Wiley: Head & Neck: Table of Contents

Longitudinal Swallowing and Salivary Changes With CLR 131 and Re‐Irradiation in Recurrent Head and Neck Cancer

Fri, 15 May 2026 23:05:01 -0700

ABSTRACT

Background

ABSTRACT

Background

Perineural invasion (PNI) in head and neck squamous cell carcinoma (SCC) results in worse overall survival. Diagnosis requires resection and microscopic evaluation.

Methods

A 63-year-old male with persistent cT4aN0 p16-positive SCC of the left base of tongue following chemoradiotherapy underwent salvage total glossectomy. Fluorescence-guided imaging of the wound bed was performed with PDE-GEN3 near-infrared (NIR) imaging following infusion of an optically EGFR-targeted antibody, Panitumumab-IRDye800 (pan800).

Results

The proximal resected hypoglossal nerve was imaged intraoperatively and demonstrated a strong green fluorescence signal, raising concern for subclinical PNI. Biopsy of the nerve revealed SCC on frozen section analysis. This was re-resected with subsequent proximal margin negative for carcinoma. Postoperatively, ex vivo imaging of the nerve using PDE-GEN3 NIR imaging again demonstrated the presence of pan800 within the initial positive nerve margin, confirming subclinical PNI.

Conclusions

This case shows the feasibility of intraoperative fluorescence as a method to help identify subclinical PNI.

Trial Registration: ClinicalTrials.gov identifier: NCT05945875

Off‐Label Use of a Tracheoesophageal Prosthesis for Occlusion of an Oronasal Fistula

Alice Su, Jackson King, Peter Belafsky, Lisa Evangelista — Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

An oronasal fistula is an abnormal communication between the oral and nasal cavities, which can arise as a result of radiation therapy for head and neck cancer, resulting in significant speech and swallowing challenges.

Methods

We present a case in which a transesophageal prosthesis (TEP) was used as an alternative to existing treatment options for oronasal fistulas, which include surgical repair or a palatal obturator prosthesis.

Results

A 59-year-old female with a history of poorly differentiated squamous cell carcinoma of the nasopharynx with metastatic neck disease, treated with radiation therapy over 20 years ago, presented with an oronasal fistula resulting in significant weight loss and hypernasal speech. Due to the discomfort caused by a palatal obturator, a TEP device was offered as an alternative treatment option for the patient's oronasal fistula. Post-procedure videofluoroscopic swallow study and speech analysis demonstrated markedly improved nasal regurgitation and speech intelligibility.

Conclusion

This case demonstrates the use of a TEP device as an effective, non-surgical treatment option for oronasal fistula.

Issue Information

Fri, 08 May 2026 06:15:10 -0700

Head &Neck, Volume 48, Issue 6, Page 1405-1407, June 2026.

Correction to “Comparison of Outcomes Between Free Ileocolonic and Tube‐Shaped ALT Fasciocutaneous Flaps in Total Hypopharyngeal Defect Reconstruction”

Exposure

Self-reported history of sexual behaviors, substance use, and medical history via electronic survey; serum testing for antibodies to low- and high-risk HPV E6, E7, E1, E2, and L1 oncoproteins using a multiplex bead-based assay.

Main Outcome and Measure

Odds of HPV-SNC or HPV-independent SNC diagnosis in relation to risk factors; differences in HPV seropositivity between groups.

Results

Among the 37 cancer patients who completed the survey, a history of tonsillectomy was significantly associated with reduced odds of HPV-SNC (OR 0.28, CI 0.09–0.86). No other factors explored (sexual behavior, substance use, or other clinical factors) were associated with HPV-associated SNC and HPV-independent SNC. Seroprevalence of anti-HPV16 E6 was significantly higher among HPV-associated SNC cases than either controls or HPV-independent SNC (45.8% vs. 0% and 13.1%), HPV-16 E6 (18.2% vs. 0% and 4.0%), and HPV-16 early proteins (16.7% vs. 0% and 0%) than HPV-independent SNC patients or controls, respectively.

Conclusions and Relevance

HPV-SNC exhibits distinct serologic features without clear behavioral risk factors. The protective association of tonsillectomy suggests lymphoid tissue may play a role in HPV-associated sinonasal oncogenesis. In contrast, the absence of identifiable risk factors for HPV-independent SNC highlights the need for further etiologic studies.

Limited Sensitivity of Ultrasound‐Guided Fine‐Needle Aspiration Cytology for Occult Nodal Metastases in Early‐Stage Oral Squamous Cell Carcinoma

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

Ultrasound-guided fine-needle aspiration cytology (US-FNAC) is commonly used in the diagnostic work-up of head and neck cancer, but its ability to detect occult lymph node metastases in early-stage oral squamous cell carcinoma (OSCC) with a clinically negative neck remains unclear.

Methods

A retrospective analysis was performed in 578 patients with early-stage OSCC (cT1-3N0) who underwent US-FNAC prior to surgery. Histopathology, sentinel lymph node biopsy, and follow-up were used as reference standards.

Results

Occult nodal metastases were found in 179 patients (31.0%). US-FNAC showed low sensitivity (15.9%) and a negative predictive value of 72.9%, resulting in 149 false-negative cases (25.8%). Specificity (99.5%) and positive predictive value (90.3%) were high, with only 2 false-positive results.

Conclusions

In patients with early-stage oral cavity squamous cell carcinoma and a clinically negative neck, US-FNAC demonstrates high specificity but limited sensitivity and negative predictive value. These findings indicate that US-FNAC alone is insufficient to exclude occult nodal metastases and should be regarded as an adjunctive diagnostic tool rather than a stand-alone nodal staging strategy.

Safety and Efficacy of Endoscopic Thyroidectomy by Gasless Unilateral Axillary for Papillary Thyroid Carcinoma in Primary Hospitals

Kangbin Wu, Xiaoming wei, Minjun Lu, Xiaorong Wei — Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Objective

To compare the safety and surgical efficacy of endoscopic thyroidectomy by gasless unilateral axillary (ETGUA) with conventional open thyroidectomy in patients with papillary thyroid carcinoma (PTC).

Methods

This prospective, single-center, and randomized controlled trial included 196 patients with PTC who met the inclusion and exclusion criteria. Patients were randomly assigned in a 1:1 ratio to the ETGUA group (n = 98) or the open thyroidectomy group (n = 98). Complications within 30 days, parathyroid function [intact parathyroid hormone (iPTH) and serum calcium], and short-term oncological outcomes were observed. Secondary outcomes included operative time, intraoperative blood loss, postoperative recovery, pain score, cosmetic satisfaction, and hospitalization cost.

Results

The ETGUA group had a significantly longer operative time than the open thyroidectomy group, less intraoperative blood loss, more postoperative drainage at postoperative day 1, as well as a shorter postoperative hospital stay (all p < 0.05). At 1 year postoperatively, surgical efficacy and oncological indicators such as the number of lymph nodes dissected, number of positive lymph nodes, stimulated thyroglobulin (sTg) level, and the proportion of patients receiving adjuvant radioactive iodine therapy were comparable between groups (p > 0.05). The ETGUA group reported lower visual analog scale (VAS) pain scores and higher cosmetic satisfaction, though the total hospitalization cost was slightly higher (all p < 0.05). The learning curve analysis indicated that operative time and intraoperative blood loss stabilized after approximately 30–40 cases.

Conclusion

ETGUA demonstrates comparable safety and oncological efficacy to conventional open thyroidectomy in PTC patients.

Oncological Outcomes of Salvage Oropharyngectomy in Irradiated Neck for Recurrent or Metachronous Squamous Cell Carcinoma

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Objective

To evaluate oncological outcomes and their predictors following salvage oropharyngectomy.

Methods

This single-center retrospective study included patients who underwent a salvage oropharyngectomy in an irradiated neck for recurrent or metachronous oropharyngeal squamous cell carcinoma (OPSCC) between 2014 and 2023.

Results

Ninety-four patients were included. Five-year overall survival (OS), disease-specific survival (DSS), and local recurrence-free survival (LRFS) were 31.7%, 58.5%, and 55.2%, respectively. In multivariable analysis, pN+ status (HR 2.32; p = 0.031), pT status ≥ 3 (HR 2.03; p = 0.020), and age (HR 1.05; p = 0.014) were associated with OS. DSS was associated with pT status ≥ 3 (HR 5.24; p < 0.001), metachronous (vs. recurrent) OPSCC (HR 0.32; p = 0.006), and cN+ status (HR 2.31; p = 0.053). LRFS was associated with metachronous OPSCC (HR 0.30; p = 0.002) and pT status ≥ 3 (HR 3.60; p = 0.001).

Conclusions

This last-resort procedure is associated with poor survival outcomes. In this series, patients with p16-positive OPSCC did not fare better than their p16-negative counterparts.

