ORCID Profile
0000-0003-3957-2738
Current Organisations
John Hunter Hospital
,
University Hospitals of Leicester NHS Trust
,
Tata Memorial Hospital
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Publications
Prospective study of the pattern of lymphatic metastasis in relation to the submandibular gland in patients with carcinoma of the oral cavity
Publisher: Wiley
Date: 27-05-2016
DOI: 10.1002/HED.24508
Abstract: The submandibular gland is responsible for 70% to 90% of unstimulated saliva production. Its excision causes a decrease in basal salivary flow resulting in increased symptoms of subjective xerostomia and decreased quality of life. In this study, we have tried to assess the pattern of nodal metastasis in relation to the submandibular gland. With this study, we have tried to find out whether submandibular gland preservation is a viable option in patients with carcinoma of the oral cavity. This was a prospective study conducted in a tertiary care cancer center. The fibrofatty tissue surrounding the submandibular gland was ided into 6 parts depending upon its location with the submandibular gland. All these 6 parts along with the submandibular gland were separately sent for histopathological analysis. Metastasis pattern in level Ib region was noted. The study included 137 patients with carcinoma of the oral cavity who underwent neck dissections. Eighty-five patients had clinic-radiologically N0 neck, 52 patients had cN+ (clinically node positive) neck. Level Ib was involved in 8.2% of the cases with cN0 (clinically node negative neck). In patients with cN+ neck, level Ib metastasis was seen in 40% of the cases. Metastasis in N0 necks in the area deep to the submandibular gland was seen in only 1 case (9% of all pathologically node-positive patients) with cN0 neck. This was the only case in which submandibular gland mobilization would have been required to take out the metastatic node. Even in cases with N+ neck, deep metastasis was seen in 4 cases only (14.8%). None of them had a primary tumor in the tongue. Therefore, there is a possibility of preserving the submandibular gland in cases of carcinoma of the tongue. Involvement of level Ib in early tongue cancers is not very common and direct metastases to the submandibular glands are rare. Even when metastasis is present in level Ib, it can be excised without affecting the submandibular gland. In early tongue lesions, submandibular gland mobilization for dissection at level Ib is not required as no metastases deep to the submandibular glands were seen in these patients. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.
Defining optimum surgical margins in buccoalveolar squamous cell carcinoma
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.EJSO.2019.01.224
Abstract: Surgical margin is one of the most important prognostic factors in oral cavity squamous cell carcinoma. There have been studies which refute the standard practice of considering 5 mm (mm) margin as free. Therefore we aimed to evaluate the impact of each mm of margin on the local recurrence free survival (LRFS) and to obtain a cut-off value which would impact the survival the most. This was a retrospective study of 602 treatment naïve patients of buccoalveolar complex cancer. ROC curve was plotted for each millimetre of margin to derive the cut-off margin for maximum LRFS. Multivariate analysis was done for the margin groups to calculate the margin beyond which no significant improvement on LRFS was achieved. Early and advanced tumors were also evaluated separately. A cut off margin of 5.5 mm was achieved on ROC for early (T1-T2) tumors and 6.5 mm cut off was achieved for advanced (T3-T4) tumors. Based on these cut off different margin groups were made. The cohort was grouped into positive margin, 1-5.5 mm, 5.6-7 mm and > 7 mm. Hazard ratio for patients with 1-5.5 mm and positive margin was 1.886 (95%CI, 1.15 to 3.09) and 5.58 (95%CI, 1.75 to 17.78) respectively. HR for margin 5.5 mm to 7 mm was 1.15 (95% CI, 1.15 to 2.06). There was no statistically significant difference in survival between margin groups of 5.6-7 mm and > 7 mm (p < 0.589) for both early and advanced tumors. Minimum surgical margins of 5.5 mm in the final histopathology should be aimed for in the bucco-alveolar carcinomas. There was significant improvement in LRFS with increasing margins upto 7 mm. Taking margins beyond 7 mm does not improve LRFS.
Outcome of patients following neo-adjuvant chemotherapy for unresectable cervical nodes in head and neck squamous cell carcinomas
Publisher: Springer Science and Business Media LLC
Date: 17-12-2018
DOI: 10.1007/S00405-018-5253-4
Abstract: This study was undertaken to assess the effects of neo-adjuvant chemotherapy (NACT) on patients with head and neck squamous cell carcinoma (HNSCC) having advanced unresectable cervical nodal metastasis. A retrospective cohort study was conducted to assess the response of unresectable nodes to NACT in a pragmatic manner. Patients were grouped according to the response noted and the treatment offered after chemotherapy. The median survival amongst the patients in these groups was compared. The study included 51 patients. Oral cavity was the commonest site (67.2%). Favourable nodal response was seen in 64.7% of the patients. Up to 87.9% of the nodal responders were amenable to curative intent therapy. The overall survival of patients undergoing surgery, definitive chemoradiotherapy, palliative chemotherapy and palliative radiotherapy was 24, 13, 10 and 9 months, respectively. NACT may be utilized in HNSCC with advanced inoperable nodal disease to make them amenable to definitive therapy.
