Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer

alexandrossfakianakis shared this article with you from Inoreader Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer via The Laryngoscope Limited data exists on the non-surgical management of stage T4 larynx and hypopharynx cancer patients who are not surgical candidates or refuse surgery. This study aims to investigate the clinical and functional outcomes of non-surgical management of T4 larynx and hypopharynx cancer patients. The outcomes reported in this study will provide guidance for those who have unresectable disease or refuse surgery for advanced laryngeal and hypopharyngeal cancer patients. Objective Limited data is available to guide non-surgical management of Stage T4 larynx and hypopharynx cancer patients who have inoperable disease or refuse surgery. We aim to review the nonoperative management of T4 laryngeal and hypopharyngeal cancer and report the long-term therapeutic and functional outcomes. Methods We reviewed the nonoperative management of T4 laryngeal (n = 44) and hypopharyngeal (n = 53) cancer from 1997 to 2015 and performed a univariate analysis (UVA). Results The 2-/5-year OS rates were 73%/38% for larynx patients and 52%/29% for hypopharynx patients. Locoregional failure (LRF) occurred in 25% and 19% of larynx and hypopharynx patients, respectively. On UVA of the larynx subset, N3 nodal status and non-intensity-modulated radiation therapy were negatively associated with OS; treatment with radiation therapy alone impacted disease-free survival; and age >70 was associated with LRF. On UVA of the hypopharynx subset, only T4b status significantly impacted OS. In the larynx and hypopharynx groups, 68% and 85% received a percutaneous endoscopic gastrostomy (PEG) tube and 32% and 40% received a tracheostomy tube, respectively. At the last follow-up visit, 66% of our larynx cohort had neither tracheostomy or PEG placed and 40% of our hypopharynx cohort had neither. Conclusion We report better than previously noted outcomes among T4 larynx and hypopharynx patients who have unresectable disease or refuse surgery. Level of Evidence Level 4 Laryngoscope, 2022 View on Web

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Predicting Progression of Oral Lesions to Malignancy Using Machine Learning

alexandrossfakianakis shared this article with you from Inoreader Predicting Progression of Oral Lesions to Malignancy Using Machine Learning via The Laryngoscope Objective To use large-scale electronic health record (EHR) data to develop machine learning models predicting malignant transformation of oral lesions. Methods A multi-institutional health system database was used to identify a retrospective cohort of patients with biopsied oral lesions. The primary outcome was malignant transformation. Chart review and automated system database queries were used to identify a range of demographic, clinical, and pathologic variables. Machine learning was used to develop predictive models for progression to malignancy. Results There were 2192 patients with a biopsied oral lesion, of whom 1232 had biopsy proven oral dysplasia. There was malignant transformation in 34% of patients in the oral lesions dataset, and in 54% of patients in the dysplasia subset. Multiple machine learning-based models were trained on the data in two experiments, (a) including all patients with biopsied oral lesions and (b) including only patients with biopsy-proven dysplasia. In the first experiment, the best machine learning models predicted malignant transformation among the biopsied oral lesions with an area under the curve (AUC) of 86%. In the second experiment, the random forest model predicted malignant transformation among lesions with dysplasia with an AUC of 0.75. The most influential features were dysplasia grade and the presence of multiple lesions, with smaller influences from other features including anemia, histopathologic description of atypia, and other prior cancer history. Conclusion With diverse features from EHR data, machine learning approaches are feasible and allow for generation of models that predict which oral lesions are likely to progress to malignancy. Level of Evidence 3 Laryngoscope, 2022 View on Web

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Dilation, Steroid Injection, and Cough Exercise for Correction of Posterior Glottic Stenosis

alexandrossfakianakis shared this article with you from Inoreader Dilation, Steroid Injection, and Cough Exercise for Correction of Posterior Glottic Stenosis via The Laryngoscope DISCO (Dilation, Steroid injection and post-operative Cough Exercise) is a novel protocol for correcting posterior glottic stenosis. Post-op cough acts as physical-therapy to improve motion and flexibility. It can restore mobility and expand glottic airway without insufficiency. Objective To describe the DISCO protocol (Dilation, Steroid injection, and post-operative Cough Exercise); a novel treatment for posterior glottic stenosis (PGS). Restoring glottic mobility in PGS is a major challenge. In orthopedic and plastic surgery, post-operative physical therapy is associated with improved motion range and flexibility; yet, this principle was never applied to laryngeal surgery. Methods A retrospective cohort of PGS adult patients, treated by the DISCO protocol during 2018–2020. DISCO involves the following: scar release, glottic dilation, and steroid injection, followed by post-operative cough as glottic physical therapy. Maximal glottic opening angle (MGOA), relative glottic opening area (RGOA), and relative glottic insufficiency area (RGIA) were calculated before and post-operatively. Results Seventeen patients were included; PGS etiology was post-intubation (n = 10), post-irradiation (n = 3), both (n = 1) and joint sclerosis (n = 3). Six patients also had additional airway disorders. Sixteen patients were tracheostomy-dependent. 2 (12%), 8 (47%) and 7 (41%) patients had type II, III and IV stenosis, respectively. Surgery included scar release, dilation and steroid injection alone in 7 patients; and additional unilateral sub-mucosal arytenoidectomy in 10. The mean follow-up was 17.5 months. There were no major complications. Successful outcomes (e.g., decannulation or permanent capping) were achieved in 14 (82%) patients with some restoration of joint movement. None had a persistent voice or swallowing complaints. Both MGOA and RGOA increased in all patients (p < 0.001). RGIA remained unchanged (p = 0.878). Conclusions The DISCO protocol is a novel, effective and safe approach for PGS correction that can be easily applied. It can restore vocal fold mobility and may expand the glottic airway without causing glottic insufficiency. Level of Evidence 4 Laryngoscope, 2022 View on Web

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Hospira Issues a Voluntary Nationwide Recall for One Lot of Propofol Injectable Emulsion, USP (Containing Benzyl Alcohol), Due to the Potential Presence of Visible Particulate

alexandrossfakianakis shared this article with you from Inoreader Hospira Issues a Voluntary Nationwide Recall for One Lot of Propofol Injectable Emulsion, USP (Containing Benzyl Alcohol), Due to the Potential Presence of Visible Particulate via Food and Drug Administration--Recalls/Safety Alerts Hospira, Inc., a Pfizer company, is voluntarily recalling one lot of Propofol Injectable Emulsion, USP (containing benzyl alcohol) to the user level due to a visible particulate observed in a single vial during annual examination of retain samples View on Web

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