Survival Impact of Immunotherapy in Advanced Head and Neck Squamous Cell Carcinoma: A National Cancer Database Analysis

Rohan Vuppala, Sallie Long, Daniel Sharbel, Forest Weir — Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

We evaluated the association between immunotherapy (IO) and overall survival (OS) in advanced head and neck squamous cell carcinoma (HNSCC) and examined outcomes by IO timing.

Methods

Retrospective cohort study of national NCDB 2004–2022 United States adults with Stages III–IVB HNSCC. Exposure was any IO. The primary outcome was OS from diagnosis; analyses used multivariable Cox models, 24-month landmarking, and propensity methods.

Results

Among 221 116 patients (mean age: 62), 10 023 (4.5%) received IO. Median follow-up 37 months. IO was associated with lower mortality (HR: 0.91; 95% CI: 0.89–0.94). Landmark analysis showed benefit 0–24 months (HR: 0.76; 0.74–0.79) that reversed thereafter (HR: 1.09; 1.04–1.14). By intent, median OS was 53.2 months (neoadjuvant), 50.1 months (adjuvant), 16.5 months (later-line), versus 60.7 months without IO. Propensity analyses attenuated effects (HR: ~1.00).

Conclusions

In real-world advanced HNSCC, IO confers modest early benefit with varied long-term results; outcomes vary by timing. Prospective biomarker-stratified trials are needed.

Molecular Characterization of Isolated Soft Tissue Deposits in Papillary Thyroid Carcinoma

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Introduction

Isolated soft tissue deposits (ISTDs) are believed to be tumor emboli from lymphatic drainage pathways, discontinuous from primary tumors and lacking lymph node architecture. While associated with poor prognosis in various malignancies, characterization of ISTDs in papillary thyroid carcinoma (PTC) is limited.

Methods

This single-center cohort study examined 11 cases of PTC with ISTDs. Multi-platform next-generation sequencing analyzing driver mutations and tumor suppressor loss of heterozygosity (LOH) was performed on primary tumors, lymph nodes, and ISTDs. Clinical and histopathologic features were compared to a 3:1 matched control cohort.

Results

Genomic alterations were identical across paired tumors, lymph nodes, and ISTDs. LOH was present in 78% of cases with driver mutations. Compared to controls, ISTD cases demonstrated increased rates of high lymph node burden (p < 0.01), extranodal extension (p = 0.012), and lymphovascular invasion (p < 0.01).

Conclusions

Associated with aggressive disease features, the molecular profiles of ISTDs mirror primary tumors and lymph node metastases.

Association Between Elective Nodal Irradiation and Oncologic Outcomes in Node‐Negative Olfactory Neuroblastoma and Sinonasal Squamous Cell Carcinoma: A Propensity‐Score Matched Analysis

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

The association between elective nodal irradiation (ENI) and oncological outcomes in clinically node-negative (cN0) sinonasal squamous cell carcinoma (SCC) and olfactory neuroblastoma (ONB) treated with postoperative chemoradiotherapy remains unclear.

Methods

We retrospectively analyzed cN0 sinonasal SCC and ONB patients receiving postoperative chemoradiotherapy at a single institution. Propensity score matching was performed to minimize confounding. Survival outcomes were assessed using Kaplan–Meier estimates, and logistic regression identified factors associated with specific failure patterns.

Results

Among 62 eligible patients (36 SCC, 26 ONB; median follow-up 44 months), ENI was associated with a lower nodal recurrence rate (4.8% vs. 34.1%; OR 0.10, p = 0.030) but not with overall or recurrence-free survival (p > 0.05). Perineural invasion was independently associated with worse recurrence-free survival. The association between ENI and reduced nodal recurrence appeared more pronounced in ONB.

Conclusions

Despite the small sample size, ENI was associated with reduced nodal recurrence but not with improved survival in cN0 sinonasal SCC and ONB.

Head and Neck Cancer Patients' Health Literacy: A Systematic Review and Meta‐Analysis

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

Head and neck cancer (HNC) is rising globally and linked to poor clinical outcomes. Health Literacy (HL) could potentially have a role throughout the HNC pathway.

Methods

Following PRISMA, this review assessed HL impact in HNC. Five databases and gray literature were searched for observational studies. Descriptive analysis and proportional meta-analyses were performed.

Results

Of the 70 studies, 11 met the inclusion criteria (2153 HNC patients), mostly from the USA (n = 7). The Brief Health Literacy Screen was the most used tool (n = 6). The post-treatment phase and quality of life (QoL) were the main outcomes studied. Inadequate HL (11.9%–47%) was more common among men, laryngeal cancer, and advanced HNC, reducing post-treatment adherence and delaying postoperative radiotherapy. Adequate HL was associated with higher education, better QoL, better health-promoting lifestyle, and shorter time to diagnosis.

Conclusions

HL influences diagnostic timelines, overall QoL, and post-treatment phase. However, its role in prevention, screening, and survival remains understudied.

Improved Survival of HPV‐Related Sinonasal Squamous Cell Carcinoma With Chemoradiation Treatment

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Objective

Human papillomavirus-related (HPV+) sinonasal squamous cell carcinoma (SNSCC) is associated with improved overall survival (OS) compared to similarly staged HPV-negative SNSCC. However, data on treatment-specific outcomes remain limited.

Methods

We analyzed the National Cancer Database (NCDB) for all SNSCC cases diagnosed between 2010 and 2017 with available HPV testing data. Prognostically significant variables were identified via multivariable Cox regression. Propensity score-matched cohorts were then created, matching HPV-positive and HPV-negative patients exactly by treatment modality and other significant prognostic factors. The association between HPV status and 5-year OS was assessed across treatment strategies.

Results

A total of 1697 HPV-tested SNSCC cases were identified; 551 (32.5%) were HPV+. Multivariable Cox regression showed that HPV status, age, comorbidity score, tumor size, lymphovascular invasion, stage, and surgical margin status were significantly associated with outcomes. Within the propensity score-matched cohort, HPV positivity was significantly associated with improved OS among patients treated with chemoradiation (HR = 0.55; 95% CI = 0.35–0.87, p = 0.01). No survival benefit was observed in patients treated with surgery alone (HR = 0.85; 95% CI = 0.35–2.04, p = 0.71), surgery with radiation (HR = 1.38; 95% CI = 0.64–3.02, p = 0.41), radiation alone (HR = 0.40; 95% CI = 0.11–1.41, p = 0.16), or in the combined group of these three treatment strategies (HR = 0.97; 95% CI = 0.57–1.62, p = 0.90).

Conclusion

These findings suggest that HPV+ SNSCC may be particularly sensitive to chemoradiation. Routine HPV testing may be warranted to investigate if tailored treatment approaches focusing on chemoradiation may benefit patients with HPV+ SNSCC.

A Novel Connector for Intraoperative Nerve Monitoring Probes in Endoscopic Thyroidectomy: Comparative Efficacy and Preclinical Evaluation in a Porcine Model

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

This study aimed to develop a connector that adapts standard endoscopic instruments into functional nerve stimulator probes.

Methods

The connector underwent engineering validation in a laboratory and preclinical testing using a porcine model. A handheld standard stimulator probe served as the control. The experimental group consisted of a long monopolar probe and two connector-adapted probes. Recurrent laryngeal nerve (RLN) and vagus nerves were stimulated to compare the efficacy and safety of the adapted probes with the standard probe.

Results

The connector, when coupled to endoscopic instruments, did not show a statistically significant difference in electromyographic (EMG) amplitude at 1 mA stimulation compared with the standard probe. Safety analysis showed no significant hemodynamic effects.

Conclusion

This proof-of-concept study demonstrates that the developed connector, when paired with endoscopic instruments, enables reliable nerve identification and preservation during endoscopic thyroid surgery, with favorable efficacy and safety profiles.

T1 Microscopic Oropharyngeal Carcinoma: Revealing the Unknown Primary Through Diagnostic TORS

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

Head and neck squamous cell carcinoma of unknown primary (hnSCCUP) remains a clinical conundrum. Diagnostic transoral robotic surgery (TORS) now routinely identifies occult primary tumors previously undetected by conventional methods. Here we analyze the histopathology of these tumors, demonstrating novel patterns of submucosal spread in predominantly microscopic tumors.

Patients/Methods

Eighty patients with HPV-mediated hnSCCUP who underwent diagnostic TORS from 2013 to 2022, analyzing tumor histopathology and oncologic outcomes.

Results

Primary tumors were identified in 66 (83%) patients averaging 6 × 3 mm in diameter. These microscopic primaries produced cervical metastases over 6 times larger, with many exhibiting ribbon-like submucosal spread through lymphoepithelial crypts that evaded conventional detection. Almost all (98%) were T1 tumors; 71% measured < 1 cm. At 38-month follow-up, 96% of patients remained alive without locoregional recurrence.

Conclusions

Diagnostic TORS reveals that most HPV+ hnSCCUP are actually T1-microscopic oropharyngeal carcinomas, which might constitute a distinct clinical entity requiring new tailored treatment approaches.

