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.

Objectives To describe the characteristics of head and neck leiomyosarcoma and to identify factors associated with survival. Design Retrospective population-based study. Patients The 17-registry Surveillance, Epidemiology, and End Results database was used to identify 578 patients with leiomyosarcoma of the head and neck. Interventions Surgery and primary and adjuvant radiotherapy. Main Outcome Measures Patient demographics and tumor characteristics were examined. Treatment modalities were compared, and survival was assessed using the log-rank test. Results The mean age at diagnosis was 64 years. Most tumors were smaller than 5 cm in greatest dimension (87%) and high grade (44% were moderately differentiated and 39% were poorly differentiated). The primary tumor demonstrated deep extension in 39% of cases, and 2% had lymph node metastases. The most common primary site was the skin and soft tissue of the head and neck (83%). Surgical treatment was provided to 89% of patients, 14% received adjuvant radiotherapy, and 4% received radiotherapy alone. The median observed survival was 84.7 months. The 5-year disease-specific survival rate was 87.6% in patients with well-differentiated tumors, 85.7% in patients with moderately differentiated tumors, and 52.7% in patients with poorly differentiated tumors (P<.001). Survival was better for patients who received surgery alone (median survival, 100.1 months [n=413]) than for those who received radiotherapy alone (median survival, 16 months [n=16]) or adjuvant radiotherapy (median survival, 64.2 months [n=80]) (P<.001). The latter group was more likely to have poorly differentiated, large, locally invasive tumors. Conclusions Leiomyosarcoma typically presents in older patients; it is often poorly differentiated; and improved survival is associated with surgical treatment.

Importance Sentinel lymph node biopsy (SLNB) provides prognostic information for melanoma; however, a survival benefit has not been demonstrated. Objective To assess the association of SLNB with survival for head and neck melanoma (HNM). Design Propensity score-matched retrospective cohort study using the Surveillance Epidemiology and End Results (SEER) database to compare patients with HNM initially treated with SLNB versus nodal observation. Setting United States population Patients Melanoma arising in head and neck subsites meeting current recommendations for SLNB, treated during the years 2004-2011 with either a) SLNB +/− neck dissection, or b) no SLNB or neck dissection. Intervention: SLNB +/− neck dissection Main Outcome Disease-specific survival (DSS) estimates based on the Kaplan-Meier method, and Cox proportional-hazards modeling to compare survival outcomes between matched-pair cohorts Results 7266 HNM patients meeting study criteria were identified from the SEER database. Matching of treatment cohorts was performed utilizing propensity scores modeled on 10 covariates known to be associated with SLNB treatment or melanoma survival. Cohorts were stratified by tumor thickness (thin: >0.75-1mm Breslow depth, intermediate: >1-4mm, and thick: >4mm) and exactly-matched within five age categories. In the intermediate-thickness cohort, 2808 HNM patients were matched and balanced by propensity score for SLNB treatment; the 5-year DSS estimate for those treated by SLNB was 89% vs. 88% for nodal observation (log-rank p=0.30). The hazard ratio for melanoma-specific death was 0.87 for those undergoing SLNB (95% CI 0.66-1.14, p=0.31). In each of the other cohorts analyzed, including the thin, thick, and overall cohorts, no significant difference in DSS was demonstrated. Conclusions This SEER cohort analysis demonstrates no significant association between SLNB and improved disease survival for patients with HNM.

Background The relationship between clinical outcomes and geographic determinants is not well known for head and neck cancer. Socioeconomic status (SES) factors and the distribution of health care resources might impact outcomes. Methods Head and neck cancer cases in the Surveillance, Epidemiology, and End Results (SEER) database were studied. Patient‐level prognostic factors were identified from the SEER, and county‐level factors were identified from the Area Health Resource File. Stage at presentation and observed survival were the outcomes of interest, with predictive factors identified by multivariate logistic and Cox proportional hazards regression. Results On multivariate analysis, tumor site, sex, race, marital status, rural residence, and county poverty level predicted stage at presentation. Sex, race, marital status, county‐level poverty, and number of otolaryngologists predicted observed survival. Conclusion Adverse county‐level SES predicted advanced cancer stage at presentation and diminished observed survival. SES was a stronger predictor of patient outcomes than rurality or number of otolaryngologists.