Patients receiving CRT experience a substantial number of treatment-related adverse events, primarily affecting oropharyngeal and laryngeal function, with improvement noted for the current IMRT protocol. Improving dental prosthetic rehabilitation and including evaluations with speech and swallowing pathologists before and during treatment may enhance patient outcomes.

Intraoperative frozen margins from the tumor bed are not ideal predictors of positive margins on the main specimen. Both frozen and specimen margins are associated with local recurrence, but the specimen margin has the stronger association. Importantly, we demonstrate that clearing positive frozen margins from the tumor bed is not associated with improved outcomes.

IMPORTANCE There is a lack of consistency in the literature regarding the definition of "close" resection margins in the surgical treatment of oral cavity squamous cell carcinoma (OCSCC), and the relationship between local recurrence (LR) rates and different distances of invasive tumor from surgical margin is not well characterized.OBJECTIVE To analyze the association between specific distances from invasive tumor to surgical margin and LR in patients with OCSCC. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 432 patients treated via en bloc resection for OCSCC between 2005 and 2014 at the University of Iowa Hospitals and Clinics. In all cases, permanent margin evaluation was performed on the main tumor specimen and with intraoperative frozen section margin assessment from the tumor bed. MAIN OUTCOMES AND MEASURESThe LR rate based on minimum millimeter distance between invasive tumor and inked main specimen margin. RESULTSOf the 432 participants, 252 (58%) were men and 180 (42%) were women (mean age, 62.14 years; range, 19-99 years). In each case, the LR rate was analyzed in relation to each millimeter distance of invasive cancer from the inked main specimen margin, with results showing an exponential inverse relationship. The LR rate for microscopic positive margins was 44% (95% CI, 34%-55%); for margins less than 1 mm, 28% (95% CI, 18%-41%); for 1 mm, 17% (95% CI, 8%-31%); for 2 mm, 13% (95% CI, 6%-27%); for 3 mm, 13% (95% CI, 5%-32%); for 4 mm, 14% (95% CI, 5%-35%); and for 5 mm or greater, 11% (95% CI, 6%-18%). Analysis of the receiver operating characteristic curve identified a cutoff of less than 1 mm as appropriate for classifying higher risk of local recurrence. Regardless of margin distance, resection of additional tissue beyond 1 mm based on intraoperative frozen section was not associated with improved local control. CONCLUSIONS AND RELEVANCEThe commonly used cutoff of 5 mm for a close margin lacks an evidential basis in predicting local recurrence. Invasive tumor within 1 mm of the permanent specimen margin is associated with a significantly higher local recurrence rate, though there is no significant difference for greater distances. This study suggests that a cutoff of less than 1 mm identifies patients at increased local recurrence risk who may benefit from additional treatment. Analysis of the tumor specimen rather than the tumor bed is necessary for this determination.

The incidence of nodal disease was higher with eyelid tumors. Sentinel lymph node biopsy can be considered for eyelid tumors, but not for non-eyelid head and neck tumors.

The authors report an investigation of burnout in practicing otolaryngologists using a validated instrument with correlation to potentially modifiable risk factors. The experience of burnout was found to correlate significantly with both personal and professional factors, each of which can potentially be addressed to curb the incidence of burnout. Further understanding of the potential risk factors for burnout is necessary to minimize and prevent burnout among practicing otolaryngologists.