Obstructive Sleep Apnea Following Head and Neck Chemoradiation: A Scoping Review With Exploratory Meta‐Analysis

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

Obstructive sleep apnea (OSA) may contribute to fatigue in head and neck cancer patients undergoing chemotherapy and radiotherapy, particularly as both have the potential to impact the mechanics and dynamics of the airway. We conducted a scoping review and exploratory meta-analysis to evaluate the risk of OSA following chemoradiation.

Methods

PubMed, Web of Science, EMBASE, and Cochrane Library were searched for studies assessing incident OSA after radiotherapy or chemotherapy. Eligible studies isolated the effect of one treatment and reported OSA rates in each group.

Results

Of 559 papers identified, 110 were duplicates and 30 underwent full-text review; 13 met criteria for exploratory meta-analysis. A modest, nonsignificant trend toward increased risk of mild OSA was observed with radiotherapy (z = 1.42, p = 0.15). Chemotherapy was not associated with mild (z = −0.83, p = 0.41) or moderate (z = 0.00, p = 1.00) OSA.

Conclusions

Studies are limited in size and number, and do not support increased risk of OSA with radiotherapy.

Exploratory Biomarker Analysis of Abemaciclib in Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma With Dysregulated CDK4/6 Pathway

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

HPV-negative HNSCC is driven by cell cycle dysregulation, including CDK4/6 activation. Abemaciclib targets this pathway and may offer therapeutic benefits. This study aimed to identify biomarkers predicting abemaciclib efficacy.

Methods

In the NGS-based TRIUMPH trial, patients with platinum-refractory HNSCC harboring CDK4/6 pathway alteration received abemaciclib, classified as “long stable disease (SD)” (progression-free survival [PFS] > 6 months) and “short SD” (PFS < 6 months). In this post hoc analysis, the genetic profiles were compared. In vitro studies were conducted to assess abemaciclib's antitumor effects in HNSCC cell lines.

Results

Among 23 patients, abemaciclib showed limited efficacy (overall response rate, 0%; disease control rate, 43.5%). CDKN2A deletion was significantly associated with long SD (p = 0.0078), unlike CCND1 amplification and CDKN2A mutation. In vitro, CDKN2A-deleted cell lines showed greater sensitivity to abemaciclib.

Conclusions

Although abemaciclib resulted in limited tumor regression, CDKN2A deletion may be a predictive biomarker for prolonged disease stabilization. Further investigations on genomically selected populations and combination strategies are required.

Age‐Related Risk Stratification in HPV‐Positive Oropharyngeal Cancer: Implications for Treatment De‐Intensification

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

Although the AJCC eighth edition staging system incorporates HPV status, it remains insufficient to guide personalized treatment in HPV-positive oropharyngeal cancer (OPC). This study aimed to identify the optimal age threshold and evaluate its association with overall survival (OS) to improve risk stratification and inform individualized treatment strategies.

Methods

Data were extracted from the SEER database (2018–2021), the University Health Network (UHN), University of Toronto, and the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (NCC). Only HPV-positive OPC cases with complete survival records were included. The optimal age threshold was identified using restricted cubic spline modeling in combination with a recursive partitioning approach. Prognostic factors beyond HPV status and AJCC eighth edition stage were evaluated using multivariable Cox proportional hazards models. Recursive partitioning analysis (RPA) was used to construct a risk stratification model. The primary endpoint was OS.

Results

Of the 10 283 eligible patients (87.9% male; median age, 62 years), 2.7% had distant metastases at diagnosis. Restricted cubic spline analysis revealed that 62 years of age represents an important critical threshold. Multivariable Cox analysis revealed that patients younger than 62 years exhibited significantly improved OS (HR, 0.61; 95% CI, 0.54–0.70; p < 0.001). RPA stratified patients into five risk groups with distinct 2-year OS: extremely low (96.8%), low (93.7%), intermediate (86.1%), high (74.6%), and extremely high risk (47.5%). Among patients classified in the extremely low-risk group (T0-2N0-1M0 and younger than 62 years), no significant difference in OS was observed between those treated with radiotherapy alone and those treated with chemoradiotherapy. External validation in the UHN (N = 843) and NCC (N = 167) cohorts suggested that extremely low-risk patients might be spared concurrent chemotherapy.

Conclusions

This study developed a risk stratification model for patients with p16-positive OPC based on the AJCC eighth edition staging and age. Patients in the extremely low-risk group may derive limited benefit from concurrent chemotherapy, suggesting that its omission could be considered in selected patients and may help guide the design of future de-escalation trials.

Transoral Styloidectomy Approach: A Systematic Review and Enhanced Endoscopic Approach

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

Synthesize transoral styloidectomy approaches, highlight advantages, disadvantages, surgical outcomes, and describe an improved endoscopic transoral technique.

Methods

A systematic review of peer-reviewed articles was conducted on November 11, 2025 in PubMed, Embase, the Cochrane Library, and Medline.

Results

Of the 204 articles screened, 45 met inclusion criteria. Four transoral approaches and four visual enhancement techniques were described. Surgical success rate was 94% with no intraoperative complications and a postoperative complication rate of 6.3%. The length of resected styloid averaged 2.91 ± 1.33 cm (range: 1–6 cm). Mean operative time was 47 ± 22 min. Median follow-up time was 6 months (IQR: 3–12 months).

Conclusion

Transoral styloidectomy is safe and effective for the treatment of Eagle's syndrome. An enhanced endoscopic approach with indocyanine green (ICG) fluoroscopy and neuromonitoring improves intraoperative visualization and helps identify critical vascular structures, potentially reducing the risk of inadvertent injury.

Minimal Extrathyroidal Extension in Bilateral Papillary Thyroid Carcinoma Is Associated With Postoperative Structural Recurrence

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

The updated American Joint Committee on Cancer (AJCC) staging system has excluded minimal extrathyroidal extension (mETE) from the T3 category. However, mETE remains classified as an intermediate-risk feature for recurrence in thyroid cancer. The prognostic significance of mETE and its association with recurrence risk remain subjects of ongoing debate.

Methods

This study analyzed a retrospective cohort of 1870 papillary thyroid carcinoma (PTC) patients who underwent total thyroidectomy (TT) with central lymph node dissection (CLND) between 2015 and 2020. Cox proportional hazards regression models and subgroup analyses were employed to evaluate the association of mETE with structural recurrence.

Results

After a median follow-up of 27.9 months, 124 patients (6.6%) experienced structural recurrence. The recurrence rate was significantly higher in patients with mETE than in those without (11.0% vs. 5.6%, p < 0.001). Subgroup analyses revealed that mETE was an independent risk factor, particularly in patients with bilateral tumors (HR: 2.99, 95% CI: 1.8–4.95) and those without Hashimoto's thyroiditis (HT) (HR: 2.33, 95% CI: 1.53–3.63). A significant interaction between tumor bilaterality and mETE was observed (p = 0.003).

Conclusions

In patients with PTC, mETE is a significant prognostic factor of structural recurrence and is associated with decreased disease-free survival (DFS). Critically, we demonstrate for the first time that mETE elevates recurrence risk to near the ATA intermediate-high threshold (17.6%) in bilateral PTC, regardless of tumor size. This synergy of mETE and bilaterality supports upgrading risk stratification and intensifying surveillance for this subset.

A Randomized Controlled Trial Comparing Cervical Range of Motion Between Video‐Guided Stretching Exercise and Standard Method in Post‐Operative Neck Dissection Patients

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

Advanced head and neck and thyroid cancers often involve cervical lymph nodes and require neck dissection, causing pain and reduced neck/shoulder mobility. We developed a video-guided neck exercise to maintain mobility and improve quality of life (QOL).

Methods

Patients who underwent neck dissection (August 1, 2022–November 1, 2023) were randomized into groups using video-guided exercise (n = 21) or printed leaflets (n = 19). Cervical range of motion (CROM) and QOL were measured before surgery. Exercise started on postoperative day 7, and follow-up was conducted at weeks 2 and 12.

Results

Of the 40 participants, 36 completed the study (18/group). At week 2, both groups showed reduced CROM without between-group differences. By week 12, the video group improved in flexion and extension, whereas the leaflet group decreased (p = 0.01 and p = 0.04, respectively). Other motions and QOL were unchanged.

Conclusions

We recommend video-guided neck exercise for patients undergoing neck dissection, with specialist-supervised training to ensure proper technique and improve clinical outcomes.

Self‐Reported Speech Outcomes in Oral Cavity Cancer

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

Individuals with oral cavity cancer (OCC) have negatively impacted functional status and quality of life. Little is known regarding patients' perspectives of their speech impairments. This study compared self-reported speech function between patients surgically treated for OCC and healthy controls using the Speech Handicap Index (SHI) and identified factors associated with worse scores.