The impact of peritumoral depapillation in cancers of the tongue
Publisher: Elsevier BV
Date: 04-2020
Organ preservation vs primary surgery in the management of T3 laryngeal and hypopharyngeal cancers
Publisher: Springer Science and Business Media LLC
Date: 29-06-2018
DOI: 10.1007/S00405-018-5047-8
Abstract: The main objective is to compare the oncologic outcomes of patients with T3 laryngeal cancers who underwent total laryngectomy or organ preservation protocol (OPP) as the initial plan of management. This is a retrospective study on 120 patients treated for T3 laryngeal and hypopharyngeal cancers. Patients with functional larynx underwent OPP and dysfunctional larynx underwent upfront laryngectomy. Median follow-up of the patients was 4.6 years. There was a significant difference in 3 year disease-free survival (DFS) between upfront laryngectomy and OPP (73.2 vs. 55.7% P = 0.028) group but not in 3 year overall survival (73.2 vs. 68.7%, P = 0.8). The rate laryngeal preservation was 65% in CCRT and 44% in only radiotherapy group. At 3 years, the laryngectomy-free survival was 57.2% and the laryngo-esophageal dysfunction-free survival (LEDS) was 53.0%. T3 laryngeal cancers treated with upfront laryngectomy have an improved DFS when compared to those treated with non-surgical modalities. Primary surgery should be offered as an option for selected patients especially when CCRT is not feasible.
Addressing the contralateral neck for ipsilateral disease recurrence in oral cavity cancers
Publisher: Elsevier BV
Date: 06-2021
Outcomes of surgically treated oral cancer patients at a tertiary cancer center in India
Publisher: Medknow
Date: 2017
A Nomogram based prognostic score that is superior to conventional TNM staging in predicting outcome of surgically treated T4 buccal mucosa cancer: Time to think beyond TNM
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.ORALONCOLOGY.2018.04.002
Abstract: T4 squamous cell carcinomas of the buccal mucosa is known to have ominous outcome. The aim of this study was to develop a nomogram for T4 buccal mucosa cancer patients and demonstrate the difference in survival based on prognosticators beyond those covered by the traditional TNM staging system. We examined medical records of treatment naïve 205 T4 buccal mucosa cancer patients operated between January 1, 2009, and December 31, 2014. A nomogram was developed using multivariate cox-regression. The nomogram was validated internally by bootstrapping and externally in an independent validation set. The nomogram for predicting 3-year overall survival was built using Tumor differentiation, Pathological Lymph node involvement, Bone and Perineural invasion. Based on nomogram, a score was assigned to each patient and they were ided into two groups based on Youden derived cut-off value (13.5). These two groups in training and validation set showed significant difference in survival. We developed a high performance, accurate and efficient nomogram to predict the probability of 3-year survival in T4 buccal mucosa cancer patients. Intensification of adjuvant treatment in these advanced cancer patients with poorer score might improve their survival.
Comparison of the seventh and eighth editions American Joint Committee Cancer classification system in oral cavity squamous cell cancers.
Publisher: Wiley
Date: 27-11-2020
DOI: 10.1002/IJC.32720
Abstract: The aim of our study was to evaluate the predictive ability of the American Joint Committee Cancer (AJCC) eighth edition (AJCC8) staging system for oral cavity cancers and validate these changes rendering the hypothesis of improving prognostication. We conducted a retrospective study including all oral cavity squamous cell carcinoma patients visiting our tertiary center from 2012 to 2015, staged as per the AJCC seventh edition (AJCC7) and AJCC8 systems. Stage-specific disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Concordance index (CI) and Akaike information criterion (AIC) were used to calculate the predictive accuracy of the both systems. The study s le consisted of 863 subjects followed up for a median of 24 months. Buccal mucosa complex (BMC) was the most common site (n = 496). We observed a 25.8% (n = 222) overall upstaging in the eighth edition, significantly seen in early tongue cancers (TCs) (Stage I) and advanced BMC cancers (Stage III). An increase in CI and reduction in AIC scores were indicative of a superior predictive accuracy for the eighth edition in assessing DFS (confidence interval [CI*] = 0.650-0.654 AIC = 3,022-3,014) and OS (CI* = 0.643-0.648 AIC = 2089-2086) across all stages. The accuracy was higher for TCs as compared to BMC. Although not statistically significant, we observed an increase in soft risk factors at higher stages in the eighth edition as compared to its predecessor. We concluded that the AJCC8 has a higher predictive accuracy than the AJCC7 edition, making it a reliable prognosticative tool.
