American Head & Neck Society

Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.

Published on by Jeffrey Myers

A Giant of Head and Neck Surgery has Passed

It is with great sadness that I write to you about the passing of one of the true giants of the field of Head and Neck Surgical Oncology, Dr. Robert Byers passed away Saturday, March 6, 2021 at 3 AM.  There will be no funeral, but there will be a Memorial Service which will be announced later this month.

Robert Maxwell Byers, M.D. was born in Union Hospital, Baltimore Maryland on September 24, 1937. He grew up on the Eastern Shore of Maryland in the small town of Elkton. Very active in the varsity sports of baseball, basketball and track during his high school years, he continued his athletic participation at Duke University along with his pre-med studies. He entered the University of Maryland Medical School in Baltimore in 1959 where he excelled in his medical studies and received membership in AOA and the Rush Honor Medical Society. The highlight of his sophomore year was his 1961 marriage to Marcia Davis, a high school sweetheart. During his junior year, he was commissioned an Ensign in the United States Naval Reserve and later rose to the rank of Captain in 1986.

In 1963, Dr. Byers begin his general surgical residency with Dr. Robert Buxton at the University Hospital in Baltimore. Five years later, as a fully trained general surgeon, he went to the Republic of Vietnam with the 1st Marine Division where he received a unit commendation medal and a combat action ribbon. On return to the United States, he spent a year at Quonset Point, Rhode Island Naval Hospital as Chief of Surgery. In 1969, the American Board of Surgery certified him. After discharge from the Navy in 1970, he and his family moved to Houston, Texas where he began a fellowship in Surgical Oncology at the University of Texas M.D. Anderson Cancer Center under the guidance of Drs. R. Lee Clark, Richard Martin, Ed White, William MacComb, Richard Jesse and Alando J. Ballantyne. This move proved to be a decisive event, as he never left. His career in Head and Neck Surgical Oncology was born nurtured and matured during the 31 years of his academic/clinical practice at the University of Texas M.D. Anderson Cancer Center. In 1974, his fourth son, MacGregor was born.

During his tenure at M.D. Anderson Cancer Center he rose through the ranks from Assistant Professor in 1972 to Associate Professor in 1976 and, finally, Professor and Surgeon in 1981. In 1998, he was honored with the Distinguished Alando J. Ballantyne Chair of Head and Neck Surgery. He was the author or co-author of over 200 published papers, book chapters and monographs. He gave invited lectures all over the world. In 1999, he was selected to give the Hayes Martin Memorial Lecture at the 5th International Conference on Head and Neck Cancer (A copy of this lecture can viewed by clicking here). He was President of the American Radium Society and President of the Society of Head and Neck Surgeons both in 1995 – 1996. His research interests and his expertise were focused on cancer of the oral cavity, head and neck cancer in young people and treatment of the neck involved with metastatic cancer with a particular interest in various neck dissections. Dr. Byers was a member of many prestigious societies of which the Southern Surgical Association, the Texas Surgical Society, the American College of Surgeons and the Society of Surgical Oncologists are but a few. He was a peer reviewer for many medical journals and on the Editorial Board of three. During his 31 years at the University of Texas M.D. Anderson Cancer Center he participated in the surgical education of over 300 residents and fellows, many of who have gone on to become prominent members of the specialty.

As a former trainee, I can honestly say that he greatly shaped my thinking about oncologic problems and attention to technical precision and hemostasis in the operating room.  Almost every time I operate, I hear his voice saying, “cut on the patient side”.  He was always on the patient’s side!  I know that he has impacted many other past trainees and colleagues in the same positive way, and we will all miss him.

Jeffrey Myers

Jeffrey N. Myers is a head and neck surgeon, Chair, Department of Head and Neck Surgery, Alando J. Ballantyne Distinguished Chair of Head and Neck Surgery, and translational scientist at the University of Texas MD Anderson Cancer Center. President of the American Head and Neck Society from 2016-2018. Dr. Jeffrey N. Myers received his medical (MD) and doctoral (PhD) degrees from the University of Pennsylvania School of Medicine and he then completed his residency training in Otolaryngology-Head and Neck Surgery at the University of Pittsburgh. He subsequently completed fellowship training in Head and Neck Surgical Oncology at the University of Texas MD Anderson Cancer Center, where he has been on the faculty ever since. Dr. Myers leads a basic and translational research program and his primary research interests are in the role of p53 mutation in oral cancer progression, metastasis and response to treatment.