Methods

This is a multiinstitutional cross-sectional study of OCC patients and healthy controls recruited between July 2024 and March 2025. Participants completed the SHI and self-reported speech quality. Demographics, tumor, and treatment details were abstracted from the electronic health record for OCC. Group differences were assessed with t-tests, χ ², and Fisher's exact tests.

Results

Among 69 OCC and 90 controls, OCC patients had significantly higher mean SHI scores (50.2 vs. 34.7, p < 0.01) and were less likely to rate their speech as “good” or “excellent” (47.8% vs. 85.6%, p < 0.01). Both speech and psychosocial domain scores were significantly worse among OCC. Free flap reconstruction was associated with worse scores (29.6 vs. 15.5, p = 0.02) and worse self-rated speech quality.

Conclusions

Patients with surgically treated oral cavity cancer have significantly impaired self-perceived speech and psychosocial functioning compared with healthy individuals. Greater deficits were observed in patients who required free flap reconstruction. Despite the functional deficit, nearly half of OCC patients reported satisfaction with their speech quality. These findings highlight the importance of using validated measures for speech function and support the need for early, multidisciplinary rehabilitation including speech therapy in this population, particularly for those undergoing free flap reconstruction.

KUSCC‐192: A Novel Tonsillar Squamous Cell Carcinoma Cell Line With Mixed (Episomal and Integrated)‐Typed Human Papillomavirus From a Korean Patient With Tonsil Cancer

Jae Hyeok Kim, Jung Hwa Moon, Cha Yeon Kim, Hee Na Jeong, Young Chang Lim — Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

Human papillomavirus-positive (HPV+) head and neck squamous cell carcinoma (HNSCC) generally has a better prognosis, but some cases are aggressive with poor outcomes. This study established KUSCC-192, a de novo HPV+ tonsillar cancer cell line, and evaluated its tumorigenicity.

Method

The HPV status in KUSCC-192 was assessed using RT-qPCR, RT-PCR, and FISH. Aggressive characteristics were compared with other HPV+ cell lines and HPV− cell lines.

Result

KUSCC-192 exhibited a mixed type with a predominantly diffused FISH pattern and a few dotted signals and lower E2 gene expression. These findings, combined with its aggressive features, suggest that the mixed type may contribute to the poor prognosis observed in 2%–30% of HPV+ HNSCC cases.

Conclusion

KUSCC-192 is a valuable model to study aggressive HPV+ cancer behaviors. Further research is needed to explore the clinical significance of mixed-type HPV integration in HNSCC.

Geographic and Institutional Patterns of Transoral Robotic Surgery in Head and Neck Cancer

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Introduction

Transoral robotic surgery (TORS) is increasingly used for oropharyngeal squamous cell carcinoma (OPSCC), yet national patterns of TORS availability for Medicare beneficiaries are not well defined. We characterized hospital type, geographic distribution, and market concentration of TORS.

Methods

We conducted a retrospective cross-sectional study of inpatient Medicare claims from 2017 to 2023, identifying OPSCC with ICD-10-CM codes and TORS with ICD-10-PCS codes including a robotic-assistance qualifier. Claims were linked to inpatient prospective payment system files for hospital teaching status, disproportionate share hospital (DSH) percentage, urbanicity, and geographic labor market area (GLMA). We mapped county-level procedure counts, calculated GLMA-level Herfindahl–Hirschman Index (HHI), and used negative binomial regression to evaluate associations of hospital factors with TORS volume and inpatient length of stay (LOS).

Results

We identified 2499 unique TORS procedures at 161 hospitals; 86.2% occurred at teaching hospitals, and annual volume rose 31% from 2017 to 2023. TORS use was geographically diffuse but locally concentrated: among 102 GLMAs with any TORS, 64.7% had HHI = 10 000 and 28.4% had HHI 5000–9999. Six GLMAs with > 100 procedures accounted for 33.6% of all cases and were predominantly teaching centers. Higher teaching intensity was associated with greater TORS use (incidence rate ratio [IRR]: 1.99, 95% CI: 1.63–2.45). LOS was longer in urban and rural hospitals versus metropolitan centers and shorter in high-volume GLMAs (IRR: 0.82, 95% CI: 0.76–0.87).

Conclusion

Among Medicare beneficiaries with OPSCC, TORS is concentrated in teaching hospitals and a few high-volume markets, with shorter LOS in high-volume regions, highlighting trade-offs between centralization and access.

An Assessment of Exposure and Maneuverability to the Upper Parapharyngeal Space Through the Multiport Endoscopic Endonasal Transpterygoid and Anterior Transmaxillary Techniques

Fri, 08 May 2026 06:15:10 -0700

ABSTRACT

Background

Treating tumors that extend into the upper parapharyngeal space (UPPS) is challenging, given the region's anatomical complexity and its proximity to the parapharyngeal carotid artery (ppICA) and the middle cranial fossa. Endoscopic techniques offer optimal surgical outcomes while also reducing morbidity related to open approaches.

Methods

Exposure and maneuverability were evaluated toward the UPPS using a multiportal endoscopic technique combining the anterior transmaxillary (TMA) and endonasal transpterygoid approaches. Bilateral stepwise dissections were performed in four specimens. Measurements of linear trajectories, angles of exposure, and surgical corridor volumes were obtained.

Results

The TMA provided superior maneuverability around the uppermost ppICA portion within the UPPS, while the endonasal corridors offered a more direct trajectory to its lowest segment.

Conclusion

Combining the TMA and endonasal transpterygoid approaches enhances surgical control over critical neurovascular structures within the UPPS by addressing the limitations of each technique used independently.

Variations in Treatment Prescription and Survival Outcomes Between Older and Younger Patients With Mucosal Head and Neck Squamous Cell Carcinoma Treated With Radiotherapy

Tue, 05 May 2026 20:51:44 -0700

ABSTRACT

Purpose

To investigate treatment variations and outcomes between older (≥ 70 years) and younger (< 70 years) patients with mucosal head and neck squamous cell carcinoma (mHNSCC) treated with radiotherapy.

Methods

A multicenter retrospective review of patients diagnosed from 2010 to 2018 was conducted. Patient, tumor, and treatment data were collected, including overall survival (OS) and progression-free survival (PFS). Multivariable analyses examined factors influencing standard-of-care (SOC) treatment, OS, and PFS.

Results

Of 1553 patients, 432 patients were ≥ 70 years. Older patients were significantly less likely to receive curative treatment, SOC, or concurrent systemic therapy. Age, marital status, ECOG status, stage, and subsite influenced SOC treatment. Three-year OS and PFS were lower in older patients. ECOG status, stage, subsite, and SOC treatment were significantly associated with OS and PFS. Older age and smoking status were significantly associated with lower OS but not PFS.

Conclusions

Older patients should be offered SOC treatment where appropriate for maximal disease control and survival.

Transoral Robotic Surgery‐Based Treatment Versus Definitive Chemoradiation for Oropharyngeal Squamous Cell Carcinoma: A Systematic Review and Meta‐Analysis

Tue, 05 May 2026 20:45:42 -0700

ABSTRACT

Background

Trans-oral robotic surgery is a minimally invasive surgical approach for the treatment of oropharyngeal squamous cell carcinoma (OPSCC), with superior functional outcomes compared to open surgery. However, its oncologic and functional outcomes are still debated in comparison to definitive radiotherapy (RT) or chemoradiotherapy (CRT).

Methods

A systematic search was conducted in PubMed, Scopus, and Embase, and relevant studies were selected in accordance with the PRISMA guidelines. Overall survival, disease-specific survival, and swallowing function are compared between TORS and primary RT or CRT using random-effects models. Dysphagia was assessed using the MD Anderson Dysphagia Index (MDADI) and the Functional Oral Intake Scale (FOIS).

Results

A total of 15 studies comprising 6767 patients (2423 underwent TORS and 4344 underwent upfront RT or CRT) were included. Overall survival was significantly better after TORS (HR 0.51; 95% CI 0.42–0.62; p < 0.0001), in all stages of disease, but not in HPV-positive cases. No significant difference was found in progression-free survival (HR 0.81; 95% CI 0.50–1.29; p = 0.374). MDADI and FOIS scores were not significantly different among the two groups (MD 0.8; 95% CI −2, −3.5; p = 0.578; and MD 0.2; 95% CI −0.3, −0.7; p = 0.469; respectively). Compared to baseline, MDADI scores were decreased in both groups; but the decline was almost two-fold larger in the RT/CRT group (MD 3.5; 95% CI 3.1–3.9; p < 0.001).

Conclusions

TORS with or without adjuvant treatment was associated with higher overall survival compared to definitive RT/CRT. TORS was also associated with less decline in functional outcomes compared to baseline. Considering the non-randomized nature of most available studies, these results should be interpreted with caution. Future studies are warranted to determine the optimal treatment strategies for patients with OPSCC and to investigate the implications of HPV status on treatment selection.

