Perioperative opioids and survival outcomes in resectable head and neck cancer: A systematic review.

BACKGROUND: Opioids are a mainstay in pain control for oncologic surgery. The objective of this systematic review is to evaluate the associations of perioperative opioid use with overall survival (OS) and disease-free survival (DFS) in patients with resectable head and neck cancer (HNC). METHODS: A systematic review of PubMed, SCOPUS, and CINAHL between 2000 and 2022 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies investigating perioperative opioid use for patients with HNC undergoing surgical resection and its association with OS and DFS were included. RESULTS: Three thousand three hundred seventy-eight studies met initial inclusion criteria, and three studies representing 562 patients (intraoperative opioids, n = 463; postoperative opioids, n = 99) met final exclusion criteria. One study identified that high intraoperative opioid requirement in oral cancer surgery was associated with decreased OS (HR = 1.77, 95% CI 0.995-3.149) but was not an independent predictor of decreased DFS. Another study found that increased intraoperative opioid requirements in treating laryngeal cancer was demonstrated to have a weak but statistically significant inverse relationship with DFS (HR = 1.001, p = 0.02) and OS (HR = 1.001, p = 0.02). The last study identified that patients with chronic opioid after resection of oral cavity cancer had decreased DFS (HR = 2.7, 95% CI 1.1-6.6) compared to those who were not chronically using opioids postoperatively. CONCLUSION: An association may exist between perioperative opioid use and OS and DFS in patients with resectable HNC. Additional investigation is required to further delineate this relationship and promote appropriate stewardship of opioid use with adjunctive nonopioid analgesic regimens

Sentinel lymph node biopsy for head and neck malignancies utilizing simultaneous radioisotope gamma probe and indocyanine green fluorescence navigation.

We depict an innovative surgical approach for sentinel lymph node biopsy (SLNB) in head and neck malignancies that utilizes both near-infrared (NIR) imaging with indocyanine green (ICG) dye and hand-held gamma probe intraoperatively to isolate and excise SLNs. Twenty-one patients presented to our institution with cutaneous melanoma, cutaneous squamous cell carcinoma (SCC), and oral cavity SCC tumors that met criteria for SLNB based on tumor depth and histology. The video offers a step-by-step approach for this technique along with descriptions of recommended equipment. Among 21 patients, two patients had positive SLNs on final pathology. One patient developed a local recurrence over an average of 16.2 months of follow-up (SD = 15.6). SLNB with ICG and radionucleotide co-localization may enhance the identification of sentinel nodes without compromising outcomes in the hands of surgeons well-versed in the technique

Examination of care processes and treatment optimization for head and neck cancer patients in a community setting “hub and hub” model

Objective To examine referral pattern, the timing of diagnostic/staging processes, and treatment initiation for new head and neck cancer patients in a community setting. Methods Patients with a newly diagnosed previously untreated diagnosis of head neck cancer managed at Asplundh Cancer Pavilion/Abington Memorial Hospital from October 2018 to March 2020. Source of referral and preceding workup were examined as well as intervals between initial head and neck consult and various timepoints of treatment initiation. Results One hundred and five patients were included in the study. The primary referral sources were external general otolaryngology (56.3%). Oral surgery and dermatology obtained tissue biopsy approximately 80% of the time before referral. The average time from the ordering of initial staging positron emission tomography/computed tomography to finalized results was 14 days (range: 10–25 days). Patients referred from dermatology and oral surgery were more likely to require single modality care, namely definitive surgical management. Time to treatment initiation average was 37 days (range: 29–41 days). Patients with longer treatment times noted significantly higher times to both radiation and medical oncology consults (48.42 vs. 18.13 days; P \u3c 0.001). Conclusions No notable differences in treatment initiation times were identified based on referral source or extent of workup performed before head/neck surgery consult. It appears the largest opportunities for improvement in terms of reducing overall treatment length exist in the optimization of radiation initiation time

Pre-treatment tumor-specific growth rate as a temporal biomarker that predicts treatment failure and improves risk stratification for oropharyngeal cancer