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Published on by AHNS Webmaster

Myers’ Family Summer Travel Fellowship in Otolaryngology Application is Open

Diversity Summer Travel Fellowship in Otolaryngology for under-represented minority medical students 

This program is sponsored by the American Head and Neck Society Research and Education Foundation, thanks to the very generous contributions of Dr. Eugene Myers and Dr. Jeffrey Myers, as well as other AHNS donors.  It is intended to expose an under-represented minority medical student to the field of Head and Neck surgery specifically and Otolaryngology in general. Please click the link here to watch the RFA video to disseminate to your URM M1 and M2 candidates of the AHNS Myers’ Family Summer Travel Fellowship in Otolaryngology.

 

A grant of $5,000 will be awarded to a medical student to cover travel, lodging and food expenses for the summer experience.  This summer program offers the interested candidate the opportunity to work in a Department of Academic Excellence in Head and Neck Surgical Oncology that has an approved Fellowship Training Program from the Advanced Training Council of the AHNS.  Participants will be assigned to a clinical faculty mentor and will rotate on his or her clinical service and have the chance to participate in the care of Head and Neck Cancer patients in the outpatient setting, inpatient environment, as well as the operating room.  Summer fellows will also have the opportunity to perform basic, translational, clinical, or population based research under the guidance of a chosen/assigned research mentor.

 

The grant of $5,000 includes the recipients roundtrip airfare, cost to travel to the meeting, transportation to and from, food and hotel stay expenses at the AHNS Annual/International Meetings. At the AHNS Annual/International Meeting the student will share their Summer experience via PowerPoint presentation and can network with AHNS members.

 

Ideally the candidate is between year 1 and 2 of medical school. Some applicants between year 2 and 3 may have the ability to participate as a fellow award winner but this depends upon their medical school year academic calendar. Our Myers’ Family Summer Travel Fellowship in Otolaryngology FAQ page can be found by clicking here.

Published on by AHNS Webmaster

New Grant Opportunity from SU2C in Head and Neck Cancer: LOI Deadline March 22, 2021

Head and neck cancer is a blanket term used to describe several different types of cancers.
About 65,000 new cases, not counting thyroid cancer, are diagnosed in the U.S. every year.
A number of causes of these cancers have been identified, potentially offering new
opportunities to screen for the cancers and create new treatments for patients.

For example, the incidence of head and neck squamous cell carcinoma in people with
Fanconi anemia is 500- to 700-fold higher than in the general population. Additionally up to
70% of certain head and neck cancers are caused by human papillomavirus (HPV) infection.
Genetic defects that cause Fanconi anemia, as well as genetic changes resulting from HPV
infection, both adversely affect DNA repair systems, which can lead to cancer. This similarity
provides investigators with different perspectives on a common problem and the opportunity
to collaborate in new and innovative ways.

Head and neck cancers can appear in the nasal cavity, sinuses, lips, mouth, salivary glands,
thyroid gland, throat or larynx. Experts estimate there are about 550,000 cases of various
kinds of head and neck cancer diagnosed around the world each year, with 300,000 annual
deaths due to the cancers. Research has also shown that Black people have higher
incidence of head and neck cancer and a lower 5-year survival rate compared to white
people. Black patients are also typically diagnosed with more advanced head and neck
cancer.

To unlock potential new treatments, Stand Up To Cancer, with the generous support of the
Fanconi Anemia Research Fund, the Farrah Fawcett Foundation, the American Head and
Neck Society, and the Head and Neck Cancer Alliance, is offering up to $3.25 million in
grants to fund research to find new treatments for head and neck cancer. The team will have
a special focus on head and neck cancers associated with Fanconi anemia and HPV. Applicants will need to ensure that people from medically disadvantaged backgrounds are included in all phases of their proposed research.

Further information and a link to the application

visit StandUpToCancer.org/HeadandNeck.

 

Published on by Daniel Clayburgh

When should sentinel node biopsy be used for cutaneous squamous cell carcinoma?

Problem:
Cutaneous squamous cell carcinoma (cSCC) is a common malignancy, accounting for 20% of all skin malignancies1; furthermore, 80-90% of cSCC are located on thehead or neck2.  With surgical excision most localized cSCC has an excellent prognosis, with 5 year cure rates >90%3.  However, cSCC does have metastatic potential; in the 4% of cases that metastasize4 to regional lymphatics, the 5-year survival rate drops to 50-60%5.  Thus, risk-stratification and identification of patients with potential metastatic spread is important to optimize treatment.  While the majority of cSCC are easily treated with surgical excision and do not require nodal evaluation, the risk of metastatic spread may be as high as 47% in some high-risk populations (Table 1)6.  Sentinel lymph node biopsy (SLNB) is a method of evaluating the draining nodal basin of a primary cancer for occult disease that is widely used in melanoma, breast cancer, and other malignancies.  SLNB increases staging and prognosis accuracy and aids in local disease control6, although recent trials have not demonstrated overall survival benefit with SLNB7.  This technique has intermittently been applied to cSCC for many years, but the optimal use of SLNB in cSCC has not yet been defined.