Associations Between Preexisting Depression and Anxiety and Postoperative Outcomes Among Medicare Beneficiaries Undergoing Head and Neck Cancer Surgery

Mon, 04 May 2026 22:54:18 -0700

ABSTRACT

Introduction

Depression and anxiety are common in patients with head and neck cancer (HNC), but their impacts on postoperative outcomes after major HNC surgery are not well defined. We evaluated whether preexisting, clinically diagnosed depression or anxiety independently predicted short-term postoperative outcomes among adults undergoing HNC resection.

Methods

We performed a retrospective cohort study using 100% Medicare Standard Analytic Files from 2016 to 2023. Beneficiaries with HNC who underwent oncologic head and neck resection were identified using ICD-10-CM/PCS codes. Preexisting depression and anxiety were defined using Chronic Conditions Warehouse algorithms (≥ 1 inpatient or ≥ 2 outpatient claims in the year before surgery). Outcomes included length of stay (LOS), extended LOS (> 75th percentile), in-hospital complications, and 30- and 90-day readmission and mortality. LOS was modeled using truncated negative binomial regression; binary outcomes were modeled with multivariable logistic regression adjusting for demographics, comorbidities, tumor site, tobacco use, hospital teaching status, procedure complexity, and co-occurring depression or anxiety.

Results

Among 45 293 patients (median age 72 years), 6.6% had preexisting depression and 7.6% had preexisting anxiety. Depression was associated with a longer LOS (incidence rate ratio [IRR] 1.06, 95% CI 1.07–1.13), higher 30-day mortality (odds ratio [OR] 1.28, 95% CI 1.06–1.54), 90-day mortality (OR 1.22, 95% CI 1.07–1.39), and higher 30- and 90-day readmissions (OR 1.20, 95% CI 1.07–1.34; OR 1.27, 95% CI 1.15–1.39), but not with in-hospital complications. Anxiety was similarly associated with longer LOS (IRR 1.10, 95% CI 1.07–1.13), extended LOS (OR 1.33, 95% CI 1.20–1.48), in-hospital complications (OR 1.18, 95% CI 1.06–1.30), and higher 30- and 90-day mortality (OR 1.38, 95% CI 1.16–1.65; OR 1.33, 95% CI 1.18–1.50), but not readmissions.

Conclusions

Among Medicare beneficiaries undergoing HNC surgery, preexisting depression or anxiety are independent markers of increased postoperative risk. Routine mental health screening and targeted perioperative support may be important components of high-quality head and neck oncologic care.

Impact of Smoking on Treatment Outcomes in Patients With Human Papillomavirus‐Related Oropharyngeal Cancer

Mon, 04 May 2026 00:00:56 -0700

ABSTRACT

Background

Patients with HPV+ oropharyngeal cancer (OPC) have worse outcomes with longer smoking history (≥ 10 pack-years). This has been confirmed in trials of primary radiotherapy but not surgery, suggesting differential smoking impact by treatment received. We assessed smoking-related outcomes at a single institution.

Methods

Kaplan–Meier and Cox proportional hazards regression compared < 10 versus ≥ 10 pack-years by treatment received for progression-free survival (PFS) and overall survival (OS).

Results

Smoking was associated with worse PFS in both primary (chemo)radiation (HR = 1.73 [1.12–2.69], p = 0.01) and primary surgery cohorts (HR = 1.77 [1.02–3.07], p = 0.04). In surgery patients, this association was attenuated after adjusting for socioeconomic indicators (HR = 1.69 [0.97–2.93], p = 0.06). On recursive partitioning analysis, ≥ 25 pack-years was associated with worse PFS and OS overall and among radiotherapy patients.

Conclusions

Smoking impacts outcomes in HPV + OPC regardless of treatment modality. Treatment-specific differences in prior randomized studies may reflect underlying differences in patient characteristics. ≥ 25 pack-years was associated with worse outcomes.

Systemic Treatments for Recurrent or Metastatic Sinonasal Carcinomas: A Retrospective Multicenter Study

Thu, 30 Apr 2026 22:00:53 -0700

ABSTRACT

Introduction

Sinonasal cancers are rare and heterogeneous and pose a therapeutic challenge at an advanced stage due to the lack of data on appropriate systemic management.

Methods

This retrospective multicenter study analyzed 83 patients with recurrent or metastatic sinonasal carcinomas ineligible for curative treatment, treated in France between 2012 and 2021 (excluding squamous cell carcinomas and adenoid cystic carcinomas). Data were extracted from the REFCOR (French Network of Expertise on Rare Head and Neck Cancers) and Onco-Occitanie databases, enabling standardized case collection.

Results

The main histological subtypes were intestinal-type adenocarcinomas (42.2%), undifferentiated sinonasal carcinomas (19.3%), and olfactory neuroblastomas (14.5%). The predominantly male (85.5%) cohort, with a median age of 60 years at diagnosis, mainly received first-line platinum-based doublet chemotherapy (platinum-etoposide, platinum-5FU). Regardless of histologies and chemotherapy protocols, median overall survival was 13.6 months [10.8; 20.3], with median progression-free survival of 5.3 months [4.4; 6.1]. Complete and partial response rates were 8.3% and 30.6%, respectively, with overall disease control in 73.6% of cases. For adenocarcinomas, platinum-5FU and platinum-taxane regimens were preferred. For sinonasal undifferentiated carcinomas, olfactory neuroblastomas, and neuroendocrine carcinomas, platinum-etoposide was most frequently used. Targeted therapies and immunotherapy were rarely used.

Conclusion

Improving prognosis requires new strategies, including genomic sequencing and enrollment in clinical trials.

Deep Learning for Pretreatment Imaging‐Based Tumor and Nodal Classification in Head and Neck Squamous Cell Carcinoma: A Systematic Review and Network Meta‐Analysis

Wed, 29 Apr 2026 00:08:03 -0700

ABSTRACT

Background

Accurate pretreatment assessment of the extent of tumor invasion and status of cervical lymph node metastasis is essential for staging and treatment planning in HNSCC. Deep learning (DL) shows promise but is limited by methodological heterogeneity.

Methods

We conducted a systematic review and network meta-analysis (PRISMA). Studies (2019–2025) evaluating DL models for pretreatment lymph node or tumor invasion classification using CT, MRI, PET/CT, or SPECT/CT were included. Diagnostic performance (AUC) was pooled using random-effects models.

Results

Twenty-three studies were included. Pooled AUC for lymph node classification was 0.78 (95% CI 0.72–0.84). In subgroup analyses, performance was lower in multicenter and externally validated studies (AUC 0.84) than in single-center studies (AUC 0.92; p = 0.029), and slightly lower with radiologic versus pathologic ground truth (0.83 vs. 0.87; p = 0.093). Network meta-analysis showed a nonsignificant advantage of fusion models. Pooled AUC for tumor invasion was 0.84. DL models outperformed human readers (ΔAUC +0.09).

Interpretation

DL demonstrates strong diagnostic performance for pretherapeutic HNSCC imaging, but results depend on study design. Standardized datasets and prospective multicenter validation are required.

Pattern of Progression of Oral Potentially Malignant Disorders From Real‐World Data: A 24‐Year Study

Wed, 29 Apr 2026 00:00:00 -0700

ABSTRACT

Background

Oral potentially malignant disorder (OPMD) prognostication is limited by uncertainty of which lesions will progress and the aggressiveness of lesion progression. We defined patterns and kinetics of progression in a large cohort of OPMD subjected to serial clinical and histologic examinations.

Methods

This 24-year study evaluated the pattern of disease progression in 668 patients with 1313 OPMDs.

Results

The disease progression pattern was grouped as (a) non-progressive (82.5%), (b) progressive, where initial low-grade dysplasia advanced to high-grade dysplasia in subsequent lesions (5.8%), and (c) transformed, where dysplastic lesions transformed into squamous cell carcinoma (11.7%). Progression showed aggressive (< 2 years) and indolent (> 2 years) patterns. An aggressive course occurred in 48.3% of progressive and 57.6% of transformed lesions. Progression was associated with high-grade lesions, floor of mouth and palate subsites, and tobacco and alcohol use.

Conclusions

The data from this study may be used to develop a risk-stratified approach for OPMD management.

Swab‐Derived Viral Load as a Biomarker of Tumor Biology in HPV‐Associated Oropharyngeal Squamous Cell Carcinoma

Tue, 28 Apr 2026 22:58:47 -0700

ABSTRACT

Introduction

Site-specific identification of human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (HPV+ OPSCC) remains a major diagnostic challenge. We developed a site-directed mucosal swab assay designed to detect and quantify tumor-derived HPV DNA shed into the oropharyngeal surface overlying HPV-associated tumors.

