IMPORTANCE Delays in the delivery of care for head and neck cancer (HNC) are a key driver of poor oncologic outcomes and thus represent an important therapeutic target. OBJECTIVE To synthesize information about the association between delays in the delivery of care for HNC and oncologic outcomes. EVIDENCE REVIEW A systematic review of the English-language literature in PubMed/MEDLINE and Scopus published between January 1, 2007, and February 28, 2018, was performed to identify articles addressing the association between treatment delays and oncologic outcomes for patients with HNC. Articles that were included (1) addressed cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) discussed patients treated in 2004 or later; (3) analyzed time of diagnosis to treatment initiation (DTI), time from surgery to the initiation of postoperative radiotherapy, and/or treatment package time (TPT; the time from surgery through the completion of postoperative radiotherapy); (4) included a clear definition of treatment delay; and (5) analyzed the association between the treatment time interval and an oncologic outcome measure. Quality assessment was performed using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies. FINDINGS A total of 18 studies met inclusion criteria and formed the basis of the systematic review. Nine studies used the National Cancer Database and 6 studies were single-institution retrospective reviews. Of the 13 studies assessing DTI, 9 found an association between longer DTI and poorer overall survival; proposed DTI delay thresholds ranged from more than 20 days to 120 days or more. Four of the 5 studies assessing time from surgery to the initiation of postoperative radiotherapy (and all 4 studies assessing guideline-adherent time to postoperative radiotherapy) found an association between a timely progression from surgery to the initiation of postoperative radiotherapy and improved overall or recurrence-free survival. Of the 5 studies examining TPT, 4 found that prolonged TPT correlated with poorer overall survival; proposed thresholds for prolonged TPT ranged from 77 days or more to more than 100 days. CONCLUSIONS AND RELEVANCE Timely care regarding initiation of treatment, postoperative radiotherapy, and TPT is associated with survival for patients with HNC, although significant heterogeneity exists for defining delayed DTI and TPT. Further research is required to standardize optimal time goals, identify barriers to timely care for each interval, and design interventions to minimize delays.

Purpose: We studied the impact of mTOR signaling inhibition with rapamycin in head and neck squamous cell carcinoma (HNSCC) in the neoadjuvant setting. The goals were to evaluate the mTOR pathway as a therapeutic target for patients with advanced HNSCC, and the clinical safety, antitumor, and molecular activity of rapamycin administration on HNSCC.Patients and Methods: Patients with untreated stage II-IVA HNSCC received rapamycin for 21 days (day 1, 15 mg; days 2-12, 5 mg) prior to definitive treatment with surgery or chemoradiation. Treatment responses were assessed clinically and radiographically with CT and FDG-PET. Pre-and posttreatment biopsies and blood were obtained for toxicity, immune monitoring, and IHC assessment of mTOR signaling, as well as exome sequencing.Results: Sixteen patients (eight oral cavity, eight oropharyngeal) completed rapamycin and definitive treatment.

Background Sialoendoscopy is the standard treatment for sialolithiasis; however, some patients may be unlikely to benefit from an endoscopic approach. This study assesses predictors of failure in the endoscopic management of sialoliths. Methods Patients treated for sialolithiasis from 2012 to 2017 at two centers were stratified into 3 groups: successful interventional sialendoscopy, incisional sialolithotomy, and gland excision. Patient, disease, and surgical factors were compared. Results Interventional sialendoscopy was attempted in 156 of 206 cases and successful for 42 (27%). Endoscopically retrieved calculi were smaller (4.96 mm) compared to incisional sialolithotomy (7.90 mm). Nonendoscopic approaches were required more often in submandibular cases 87% (P ≤ .005). Palpable stones were present in 74% of incisional sialolithotomies (P < .001). Submandibular location (OR 3.50, 1.53‐7.98), palpability (OR 2.74, 1.21‐6.18), CT localization (OR 3.05, 1.32‐7.10, P = .010), and increased diameter (OR 1.25, 1.09‐1.44) were predictive of incisional management. Conclusion Stone size/location, CT‐localization, and palpability were predictive of calculi that require an incisional approach. If these factors are recognized, the surgeon can consider proceeding directly to incisional sialolithotomy. Level of evidence III

Although cryotherapy appears safe and efficacious, heterogeneous past investigations with low-quality evidence make strong, evidence-based recommendations difficult to make. Further study with validated metrics and controlled populations is certainly warranted and should be encouraged.