Evidence
There are currently no large-scale, prospective, randomized clinical trials examining the use of SLNB in cSCC.  There are many prospective observational, retrospective, and meta-analysis studies examining this question, which are generally small (<200 patients) and limited to single-institution studies.  These studies demonstrate significant heterogeneity in patient inclusion criteria, methodology, and outcome measurements.  SLN positivity rates range from 0-66% across studies8, while meta-analyses of multiple studies have found positivity rates of 8%, 12%, and 14%.9,10,11  One literature review reported the sensitivity of SLNB to be 79%, specificity of 100%, and negative predictive value of 96%.12  A significant source of heterogeneity in these studies is the number and type of high risk features of the patients within each study.  While there is generally consensus regarding what constitutes high-risk features of cSCC (Table 1), it is not clear which of these features may provide the strongest indication for SLNB.

There is some data to support SLNB as a prognostic test in cSCC.  One study13 of 62 patients found a 100% 3-year survival in patient with negative SLNB, and a 20.8% 3 year survival in those with a positive SLNB.  Similarly, a second prospective study14 of 57 patients found a significant difference in disease-specific survival between SLNB positive and negative patients. In addition, other studies have shown that locoregional and distant recurrence is more likely in patient with positive SLNB.  In all studies, patients with positive SLNB were treated with additional surgery, radiation, or both.  Only one retrospective study compared SLNB patients to an observation arm; in this study of 720 patients, there were slightly more cSCC-related deaths in the SLNB arm (7.14% vs 4.74% in the observation arm) although this was not statistically significant.15  Thus, it remains unclear if SLNB and directed adjuvant therapy may improve survival in patients with cSCC.

Current guidelines on SLNB
Management of high-risk cSCC can be complex, and multiple guidelines exist to guide treatment decisions in these patients.  Most guidelines currently available discuss SLNB and conclude the data surrounding SLNB is limited, and few definitive statements are available.  Canadian guidelines16 provide a weak recommendation to consider SLNB as an optional procedure in certain high-risk patients; alternatively, European guidelines17 state that SLNB cannot be recommended outside of a clinical trial.  SLNB is not incorporated into any National Comprehensive Cancer Network treatment algorithms for cSCC; it contains a statement that “it is unclear whether SLNB followed by completion lymph node dissection or adjuvant RT will improve patient outcomes.  The criteria for selecting patients for SLNB are also unclear.”18

Bottom line:
SLNB likely provides some prognostic information in cSCC, but to date it is unclear which patients may benefit from this procedure, or its effect on the overall disease course.  Large-scale, well-controlled clinical trials are needed to define when SLNB is most useful in the management of cSCC.  While no clear recommendations currently exist, it does appear reasonable to consider SLNB in certain high-risk cases of cSCC; for example, patients with two or more high-risk features or after collaborative decision-making in a multidisciplinary treatment setting.