Methods

Patients with biopsy-proven HPV+ OPSCC or oral cavity SCC as controls were enrolled after providing informed consent. Swabs of the tumor site as well as the contralateral normal mucosa were collected. Swab-derived DNA was extracted and analyzed by quantitative PCR targeting HPV16 and HPV genotyping with Sanger sequencing. Multivariable linear regression models were used to evaluate associations between swab-based viral load and clinicopathologic features.

Results

In a prospective cohort of 30 patients with HPV+ OPSCC, tumor-side swabs detected HPV DNA in 30 of 30 cases. Swabs obtained from the contralateral mucosa showed substantially lower HPV DNA levels, demonstrating strong spatial specificity for the tumor-bearing region. The assay limit of detection was determined to be ~10 HPV16 copies per reaction (1 viral genome per 500 diploid cells). All negative control patients with oral cavity SCC had negative results. Regression models revealed node-positive status to be independently associated with low quantitative HPV16 viral load (fold change = 0.013, 95% CI: 0.001–0.178).

Conclusions

By enabling minimally invasive, anatomically targeted detection of HPV-driven cancer at the primary site, this swab-based assay has the potential to shorten the diagnostic pathway for HPV+ OPSCC while providing quantitative viral load measurements that may serve as a surrogate biomarker for intratumoral biology in HPV+ OPSCC.

Comparison of In‐Office and General Anesthesia Biopsies for Oropharyngeal Squamous Cell Carcinoma in a Public Healthcare System

Tue, 28 Apr 2026 19:15:50 -0700

ABSTRACT

Background

We compared treatment delays, costs, and management impact between oropharyngeal squamous cell carcinoma (OPSCC) patients undergoing in-office versus general anesthesia panendoscopy-guided biopsies in two large tertiary centers in a public healthcare system.

Methods

All OPSCC patients included were treated between 2010 and 2024 with either curative radiation alone or chemoradiation.

Results

Demographic and tumor characteristics were comparable, except for smaller tumors in the panendoscopy group (n = 36) compared to the in-office group (n = 37) (mean size; 29.4 mm vs. 36.6 mm, respectively; difference −7.2 mm [95% CI, −11.3 to −3.1]). The panendoscopy group experienced substantially longer treatment initiation delays (mean days; 70.1 days vs. 44.5 days; difference 25.7 days [95% CI 13.0 to 38.2]). No additional synchronous tumors were detected through panendoscopy. Panendoscopy incurred a mean additional cost of 2025CAD $3886.

Conclusions

Panendoscopy for OPSCC prolongs treatment initiation, incurs additional expenses, and provides no incremental synchronous tumor detection. When clinically feasible, in-office biopsies should be preferred.

Management of the Clinically Node‐Negative Neck in Intermediate‐Grade Mucoepidermoid Carcinoma of the Head and Neck: A Single‐Institution Retrospective Study

Min‐Chuan Lin, Xu Jiang, Zi‐Chen Qiu, Xiong Zhou, Ya‐Lan Tao — Mon, 27 Apr 2026 22:09:04 -0700

ABSTRACT

Background

Management of the clinically node-negative (cN0) neck in intermediate-grade mucoepidermoid carcinoma (MEC) of the head and neck remains controversial.

Methods

We retrospectively reviewed patients with cN0 intermediate-grade MEC treated between 2008 and 2025. Patients underwent observation or elective neck treatment, including elective neck dissection and/or radiotherapy. Survival outcomes were analyzed using Kaplan–Meier methods and Cox proportional hazards models.

Results

Sixty patients were included (27 observation, 33 elective treatment). After a median follow-up of 53 months, regional recurrence occurred in three patients in the observation group and in none receiving elective treatment. Five-year regional recurrence-free survival, disease-free survival, and disease-specific survival were high in both groups, without significant differences. Perineural invasion was associated with worse disease-free survival.

Conclusions

In cN0 intermediate-grade MEC, regional control outcomes were favorable, and a statistically significant benefit of elective neck treatment was not demonstrated in this cohort. For carefully selected patients without adverse clinicopathologic features, close observation of the neck may be a reasonable strategy. These findings should be interpreted cautiously given the limited sample size and low event rate.

A Multimodal Analgesia Protocol to Reduce Opioid Use Following Oral Cavity Free Flap Reconstruction

Sun, 26 Apr 2026 19:45:10 -0700

ABSTRACT

Background

Opioid-based patient-controlled analgesia (PCA) is widely used after head and neck cancer surgery but carries risks such as dependence, sedation, and respiratory depression. Multimodal analgesia (MMA) may offer acceptable pain control with fewer adverse effects.

Methods

We retrospectively analyzed patients who underwent oral cavity resection with free flap reconstruction over 18 months. An MMA regimen of scheduled acetaminophen, celecoxib, and gabapentin was compared to PCA. Outcomes included opioid use, pain scores, and complications.

Results

A total of 237 patients were included (PCA: n = 120; MMA: n = 117). The mean age was 64.3 years (SD = 13.2). Opioid use was significantly lower in the MMA group on all postoperative days (PODs), with the greatest mean differences on POD 1 (MD = 75.3) and POD 2 (MD = 31.9) (both p < 0.001). Pain scores were significantly lower in the MMA group on all PODs (p < 0.05).

Conclusions

MMA can provide comparable pain control while significantly reducing opioid use following oncologic oral cavity resection with free flap reconstruction.

Tissue and Blood‐Based Tumor Mutational Burden Predicts Treatment Response to PD‐1 Blockade in Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta‐Analysis

Xinmeng Wang, Ziming Li, Feifan Ouyang, Shibei Zheng, Huichuan Yu, Qian Cai — Sun, 26 Apr 2026 19:15:27 -0700

ABSTRACT

Background

Tumor mutational burden (TMB) is a predictive biomarker for immune checkpoint inhibitors (ICIs). Its clinical utility in head and neck squamous cell carcinoma (HNSCC) is limited by differences in detection approaches and inconsistent cut-off values. In this meta-analysis, we systematically reviewed multiple high-quality studies to assess the predictive value of tissue-based TMB (tTMB) and blood-based TMB (bTMB) for treatment response of ICIs.

Methods

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched PubMed, Web of Science, Scopus, and SpringerLink for studies published through January 2026. Eligible studies included HNSCC patients treated with ICIs, with outcomes stratified by TMB status. The primary endpoint was objective response rate (ORR), and the secondary endpoints were overall survival (OS) and progression-free survival (PFS). In addition, subgroup analyses were conducted to further explore between-study differences according to different TMB detection approaches.

Results

We included 17 independent high-quality cohorts comprising 1472 patients. High TMB was evaluated using two approaches: tTMB and bTMB, and this two-modality framework was consistently applied to survival outcomes. Overall, high TMB showed prognostic utility across both tissue and blood measurements. Specifically, high TMB was associated with improved ORR (odds ratio [OR] = 2.80; 95% CI, 2.14–3.65; p < 0.001) with negligible heterogeneity (I ² = 0%). Similarly, superior outcomes were observed for OS (hazard ratio [HR] = 0.58; 95% CI, 0.51–0.67; p < 0.001) and PFS (HR = 0.66; 95% CI, 0.57–0.77; p < 0.001). Subgroup analysis of platform-specific patterns revealed distinct cut-off tendencies: tissue-based targeted panels often clustered around a threshold of 10 mut/Mb, whereas blood-based assays required higher cut-offs (≥ 16 mut/Mb) to show predictive signals.

Conclusions

TMB shows promise as a predictive biomarker for objective response and survival in HNSCC patients receiving immunotherapy. In our analysis, both tTMB and bTMB were associated with improved objective response, although evidence for bTMB remains limited. Differences between tTMB and bTMB may contribute to variability in commonly used cut-off values, which should be considered when interpreting results across studies and platforms.

Association of Socioeconomic Factors and Immunotherapy in Cutaneous Squamous Cell Carcinoma of the Head and Neck

Sun, 26 Apr 2026 18:54:34 -0700

ABSTRACT

Background

There is little data on the relationship between socioeconomic factors and immunotherapy in advanced cutaneous squamous cell carcinoma of the head and neck (cSCCHN).

Methods

Our study analyzed patients with Stage IV cSCCHN diagnosed between 2018–2026 using the EPIC Cosmos database. Socioeconomic status was measured based on the social vulnerability index (SVI) and corresponding themes. Immunotherapy receipt was evaluated with Robust Poisson models.

Results

A total of 1140 patients were identified with Stage IV cSCCHN, with 338 (29.6%) of whom received immunotherapy. Higher SVI was associated with a lower likelihood of receiving immunotherapy (incidence rate ratio = 0.96). Patients in the most vulnerable overall SVI quintile had a 29% lower rate of receiving immunotherapy compared to the least vulnerable quintile (p = 0.018). Participants' race/ethnicity, insurance status, and urbanicity were not significantly associated with immunotherapy receipt.

Conclusion

Increased social vulnerability is associated with reduced likelihood of treatment with immunotherapy among patients with Stage IV cSCCHN.

