Efficacy of postoperative pain management in head and neck cancer patients.

BACKGROUND: Our study quantifies the effectiveness of perioperative pain control in a cohort of patients undergoing major head and neck surgery with free flap reconstruction. Our long-term goal is to improve pain control and thereby increase mobility, decrease postoperative complications and decrease hospital stay. METHODS: A retrospective analysis was performed at a tertiary, academic head and neck surgical oncology program in Calgary, Alberta, Canada from January 1, 2015 - December 31, 2015. Pain scores were recorded prospectively. Primary outcomes were frequency of postoperative pain assessments and pain intensity using the numeric rating scale. RESULTS: The cohort included 41 patients. Analysis was limited to pain scores recorded from postoperative days 1-14. There was an average of 7.3 pain measurements per day (SD 4.6, range 1-24) with the most frequent monitoring on postoperative days 1-4. Median pain scores ranged from 0 to 4.5 with the highest median score on postoperative day 6. The daily maximum pain scores recorded ranged from 8 to 10 with scores of 10 recorded on postoperative days 1, 2, 3, 5, 7, 8, and 10. Patients most frequently had inadequate pain control on postoperative days 1, 2, 4, and 5 with the majority occurring on postoperative day 1. CONCLUSIONS: Postoperative pain control could be improved at our centre. The frequency of pain assessments is also highly variable. Ongoing measurement, audit, and feedback of analgesic protocol effectiveness is an excellent first step in improving perioperative pain management in patients undergoing major head and neck cancer surgery with free flap reconstruction.

Diagnostic utility of central node necrosis in predicting extracapsular spread among oral cavity squamous cell carcinoma.

BACKGROUND: Oral cavity squamous cell carcinoma (SCC) represents the most common SCC affecting the head and neck region. Long-term survival of patients with oral cavity SCC is adversely affected by lymph node metastasis and further decreased by the presence of lymph node extracapsular spread (ECS). METHODS: Using a case-control design, preoperative CT scans from patients with oral cavity SCC and metastatic lymphadenopathy were evaluated by 2 independent neuroradiologists, blinded to the study, for a number of radiologic parameters, including central node necrosis. Multivariate logistic regression was used to identify parameters independently predicting pathologic ECS. RESULTS: For both neuroradiologists, central node necrosis was a significant predictor of ECS, with high interrater agreement (kappa = 0.71). On multivariate analysis, only central node necrosis independently predicted ECS (odds ratio [OR] = 12.1; 95% confidence interval [CI] = 1.24-119). Central node necrosis predicted ECS with 91% sensitivity and 88% negative predictive values. CONCLUSION: Our findings suggest that central node necrosis on preoperative CT scans is strongly associated with the presence of ECS.

Basal Ki67 expression measured by digital image analysis is optimal for prognostication in oral squamous cell carcinoma.

AIM: The prognostic significance of Ki67 expression in cancers, including oral squamous cell carcinoma (OSCC), is unclear. This may be partly attributed to the lack of consensus surrounding the optimal approach for measuring tumour Ki67 expression. The aim of this study was to evaluate the association between different measures of Ki67 expression and disease-specific survival (DSS) in OSCC. METHODS: Tissue microarrays (TMAs) were assembled from triplicate cores of formalin-fixed paraffin embedded (FFPE) pre-treatment tumour tissue obtained from 121 OSCC patients diagnosed between 1998 and 2006. Ki67 expression was quantified using fluorescence immunohistochemistry (IHC) and AQUAnalysis® in normal oral cavity squamous epithelium (OCSE) and OSCC tumour samples. Intensity and percentage-based approaches for Ki67 scoring were tested for their association with survival. RESULTS: Ki67 scores obtained from intensity and percentage-based approaches had similar associations with prognosis. We also found that high basal (lowest observed in triplicate cores) Ki67 expression was more strongly associated with improved 5-year disease-specific survival than hot-spot and average Ki67 measurements. The association of high basal Ki67 expression with improved prognosis was most pronounced in patients who received postoperative radiation. Cox proportional hazards analysis showed that the basal Ki67 expression is an independent prognostic marker in our OSCC cohort when adjusted for pathological T-stage, nodal status and treatment. CONCLUSIONS: Our study provides a framework for reaching a consensus on the optimal approach for measuring Ki67 expression in cancers. Our results suggest that rigorous comparisons of measurement approaches should be applied in a tumour-type and treatment-specific manner to enhance the clinical application of Ki67 assessment.

Head and neck osteosarcoma in adults: the province of alberta experience over 26 years.

OBJECTIVE: The goal of this study was to describe the incidence, treatment, and outcomes of osteosarcomas in the head and neck over 26 years in the province of Alberta, Canada. DESIGN: Retrospective analysis of 14 patients identified and treated in Alberta between 1974 and 1999. Overall and disease-specific survival were the most important outcomes of interest. RESULTS: The average age was 43 years. The maxilla was the most common primary site. The majority of the patients received surgical treatment in combination with adjuvant chemotherapy. Disease-specific survival was 42% at 2 years and 30.1% at 5 years. Four patients developed osteosarcomas in the field of previous radiation. CONCLUSIONS: Osteosarcoma of the head and neck is very aggressive. In our series, mostly high-grade malignancy affected a middle-aged population. Surgical resection is difficult owing to anatomic restraints, and adjuvant chemotherapy should be considered in most patients. The series is notable for the poor outcome, with a 5-year actuarial survival of 30%. This may reflect the lack of a standardized treatment protocol.