References

  1. Green AC, Olsen CM. Cutaneous squamous cell carcinoma: an epidemiological review. Br J Dermatol 2017;177:373e81.
  2. Alam M, Ratner D. Cutaneous squamous-cell carcinoma. N Engl J Med 2001;344:975e83.
  3. Bougham ND, Dennett ER, Cameron R, Tan ST. The incidence of metastasis from cutaneous squamous cell carcinoma and the impact of its risk factors. J Surg Oncol 2012;106:811e5.
  4. Brantsch KD, Meisner C, Schonfisch B, Trilling B, Wehner-Caroli J, Rocken M, et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol 2008;9:713e20.
  5. Robsahm TE, Helsing P, Veierod MB. Cutaneous squamous cell carcinoma in Norway 1963-2011: increasing incidence and stable mortality. Cancer Med 2015;4:472e80.
  6. Rowe DE, Carroll RJ, Day CL Jr. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip: implications for treatment modality selection. J Am Acad Dermatol. 1992;26:976–90.
  7. Faries MB, Thompson JF, Cochran AJ, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376:2211–22.
  8. Mooney CP, et al. Sentinel Node Biopsy in 105 High-Risk Cutaneous SCCs of the Head and Neck: Results of a Multicenter Prospective Study. Ann Surg Oncol 2019; 26:4481-4488
  9. Navarrete-Dechent C, Veness MJ, Droppelmann N, Uribe P. High-risk cutaneous squamous cell carcinoma and the emerging role of sentinel lymph node biopsy: A literature review. J Am Acad Dermatol 2015;73:127e37.
  10. Tejera-Vaquerizo A, Garcia-Doval I, Llombart B, Canueto J, Martorell-Calatayud A, Descalzo-Gallego MA, et al. Systematic review of the prevalence of nodal metastases and the prognostic utility of sentinel lymph node biopsy in cutaneous squamous cell carcinoma. J Dermatol 2018;45:781e90.
  11. Schmitt AR, Brewer JD, Bordeaux JS, Baum CL. Staging for cutaneous squamous cell carcinoma as a predictor of sentinel lymph node biopsy results: meta-analysis of American Joint Committee on Cancer criteria and a proposed alternative system. JAMA Dermatol 2014;150:19e24.
  12. Allen JE, Stolle LB. Utility of sentinel node biopsy in patients with high-risk cutaneous squamous cell carcinoma. Eur J Surg Oncol 2015;41:197e200.
  13. Takahashi A, Imafuku S, Nakayama J, Nakaura J, Ito K, Shibayama Y. Sentinel node biopsy for high-risk cutaneous squamous cell carcinoma. Eur J Surg Oncol. 2014;40:1256-1262.
  14. Gore SM, Shaw D, Martin RC, Kelder W, Roth K, Uren R, Gao K, Davies S, Ashford BG, Ngo Q, Shannon K, Clark JR. Prospective study of sentinel node biopsy for high-risk cutaneous squamous cell carcinoma of the head and neck. Head Neck 38: E884–E889, 2016
  15. Kofler L, Kofler K, Schulz C, Breuninger H, Hafner HM, Sentinel lymph node biopsy for high-thickness cutaneous squamous cell carcinoma. Arch Dermatol Res. 2021 Mar;313(2):119-126
  16. Sapijaszko M, Zloty D, Bourcier M, Poulin Y, Janiszewski P, Ashkenas J. Non-melanoma skin cancer in Canada chapter 5: management of squamous cell carcinoma. J Cutan Med Surg 2015; 19: 249–259
  17. Stratigos AJ, Garbe C, Dessinioti C, et al. European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. Epidemiology, diagnostics, and prevention. European Journal of Cancer 128 (2020) 60-82
  18. National Comprehensive Cancer Network (NCCN) Clinical Practice Guideline for Squamous Cell Skin Cancer. Version 2.2020, 7/14/20. Accessed 1/29/2021.
Daniel Clayburgh

Daniel Clayburgh

Daniel Clayburgh is an associate professor of Otolaryngology-Head and Neck Surgery at Oregon Health Sciences University and the Chief of Surgery at the Portland Veterans Affairs Medical Center. He completed medical and graduate school at the University of Chicago, otolaryngology residency at Oregon Health Sciences University, and head and neck fellowship at the University of Pittsburgh. His research interests primarily focus on perioperative optimization of head and surgical outcomes and developing novel prognostic factors in head and neck cancer patients.
Daniel Clayburgh

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Published on by AHNS Webmaster

AHNS Virtual Education Series

To Reconstruct or Not: Early Stage Oral Cavity Cancers

AHNS Virtual Education Series: To Reconstruct or Not: Early Stage Oral Cavity Cancers

The AHNS gratefully acknowledges support of this webinar from KLS Martin.

Date: Tuesday, February 23, 2021

Time: 4:00 PM Pacific /6:00 PM Central / 7:00 PM Eastern

This session is an hour long

Complimentary to all attendees

Register Here

Faculty:

Host: Urjeet Patel, MD, FACS, Cook County Hospital Stroger

Moderator: Matthew Old, MD, FACS, Wexner Medical Center, The Ohio State University

Panelists:
Alice Lin, MD, FACS, Kaiser Permanente – Los Angeles Medical Center
Larissa Sweeny, MD, Louisiana State University at New Orleans
Neal Futran, MD, Univ of Washington Med Center
Stephan Kang, MD, The Ohio State University
Rizwan Aslam, MD, Tulane University
Rodrigo Bayon, MD, FACS, University of Iowa Hospitals & Clinics
Arnaud Bewley, MD, University of California – Davis Medical Center
Steven Chinn, MD MPH FACS, University of Michigan
Michael Moore, MD, Indiana University School of Medicine
Jason Rich, MD, Washington University School of Medicine
Chad Zender, MD, FACS, University of Cincinnati College of Medicine