Lateral Cervical Ectopic Thyroid: A Seven‐Step Diagnostic Algorithm and Dual‐Axis Treatment Strategy Derived From Case Analysis and Literature Review

Sat, 25 Apr 2026 00:54:55 -0700

ABSTRACT

Background

Lateral cervical ectopic thyroid gland (LETG) is rare and often difficult to distinguish from metastatic lymphadenopathy; furthermore, no standardized surgical strategy is available. This study aims to clarify the clinical features of and establish an optimized management framework for this anomaly.

Methods

We present one benign LETG case and one malignant LETG case and performed a systematic literature review (2000–2025), yielding a pooled analysis of 69 cases.

Results

The analysis revealed that a definitive pre- or intra-operative diagnosis was pivotal. Malignant pathology in both the lateral neck lesion and the orthotopic thyroid gland predicted multiple surgeries (41.7%, p = 0.007; 39%, p = 0.038). Crucially, the utilization of intraoperative frozen sections was decisive, as all patients who underwent this approach avoided a second operation.

Conclusions

LETG management necessitates a systematic approach. Our proposed “Seven-Step Diagnostic Algorithm” and “Dual-Axis Treatment Strategy” facilitate precise differentiation, enable a definitive single-stage surgery, minimize reoperations, and guide selective preservation of the orthotopic thyroid.

Establishment of Salivary Gland Tumors Arising in Salivary Gland‐Specific EWSR1::ATF1 Transgenic Mice

Sat, 25 Apr 2026 00:40:39 -0700

ABSTRACT

Background

Salivary gland carcinomas are uncommon malignancies with various histological subtypes harboring fusion genes. The EWSR1::ATF1 fusion gene, resulting from a translocation between chromosomes 12 and 22, is frequently observed in hyalinizing clear cell carcinoma (HCCC). However, the role of this fusion gene in HCCC oncogenesis remains unclear.

Methods

We generated EWSR1::ATF1 transgenic mice by introducing an EWSR1::ATF1 fusion gene with a breakpoint in HCCC. These mice were crossed with Lama parotid secretory protein (PSP)-Cre transgenic mice, expressing Cre recombinase in salivary glands, to produce salivary gland-specific EWSR1::ATF1 transgenic mice. Tumor samples were analyzed using Western blotting, histopathology, and RNA sequencing.

Results

We generated salivary gland-specific EWSR1::ATF1 transgenic mice, and tumors developed in major salivary glands in three mice. These tumors exhibited more malignant characteristics than human HCCC.

Conclusions

These results suggest that salivary gland-specific expression of EWSR1::ATF1 plays an important role in malignant tumor formation in major salivary glands.

Cigarette Smoke Exposure Attenuates T2R‐Mediated Apoptosis in Head and Neck Squamous Cell Carcinoma

Sat, 25 Apr 2026 00:34:30 -0700

ABSTRACT

Background

Tobacco use is associated with worse outcomes in head and neck squamous cell carcinoma (HNSCC). Bitter taste receptor (T2R) activation induces apoptosis via calcium-dependent signaling, and higher T2R expression correlates with increased survival in HNSCC. However, the effects of cigarette smoke on T2R signaling remain unclear.

Methods

HNSCC cell lines were treated with cigarette smoke condensate (CSC). T2R expression was measured by qPCR, and function evaluated by calcium imaging, viability, and apoptosis assays following stimulation with denatonium benzoate and flufenamic acid. T2R expression was also assessed in patient-derived tumor tissue and The Cancer Genome Atlas (TCGA).

Results

CSC reduced T2R expression, impaired calcium signaling, and diminished T2R-mediated apoptosis, particularly in SCC47 cells. Lower expression was observed in CSC-exposed patient-derived tumor tissue and TCGA tumors from smokers versus nonsmokers.

Conclusions

Cigarette smoke disrupts T2R signaling and reduces apoptosis in HNSCC, suggesting a mechanism by which ongoing tobacco use may alter tumor biology and treatment response.

Understanding the Symptom Burden of Complex Skull Base Tumors From the Patient's Perspective

Thu, 23 Apr 2026 19:01:09 -0700

ABSTRACT

Background

Symptom burden of skull base tumor (SBT) patients, especially those undergoing multimodality treatment, is poorly understood. We aim to understand symptom burden in this patient group using the core module the MD Anderson Symptom Inventory (MDASI).

Methods

Twenty-nine patients with benign and malignant SBT underwent qualitative interviews to capture symptoms at diagnosis, during, and after treatment. An expert panel of 47 members (patients, caregivers, and providers) rated identified symptoms for relevance.

Results

Fifty-six individual symptoms were identified. Twenty-four symptoms met criteria for inclusion; 10 were already present in the MDASI core. Fourteen new SBT-specific symptoms were selected, adding to 13 core MDASI symptoms and 6 interference items to form the provisional MDASI-Skull Base.

Conclusions

SBT patients experience wide ranging symptoms. A core cluster of symptoms is frequently reported across multiple SBT anatomical subsites. Further evaluation of the provisional MDASI-SB through psychometric testing in a larger group of patients is needed.

The Utility of Comprehensive Sampling in Cervical Lymph Node Dissection for Head and Neck Squamous Cell Carcinoma: Is More Better?

Thu, 23 Apr 2026 19:00:40 -0700

ABSTRACT

Purpose

To evaluate whether comprehensive sampling of cervical lymphadenectomy tissue increases lymph node yield (LNY) and improves staging adequacy beyond standard grossing practice.

Methods

At a single academic center, a comprehensive grossing protocol was introduced in which entire cervical lymphadenectomy specimens (levels I–V) were submitted for histologic evaluation rather than only grossly identified lymph nodes. Ninety-one cervical lymphadenectomy specimens from 22 HNSCC patients were analyzed. For each case, standard-protocol LNY was recorded; additional lymph nodes (positive and negative) recovered by the comprehensive protocol were counted, and changes in pathologic stage and adequacy relative to the 18-node benchmark were assessed. Additional prosection time, tissue block usage, and the correlation between standard and added nodes were also evaluated.

Results

The comprehensive protocol increased LNY by a mean of 15.9 ± 12.9 nodes per patient (median 13; 50.1% overall increase), and by 3.8 ± 5.2 nodes per specimen. Only two additional positive nodes (< 0.6%), measuring 1.4 and 4.1 mm, were identified and did not change staging. Two patients with LNY < 18 under the standard protocol exceeded 18 nodes with the comprehensive protocol. Implementation added a mean of 18.5 prosection minutes and 23 extra blocks per case, with poor correlation between standard and added nodes (r ² = 0.15).

Conclusion

Comprehensive submission markedly increases lymph node counts and can convert some dissections from inadequate to adequate by numeric criteria. However, in this cohort it produced no staging changes and required substantial laboratory resources. These findings support selective rather than universal use of comprehensive sampling in neck dissection evaluation.

Predominance of In‐Field Recurrence After Radiotherapy for Sinonasal Cancer: A Single‐Center Retrospective Study

Thu, 23 Apr 2026 18:34:22 -0700

ABSTRACT

Background

Sinonasal malignancies (SNM) are rare, heterogeneous tumors with poor prognosis. There is an unmet need to improve treatment outcomes. Despite advances in imaging and molecular classification, optimal curative radiotherapy (RT) strategies remain undefined. We analyzed the pattern of failure after RT, focusing in depth on local recurrence.

Methods

This retrospective cohort study included 104 SNM patients treated with curative-intent RT (either primary or after endoscopic surgery) at a tertiary center between 2010 and 2022. Local recurrences were delineated on follow-up imaging and registered to pretreatment plans. Recurrence location was classified as in-field, marginal, or out-of-field based on dose at the center of mass.

Results

Local recurrence rate was 25%. Most local recurrences (81%) occurred in-field in the high-dose region (> 95% of prescribed dose), with a median dose of 65 Gy. Perineural spread accounted for most out-of-field failures. Local recurrence significantly impaired disease-specific survival.

Conclusions

Local failures after RT for SNM predominantly arise in-field within adequately irradiated volumes, suggesting biological radioresistance. These findings support the need for histology-driven, biologically tailored treatment strategies.

Calculating Glucagon‐Like Pepide‐1 Receptor Agonist‐Associated Medullary Thyroid Cancer Risk: A Novel Integration of the Surveillance, Epidemiology and End Results Cancer Registry and the FDA Adverse Event Reporting System

Sun, 19 Apr 2026 22:37:59 -0700

ABSTRACT

Background

GLP-1 receptor agonists carry an FDA boxed warning for medullary thyroid carcinoma (MTC) risk, though conflicting clinical evidence has generated tremendous controversy regarding this association.

Methods

We analyzed SEER and FAERS databases to compare MTC and papillary thyroid cancer (PTC) reporting proportions (RP) between the general population and GLP-1RA users (n = 109 168), controlling for surveillance bias by comparing against other endocrine and non-endocrine drugs. Negative binomial regression was used to estimate the incidence rate ratios (IRR) in the FAERS dataset among patients with reported AEs.

