Background Prospective quality metrics for neck dissection have not been established for patients with head and neck squamous cell carcinoma. The purpose of this study is to investigate the association between lymph node counts from neck dissection, local-regional recurrence, and overall survival. Methods The number of lymph nodes counted from neck dissection in patients treated on NRG Oncology RTOG trials 9501 and 0234 was evaluated for its prognostic impact on overall survival using a multivariate Cox model adjusted for demographic, tumor, and lymph node data, and stratified by postoperative treatment group. Results 572 patients were analyzed at median follow-up of eight years. 98% of patients were pathologically N+. Median number of lymph nodes recorded on the left and right sides were 24 and 25. Fewer than 18 nodes identified was associated with worse overall survival relative to ≥18 nodes (hazard ratio 1.38, 95%CI 1.09–1.74, p=0.007). The difference appeared to be driven by local-regional failure (HR 1.46, 95%CI 1.02–2.08, p=0.04) but not distant metastases (HR 1.08, 95%CI 0.77–1.53, p=0.65). When analysis was limited to NRG Oncology RTOG 0234 patients, adding p16 status to the model did not affect the hazard ratio for dissected nodes and the effect of nodes was not different by p16 status. Conclusion The removal and identification of 18 or more lymph nodes was associated with improved overall survival and lower rates of local-regional failure, and should be further evaluated as a measure of quality in neck dissections for mucosal squamous cell carcinoma.

In recent years, the general profile of patients with AK has changed at WEH. Currently, we are treating older patients with more severe keratitis who are presenting later and with worse vision compared with our previous patients. At the same time, treatment outcomes have been poorer.

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Purpose The purpose of the present study was to evaluate severity of cetuximab-induced skin rash and its correlation with clinical outcome and late skin toxicity in patients with head and neck squamous cell carcinoma treated with chemoradiotherapy and cetuximab. Materials & Methods Analysis included patients who received loading dose and ≥ 1cetuximab dose concurrent with definitive chemoradiotherapy (70Gy + cisplatin) or postoperative chemoradiotherapy (60–66Gy + docetaxel or cisplatin). Results Six hundred two patients were analyzed; 383 (63.6%) developed Grade 2–4 cetuximab rash. Patients manifesting Grade 2–4 rash had younger age (p<0.001), fewer pack-years smoking history (p<0.001), were more likely to be males (p=0.04), and had p16-negative (p=0.04) oropharyngeal tumors (p=0.003). In univariate analysis, Grade 2–4 rash was associated with better overall survival (OS) (hazard ratio [HR] 0.58, p<0.001) and progression-free survival (PFS) (HR 0.75, p=0.02), and reduced distant metastasis (DM) rate (HR 0.61, p=0.03), but not local-regional failure (LRF) (HR 0.79, p=0.16) relative to Grade 0–1 rash. In multivariable analysis, HRs for OS, PFS, DM, and LRF were 0.68 (p=0.008), 0.85 (p=0.21), 0.64 (p=0.06), and 0.89 (p=0.48). Grade ≥2 rash was associated with improved survival in p16 negative patients (HR 0.28 (0.11–0.74)) but not in p16 positive patients (HR 1.10 (0.42–2.89)) (p=0.05 for interaction). Twenty-five percent of patients with Grade 2–4 acute in-field radiation dermatitis experienced Grade 2–4 late skin fibrosis vs. 14% of patients with Grade 0–1 acute in-field radiation dermatitis (p=0.002). Conclusion Grade 2–4 cetuximab rash was associated with better survival possibly due to reduction of distant metastasis. This observation was noted mainly in p16 negative patients. Grade 2–4 acute in-field radiation dermatitis was associated with higher rate of late Grade 2–4 skin fibrosis.

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Purpose To determine the relationship between p16 status and the regional response of patients with node-positive oropharynx cancer treated on NRG Oncology RTOG 0129. Methods and Materials Patients with N1-N3 oropharynx cancer and known p16 status who underwent treatment on RTOG 0129 were analyzed. Pathologic complete response (pCR) rates in patients treated with a postchemoradiation neck dissection (with p16-positive or p16-negative cancer) were compared by Fisher exact test. Patients managed expectantly were compared with those treated with a neck dissection. Results Ninety-nine (34%) of 292 patients with node-positive oropharynx cancer and known p16 status underwent a posttreatment neck dissection (p16-positive: n = 69; p16-negative: n = 30). The remaining 193 patients with malignant lymphadenopathy at diagnosis were observed. Neck dissection was performed a median of 70 (range, 17-169) days after completion of chemoradiation. Neither the pretreatment nodal stage (P = .71) nor the postradiation, pre-neck dissection clinical/radiographic neck assessment (P = .42) differed by p16 status. A pCR was more common among p16-positive patients (78%) than p16-negative patients (53%, P = .02) and was associated with a reduced incidence of local–regional failure (hazard ratio 0.33, P = .003). On multivariate analysis of local–regional failure, a test for interaction between pCR and p16 status was not significant (P = .37). One-hundred ninety-three (66%) of 292 of initially node-positive patients were managed without a posttreatment neck dissection. Development of a clinical (cCR) was not significantly influenced by p16-status (P = .42). Observed patients with a clinical nodal CR had disease control outcomes similar to those in patients with a pCR neck dissection. Conclusions Patients with p16-positive tumors had significantly higher pCR and locoregional control rates than those with p16-negative tumors.

IMPORTANCE Individuals with perceived experience and expertise are invited by editorial boards to provide commentary through editorials. Female representation among editorialists is not yet defined.OBJECTIVE To determine female representation as editorial authors in 3 high-impact general ophthalmology journals.

Precis A recent review in this Journal, which criticizes NCCN’s recommendations based, in part, on the RTOG 9501 and the EORTC 22931 trials, warrants comment. We herein provide additional data addressing many of the points and misinterpretations raised in that review which convincingly supports the use of concomitant chemotherapy and radiotherapy in patients with good performance status and high-risk pathologic features after surgery for mucosal head and neck squamous cell carcinoma.