solution). After pancreas preservation in EJ solution, JNK activity was maintained at a relatively low level during islet isolation. Islet yield before and after purification was significantly higher in the EJ group than in the EJ-J group. After islet transplantation into streptozotocin-induced diabetic mice, blood glucose levels reached the normoglycemic range in 61.5% and 7.7% of diabetic mice in the EJ and EJ-J groups, respectively. Moreover, EJ solution exhibited reduced inhibition of collagenase digestion compared to UW solution. Conclusion Advantages of EJ solution over UW solution were inhibition of JNK activity and reduced collagenase inhibition. EJ solution may therefore be more suitable for islet isolation than UW solution. *Address correspondence to: Hirofumi Noguchi, MD, PhD, Department of Regenerative Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan. Tel: +81-98-895-1696; Fax: +81-98-895-1684. E-mail: noguchih@med.u-ryukyu.ac.jp Author Contributions H.N. designed the experiments and analyzed the data. H.N. carried out most of the experimental work with the help of. C.M-S., Y.N. N.E., E.H., Y.T., and K.K., S.K., N.K., I.S., and M.W. provided materials and discussion. H.N. wrote the manuscript. All authors discussed and commented on the manuscript. Competing Interests: The authors declare that they have no competing interests. Funding sources: This work was supported in part by JSPS KAKENHI Grant Numbers JP16H05404, JP16K10435, and JP18K08545, Japan Agency for Medical Research and Development, Okinawa Science and Technology Innovation System Construction Project, the Waksman Foundation of Japan, Inc., and The Naito Foundation. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Home-based Cognitive Prehabilitation in Older Surgical Patients: A Feasibility Study

Background: Cognitive training is beneficial in various clinical settings, although its perioperative feasibility and impact remain unknown. The objective of this pilot study was to determine the feasibility of home-based cognitive prehabilitation before major surgery in older adults. Materials and Methods: Sixty-one patients were enrolled, randomized, and allocated to either a home-based preoperative cognitive training regimen or no training before surgery. Outcomes included postoperative delirium incidence (primary outcome; assessed with the 3D-Confusion Assessment Method), perioperative cognitive function based on NIH Toolbox measures, hospital length of stay, and physical therapy session participation. Reasons for declining enrollment were reported, as were reasons for opting out of the training program. Results: Postoperative delirium incidence was 6 of 23 (26%) in the prehabilitation group compared with 5 of 29 (17%) in the control group (P=0.507). There were no significant differences between groups in NIH Toolbox cognitive function scoring, hospital length of stay, or physical therapy participation rates. Study feasibility data were also collected and reported. The most common reasons for declining enrollment were lack of computer access (n=19), time commitment (n=9), and feeling overwhelmed (n=9). In the training group, only 5 of 29 (17%) included patients were able to complete the prescribed 7 days of training, and 14 of 29 (48%) opted out of training once home. Most common reasons were feeling overwhelmed (n=4) and computer difficulties (n=3). Conclusions: Short-term, home-based cognitive training before surgery is unlikely to be feasible for many older patients. Barriers to training include feeling overwhelmed, technical issues with training, and preoperative time commitment. P.E.V. is supported by National Institutes of Health Grant K23GM126317. The study was also supported by the Department of Anesthesiology, University of Michigan Medical School (Ann Arbor, MI). The methodology of this trial was presented as a poster presentation at the Foundation for Anesthesia Education and Research 2017 Medical Student Anesthesia Research Fellowship Symposium (MSARF Fellow: A.R.D.). The authors have no funding or conflicts of interest to disclose. Address correspondence to: Phillip E. Vlisides, MD, Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, SPC-5048, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048 (e-mail: pvliside@med.umich.edu). Received September 12, 2018 Accepted November 16, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Rates of sialoendoscopy and sialoadenectomy in 5,111 adults with private insurance

Objective

To determine frequencies and trends in sialoendoscopy and sialoadenectomy for the treatment of obstructive, nonneoplastic submandibular gland disease in the United States.

Methods

Epidemiologic study of insurance claims from 2006 to 2013 in a large, private insurance claims database. Rates were calculated for patients undergoing one or both index procedures.

Results

A total of 5,111 adults with sialadenitis who underwent sialoendoscopy or submandibular gland excision were included. Mean age was 47.6 years, and patients undergoing sialoendoscopy were less likely to be male (relative risk [RR] = 0.84; 95% confidence interval [CI], 0.78–0.89), more likely to have sialoadenitis without stones (RR = 1.60; 95% CI, 1.53–1.66), and had a similar number of comorbidities (RR = 1.00; 95% CI, 0.91–1.06) compared to patients undergoing sialoadenectomy. The most common complication after sialoadenectomy was surgical site infection (1.4%; 95% CI, 1.1–1.8%), and complications after sialoendoscopy were rare. From 2007 to 2013, use of sialoendoscopy increased from 0.13 (95% CI, 0.08–0.18) to 0.42 (95% CI, 0.40–0.45) per 100 thousand people, and sialoadenectomy decreased from 2.41 (95% CI, 2.39–2.42) to 1.43 (95% CI, 1.40–1.44) per 100 thousand. The highest mean rate of sialadenectomy was seen in the south (2.15 per 100,000; 95% CI, 2.13–2.16), the lowest was in the west (1.6 per 100,000; 95% CI, 1.57–1.62), and it decreased in all regions over time.

Conclusion

Utilization of sialoendoscopy has increased over time, and the overall rate of sialoadenectomy is decreasing. Both procedures are safe for treatment of patients with sialadenitis and sialolithiasis. Future research should examine whether availability of sialoendoscopy leads to a decreased rate of sialoadenectomy in patients with salivary gland disease.

Level of Evidence

2c. Laryngoscope, 2018

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The use of dermoscopy in differentiating Sister Mary Joseph nodule and cutaneous endometriosis

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The use of dermoscopy in differentiating Sister Mary Joseph nodule and cutaneous endometriosis

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