Results

The 10-year mean MTC RP in SEER/FAERS was 0.0002%/0.0014%, while PTC was 0.012%/0.0087%. Strikingly, GLP-1RA users showed increased RPs as compared to the total FAERS RPs: MTC 0.071% (50.7-fold increase) and PTC 0.164% (18.9-fold increase) with significantly elevated IRRs (p = 0.0001) compared to reference groups.

Conclusion

GLP-1RAs showed a higher RP for MTC compared to other drug classes, warranting prospective studies to investigate further.

Effectiveness of the Association Between ILIB and Photobiomodulation in Oral Mucositis Among Oncology Patients: A Prospective Study

Fri, 17 Apr 2026 23:55:38 -0700

ABSTRACT

Background/Purpose

Oral mucositis is one of the most frequent and debilitating adverse effects of antineoplastic therapy, significantly impairing treatment adherence and patients' quality of life. This study aimed to evaluate the effectiveness of Intravenous Laser Irradiation of Blood (ILIB), applied alone or combined with low-level laser therapy, in reducing oral mucositis and improving the quality of life of oncology patients.

Methods

This quasi-experimental prospective study with parallel groups was conducted between 2023 and 2024 at the Memorial Hospital of Arcoverde (PE), involving 76 patients equally allocated into four groups (n = 19): ILIB alone (A and C) and ILIB combined with laser therapy (B and D), applied therapeutically or preventively over weeks. Oral mucositis grade (WHO scale) and quality of life (OHIP-14) were assessed before and after the interventions.

Results

No baseline differences were observed between groups (p > 0.05). After the intervention, the combined therapy groups showed greater reductions in mucositis (B: −1.60; −55.2% and D: −1.70; −60.7%) compared with ILIB alone (A: −0.70; −25.0% and C: −0.70; −25.9%) (p < 0.05). Improvements in quality of life were also more pronounced in the combined groups (B: −9.00; −31.0% and D: −10.40; −36.0%) compared with ILIB alone (A: −4.50; −15.8% and C: −4.30; −15.5%) (p < 0.05).

Conclusion

The ILIB + laser therapy association was more effective than ILIB alone in reducing oral mucositis and improving quality of life, both in prevention and treatment contexts.

Lip Melanoma: A Systematic Review of the Literature

Thu, 16 Apr 2026 23:25:08 -0700

ABSTRACT

Background

Lip melanoma is a rare malignant neoplasm arising at the cutaneous-mucosal interface, and its clinicopathologic profile remains insufficiently characterized. We conducted a systematic review to synthesize current evidence on its epidemiology, clinicopathological features, management, and outcomes.

Methods

Electronic searches were performed in PubMed, Scopus, Embase, Web of Science, and LILACS, supplemented by manual scrutiny and gray-literature sources. Case reports and case series were included. Data were analyzed descriptively and analytically.

Results

Forty-three studies describing 139 affected individuals were included. Individuals were predominantly male (71.2%), with a mean age of 51.1 years. Most lesions involved the lower lip (63.8%) and presented clinically as pigmented, nodular, and frequently ulcerated lesions; approximately 8% were amelanotic. Histopathologic patterns included superficial spreading, lentiginous, nodular, desmoplastic, and neurotropic melanoma. Surgery was the mainstay therapeutic modality, often requiring labial reconstruction. Local recurrence occurred in 25.9% of cases and distant metastasis in 38.8%. Crude overall survival was approximately 48%, whereas Kaplan–Meier analysis demonstrated an estimated 5-year survival of 74%.

Conclusions

This first review of lip melanoma underscores the need for tailored management strategies. Continued accumulation of standardized clinicopathological data remains essential to refine prognostic stratification and guide clinical decision-making.

Active Surveillance in Papillary Thyroid Cancer With Primary Tumors Greater Than 1.5 cm

Thu, 16 Apr 2026 22:57:58 -0700

ABSTRACT

Background

While accepted as a viable initial management option for properly selected small (< 1.5 cm) papillary thyroid cancer (PTC), the natural history and clinical outcomes of active surveillance in larger tumors are not well described.

Methods

This is a retrospective chart review of patients with PTC > 1.5 cm opting for active surveillance as part of routine clinical care.

Results

In 45 patients with PTC > 1.5 cm (range 1.6–2.9 cm) followed with active surveillance for a median of 4.2 years: 6 patients (13%, 6/45) demonstrated an increase in tumor volume, 5 patients (11%, 5/45) demonstrated newly identified cervical lymph node metastasis. Only 9 patients (20%, 9/45) transitioned to surgical intervention with no evidence of disease, a median of 3.1 years after surgical intervention.

Conclusion

These findings suggest that active surveillance is a viable initial management option in properly selected patients with PTC greater than 1.5 cm in maximal diameter.

Comparative Use of Double Bipolar Forceps Versus Ultrasound Energy Device in Transoral Robotic Thyroidectomy

Thu, 16 Apr 2026 22:47:56 -0700

ABSTRACT

Purpose

Transoral robotic thyroidectomy (TORT) offers excellent cosmetic outcomes and safe access to the central neck without a cervical incision. Traditionally, ultrasonic energy devices have been used for dissection and hemostasis, though these instruments are limited by unilateral use, bulkiness, and greater thermal spread. Double bipolar forceps, when used bilaterally, provide enhanced precision, full articulation, smoke reduction, and integration with intraoperative nerve monitoring, thereby enabling efficient bimanual dissection and continuous traction without frequent instrument exchanges.

Method

This video illustrates the operative techniques of both ultrasonic energy devices and double bipolar forceps in TORT, highlighting their technical nuances and practical advantages.

Finding

In a retrospective study of 1726 TORT cases performed by a single surgeon, operative times were significantly shorter in the double bipolar forceps group compared with the ultrasonic device group (lobectomy: 131.7 ± 25.1 min vs. 174.7 ± 35.2 min, p < 0.001; total thyroidectomy: 185.6 ± 44.7 min vs. 217.4 ± 65.8 min, p < 0.001), while complication rates were comparable.

Conclusion

Together, the video and clinical data underscore the value of bipolar forceps as an effective alternative to conventional energy devices in robotic thyroid surgery.

Evaluating the Clinical Impact of the Direct‐To‐Test Neck Lump Referral Pathway. A Retrospective Review at a District General Hospital

Thu, 16 Apr 2026 22:05:17 -0700

ABSTRACT

Objective

To evaluate a precision-triage, direct-to-test (DTT) neck-lump referral pathway under the National Health Service (NHS) Faster-Diagnosis-Standard (FDS).

Setting

A district-general hospital in England.

Methods

Prospective review of FDS referrals for “neck lump” or “unexplained thyroid lump” from November 1, 2023 to December 31, 2024. After triage, patients proceeded directly to ultrasound (DTT-USS) with further tests as needed. Minimum follow-up: 6-months.

Results

417/440 referrals were included; 55.6% lacked clinical details. USS was normal in 110 (26.4%). Suspicious lesions requiring biopsy were found in 130, with malignancy in 12.7%, consistent with national data. Following benign/normal USS, 348 (83.5%) were removed from the cancer pathway; 71 (20%) requested review and 21 (6%) chose routine surgery. Straight-to-biopsy reduced diagnostic intervals (15 vs. 24 days, p < 0.001).

Conclusion

The DTT-USS pathway streamlines referrals, ensures diagnostic accuracy, and improves efficiency. Standardized referral data, radiologist-led biopsy, and structured benign follow-up could further enhance sustainability.

Cumulative Incidence and Risk of Depression After Opioid Use in Head and Neck Cancer Patients

The 23 patients included 10 men and 13 women, with a mean age of 43.4 years. Among the 23 cases, only 3 cases (13.0%) had unilateral lesions, and 20 cases (87.0%) had lesions involving bilateral nasal and/or paranasal sinuses. In some patients, the lesions were limited to the nasal and paranasal sinuses (8 cases), while in some patients, the lesions invaded the surrounding tissues (15 cases). 11 patients (47.8%) had enlarged lymph nodes in the retropharynx, parotid gland, and neck. The lesions showed isodense on CT images, accompanied by mild bony absorption and hyperostosis. The lesions showed isointensity on T1WI, mainly hypointensity to isointensity on T₂WI, and a few showed hyperintensity. After enhancement, the lesions showed moderate to obvious enhancement, and the enhancement was homogeneous without necrosis. The diffusion of the lesion was limited on diffusion-weighted imaging, and the average apparent diffusion coefficient value was 674.5 × 10⁻³ mm²/s. Dynamic enhanced MRI showed a rapidly enhancing and slow washout pattern of time-intensity curve.

Conclusions

The possibility of RDD should be considered when a bilateral diffuse mass growing along the nasal mucosa is found, with low T₂ signal, limited diffusion, no necrosis, and slight bone destruction and sclerosis.