Objective Delayed treatment significantly affects survival in head and neck cancer, but defining delays for specific subsites remains controversial. The purpose of this study is to elicit the time point for delay in treatment initiation in all laryngeal cancers using a large cohort of patients within the National Cancer Database (NCDB). Study Design A retrospective cohort study. Setting NCDB. Subjects and Methods Patients with laryngeal cancer within the NCDB from 2006 to 2014 were identified. A recursive partition analysis (RPA) was performed to identify the time point at which delay contributed to increased hazard. Patients were stratified into 3 groups: no delay, at risk, and overtly delayed. Kaplan-Meier method was used to compare overall survival of these cohorts. Multivariate logistic regression analysis was used to identify predictors of delay. A multivariate Cox regression model was used to identify the final covariates that significantly affect overall survival. Results RPA identified the threshold for delay becomes significant at 46 days and exceeds baseline hazard at 73 days. Delay beyond 73 days is associated with a 16.1-month decrease in median survival (P < .001). To ensure this was not due to any confounding variables, a subsequent Cox multivariate regression confirmed a significantly increased adjusted hazard ratio (HR) for patients who were at risk or delayed (adjusted HR [confidence interval], 1.09 [1.04-1.15] and 1.26 [1.18-1.35], respectively). Conclusion Treatment of laryngeal cancer requires a multidisciplinary approach, and coordinating this care can take time. Our study highlights that delay beyond 46 to 73 days significantly affects survival and identifies patients experiencing these delays.

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ObjectivesObstructive sleep apnea (OSA) is a prevalent disease with significant health impacts. While first line therapy is CPAP, long-term compliance is low and device misuse is common, highlighting the need for alternative therapies. Upper airway surgery is one alternative, but substantial side effects hamper efficacy. A new alternative is an implantable hypoglossal nerve stimulator (HNS). These devices utilize neuromodulation to dilate/reinforce the airway and reduce side effects associated with traditional surgery. Several recent trials investigated the efficacy of these devices. The purpose of this study was to perform meta-analysis of available HNS studies investigating treatment of OSA to analyze objective and subjective outcomes and side effects.MethodsA comprehensive literature search of PubMed and Scopus was performed. Two independent reviewers examined clinical trials investigating HNS in treatment of sleep apnea in adults. Studies with objective and subjective endpoints in sleep were included for analysis. Adverse events from trials were also recorded.ResultsAcross 16 studies, 381 patients were analyzed. At 6 months (p = 0.008), mean SAQLI improved by 3.1 (95%CI, 2.6–3.7). At 12 months (p < 0.0001), mean AHI was reduced by 21.1 (95%CI, 16.9–25.3), mean ODI was reduced by 15.0 (95%CI, 12.7–17.4), mean ESS was reduced by 5.0 (95%CI, 4.2–5.8), mean FOSQ improved by 3.1 (95%CI, 2.6–3.4). Pain (6.2%:0.7–16.6), tongue abrasion (11.0%:1.2–28.7), and internal (3.0%:0.3–8.4)/external device (5.8%:0.3–17.4) malfunction were common adverse events.ConclusionsHNS is a safe and effective treatment for CPAP refractory OSA. Further study comparing HNS to other therapies is required.

The incidence of lung cancer has significantly increased over the last century, largely due to smoking, and remains the most common cause of cancer deaths worldwide. This is often due to lung cancer first presenting at late stages and a lack of curative therapeutic options at these later stages. Delayed diagnoses, inadequate tumor sampling, and lung cancer misdiagnoses are also not uncommon due to the limitations of the tissue biopsy. Our better understanding of the tumor microenvironment and the systemic actions of tumors, combined with the recent advent of the liquid biopsy, may allow molecular diagnostics to be done on circulating tumor markers, particularly circulating tumor DNA. Multiple liquid biopsy molecular methods are presently being examined to determine their efficacy as surrogates to the tumor tissue biopsy. This review will focus on new liquid biopsy technologies and how they may assist in lung cancer detection, diagnosis, and treatment.