Background Despite better prognosis, there is a group of oropharyngeal squamous cell carcinoma (SCC) human papillomavirus (HPV)+ patients who experience treatment failure and succumb to distant metastasis. Methods Seventy-eight previously untreated patients nested in a concurrent chemoradiation protocol were reviewed to correlate patterns of local-regional tumor extent to distant metastasis. Biomarker assessment was: HPV in situ hybridization and epidermal growth factor receptor (EGFR) immunointensity. Results The 3-year disease-specific survival (DSS) for patients presenting with and without matted nodes was 69% and 94%, respectively (p = .003). Matted nodes were a poor prognostic factor independent of T classification, HPV, EGFR, and smoking status. For patients who were HPV+, 7 of 11 died of distant metastasis and 6 of 7 with distant metastasis had matted nodes. Conclusion Matted nodes are a novel marker of poor prognosis in oropharyngeal SCC independent of established prognostic factors. Matted nodes may identify patients at risk for the development of distant metastasis who could benefit from systemic therapy, whereas patients without matted nodes may be candidates for de-escalation of therapy.

Background The current AJCC staging system may not accurately reflect survival in patients with HPV+OPSCC. The purpose of this study is to develop a system that more precisely predicts survival. Methods CT scans from 156 patients who underwent chemoradiation for advanced-stage OPSCC with >2years follow-up were reviewed. We modeled patterns of nodal metastasis associated with different survival rates. We defined HPV+N1 as a single node <6cm, ipsilaterally,contralaterally or bilaterally. HPV+N2 was defined as a single node ≥6cm or ≥2nodes ipsilaterally/contralaterally or ≥3nodes bilaterally. HPV+N3 was defined as matted nodes. Results There was no significant difference in DSS(p=0.14) or OS(p=0.16) by AJCC classification. In patients grouped by HPV+N1,HPV+N2,and HPV+N3 nodal classification, significant differences in DSS(100%,92%,55%,respectively,p=0.0001) and OS(100%,96%,55%,respectively,p=0.0001) were found. Conclusions A staging system with reclassification of size,bilaterality and matted nodes more accurately reflects survival differences in this cohort of patients. Review of the AJCC staging system with these criteria should be considered for HPV+OPSCC.

Background We recently described the imaging characteristics of multiple confluent regional metastases (matted nodes) and found that this characteristic was associated with distant metastasis in patients with oropharyngeal squamous cell carcinoma (OPSCC). The purpose of this study is to determine if matted nodes are a predictive marker for distant metastasis. Methods Radiologic lymph node characteristics on 205 untreated stage III/IV with OPSCC patients of whom 192 had known HPV status underwent weekly carboplatin and paclitaxel with concomitant IMRT between 2003–2010 with minimum 2 years of follow-up. Results The 3-year DSS for patients with matted nodes was 58% versus 97% with non-matted nodes(p=0.0001). The prevalence of matted nodes in the population was 20%. The positive predictive value of matted nodes for distant metastasis is 66%, and the negative predictive value is 99%. Conclusions Matted nodes are a predictive marker for distant disease and can be used for planning new clinical interventions.

Background To describe the relationship of p16 and EGFR expression with survival in surgically treated patients who had oropharyngeal and oral cavity squamous cell carcinoma (OPSCC and OCSCC). Methods Tissue from 36 OPSCC and 49 OCSCC patients treated between 1997 and 2001 was imbedded and immunostained using a tissue microarray. Results p16 was positive in 57% and 13% of OPSCC and OCSCC patients, respectively. EGFR was positive in 60% and 63% of OPSCC and OCSCC patients, respectively. In OPSCC patients, p16 expression was associated with improved disease specific survival (DSS), overall survival (OS), and time to recurrence (TTR) (p <0.01, <0.01, <0.01). EGFR expression was associated with poorer DSS, OS, and TTR (p <0.01, =0.01, <0.01). For OPSCC, when examining both p16 and EGFR expression as combined biomarkers, high p16 expression coupled with low EGFR expression was associated with improved disease-specific survival (pp16 = 0.01; pEGFR= 0.01). OCSCC patients showed no association between biomarker and outcome. Conclusions For patients with OPSCC, high p16 and low EGFR were associated with improved outcome, suggesting a predictive role in surgically treated patients.

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The Tdast is an excellent choice for reconstruction in the head and neck as an alternative to procedures requiring vein grafting and multiple free tissue transplants, or in which the 3-dimensional contour of the scapular tip aids in reconstruction. The complication rate should be assessed in the context of the risk factors of the patient population and the outcome with respect to stable employment, increasing body mass index, and maintenance of shoulder function.