•Serial imaging permits estimates of tumor-specific growth rate (TSGR) for OPC.•Faster TSGR correlates well with p16 status, T-stage and smoking.•TSGR predicts outcomes for oropharyngeal cancer (OPC) in the HPV era.•TSGR calculation may improve identification of de-escalation candidates. To assess the relationship between tumor-specific growth rate (TSGR) and oropharyngeal cancer (OPC) outcomes in the HPV era. Primary tumor volume differences between a diagnostic and secondary scan separated ⩾7days without interval treatment were used to estimate TSGR, defined as percent volume growth/day derived from primary tumor volume doubling time for 85 OPC patients with known p16 status and smoking pack-years managed with (chemo)radiation. Variables were analyzed using Kruskal–Wallis or Fisher’s exact test as appropriate. Log-rank tests and Cox proportional models analyzed endpoints. Using concordance probability estimates (CPE), TSGR was incorporated into RTOG 0129 risk grouping (0129RG) to assess whether TSGR could improve prognostic accuracy. Median time between scans was 35days (range 8–314). Median follow up was 26months (range 1–76). The 0129RG classification was: 56% low, 25% intermediate, and 19% high risk. Median TSGR was 0.74%/day (range 0.01–4.25) and increased with 0129RG low (0.41%), intermediate (0.57%) and high (1.23%) risk, respectively (p=0.015). TSGR independently predicted for TF (TSGR: HR (95%CI)=2.79, 1.67–4.65, p<0.001) in the Cox model. On CPE, prognostic accuracy for TF, disease-free survival and overall survival was improved when 0129RG was combined with TSGR. Dichotomizing 0129RG by median TSGR yielded no observed recurrences in low risk patients with TSGR<0.74% and demonstrated significant difference for intermediate risk (8% vs. 50% for TSGR<0.74% vs. ⩾0.74%, respectively, p<0.001). Tumor-specific growth rate correlates with increasing 0129RG and predicts treatment failure, potentially improving the prognostic strength and risk stratification of established 0129 risk groups

Perioperative opioids and survival outcomes in resectable head and neck cancer: A systematic review

Abstract Background Opioids are a mainstay in pain control for oncologic surgery. The objective of this systematic review is to evaluate the associations of perioperative opioid use with overall survival (OS) and disease‐free survival (DFS) in patients with resectable head and neck cancer (HNC). Methods A systematic review of PubMed, SCOPUS, and CINAHL between 2000 and 2022 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Studies investigating perioperative opioid use for patients with HNC undergoing surgical resection and its association with OS and DFS were included. Results Three thousand three hundred seventy‐eight studies met initial inclusion criteria, and three studies representing 562 patients (intraoperative opioids, n = 463; postoperative opioids, n = 99) met final exclusion criteria. One study identified that high intraoperative opioid requirement in oral cancer surgery was associated with decreased OS (HR = 1.77, 95% CI 0.995–3.149) but was not an independent predictor of decreased DFS. Another study found that increased intraoperative opioid requirements in treating laryngeal cancer was demonstrated to have a weak but statistically significant inverse relationship with DFS (HR = 1.001, p = 0.02) and OS (HR = 1.001, p = 0.02). The last study identified that patients with chronic opioid after resection of oral cavity cancer had decreased DFS (HR = 2.7, 95% CI 1.1–6.6) compared to those who were not chronically using opioids postoperatively. Conclusion An association may exist between perioperative opioid use and OS and DFS in patients with resectable HNC. Additional investigation is required to further delineate this relationship and promote appropriate stewardship of opioid use with adjunctive nonopioid analgesic regimens

Supplementary File 12 from Integrative metatranscriptomic analysis reveals disease-specific microbiome-host interactions in oral squamous cell carcinoma

Host pathways (GSEA genesets) correlating with microbial enzyme classes</p

Supplementary File 8 from Integrative metatranscriptomic analysis reveals disease-specific microbiome-host interactions in oral squamous cell carcinoma

Differentially abundant microbial taxa (MaAsLin2)</p

Supplementary File 11 from Integrative metatranscriptomic analysis reveals disease-specific microbiome-host interactions in oral squamous cell carcinoma

Host pathways (GSEA genesets) correlating with microbial genera</p

Supplementary File 5 from Integrative metatranscriptomic analysis reveals disease-specific microbiome-host interactions in oral squamous cell carcinoma

Host differentially expressed genes and pathways by lymph node status</p