A systematic review and meta-analysis comparing the diagnostic accuracy of initial RT-PCR and CT scan in suspected COVID-19 patients
Publisher: British Institute of Radiology
Date: 03-2021
DOI: 10.1259/BJR.20201039
Abstract: To perform a systematic review and meta-analysis to compare the diagnostic accuracy of CT and initial reverse transcriptase polymerase chain reaction (RT-PCR) for detecting COVID-19 infection. We searched three databases, PubMed, EMBASE, and EMCARE, to identify studies reporting diagnostic accuracy of both CT and RT-PCR in detecting COVID-19 infection between December 2019 and May 2020. For accurate comparison, only those studies that had patients undergoing both CT and RT-PCR were included. Pooled diagnostic accuracy of both the tests was calculated by using a bivariate random effects model. Based on inclusion criteria, only 11 studies consisting of 1834 patients were included in the final analysis that reported diagnostic accuracy of both CT and RT-PCR, in the same set of patients. Sensitivity estimates for CT scan ranged from 0.69 to 1.00 and for RT-PCR varied ranging from 0.47 to 1.00. The pooled estimates of sensitivity for CT and RT-PCR were 0.91 [95% CI (0.84–0.97)] and 0.84 [95% CI (0.71–0.94)], respectively. On subgroup analysis, pooled sensitivity of CT and RT-PCR was 0.95 [95% CI (0.88–0.98)] and 0.91 [95% CI (0.80–0.96), p = o.ooo1]. The pooled specificity of CT and RT-PCR was 0.31 [95% CI (0.035–0.84)] and 1.00 [95% CI (0.96–1.00)]. CT is more sensitive than RT-PCR in detecting COVID-19 infection, but has a very low specificity. Since the results of a CT scan are available quickly, it can be used as an adjunctive initial diagnostic test for patients with a history of positive contact or epidemiological history.
Prognostic Value of 18F‐Fluoro‐Deoxyglucose‐Positron Emission Tomography Volumetric Parameters in Human Papillomavirus‐Related Oropharyngeal Squamous Cell Carcinoma
Publisher: Wiley
Date: 26-08-2022
DOI: 10.1002/LARY.30362
Abstract: This study evaluates and compares the prognostic significance of 18 F‐fluoro‐deoxyglucose‐positron emission tomography ( 18 F‐FDG PET) volumetric parameters in human papillomavirus‐related oropharyngeal squamous cell carcinoma (OPSCC). A retrospective review of all patients treated for OPSCC with curative intent between 2012 and 2018 was performed. Volumetric parameters analyzed included the maximum standardized uptake value (SUV max ), SUV peak , metabolic tumor volume (MTV), and total lesion glycolysis (TLG) in both the primary tumor and nodal metastases. Prognostic significance was determined using Cox proportional hazards models for disease‐free survival (DFS) and overall survival (OS). Primary tumor MTV and TLG significantly correlated with both DFS and OS however the commonly reported SUV max was not found to be predictive. Nodal measures of SUV max , MTV, and TLG were not significant predictors of survival outcomes. A higher burden of metabolically active primary tumor as measured on volumetric 18 F‐FDG PET parameters is associated with poorer DFS and OS. This improved prognostication may be used to counsel patients and select those appropriate for treatment de‐escalation in the future. 3 Laryngoscope , 133:1667–1672, 2023
A Study of Tumours Giving Rise to Unilateral Proptosis
Publisher: Springer Science and Business Media LLC
Date: 15-01-2012
Perineural invasion: Independent prognostic factor in oral cancer that warrants adjuvant treatment
Publisher: Wiley
Date: 29-04-2018
DOI: 10.1002/HED.25170
Abstract: Controversy exists regarding the administration of adjuvant radiotherapy (RT) when perineural invasion (PNI) is the only adverse histological feature. The purpose of this study was to evaluate the impact of PNI on the survival of patients with oral cavity squamous cell carcinoma (SCC). A retrospective study of 1524 treatment naive patients with oral cavity SCC who underwent surgery from January 2012 to March 2015 was conducted. Survival analysis was performed using Cox regression model. The incidence of PNI was 20.3% and higher in tongue cancers (odds ratio 2.43). The PNI significantly affected both disease-free survival (DFS hazard ratio [HR] 1.84) as well as overall survival (OS HR 1.7). Patients with early node-negative oral cavity SCC with PNI are more likely to develop recurrences and have mortality (HR 2.79 for DFS HR 2.54 for OS). However, the addition of adjuvant radiation in these patients showed improvement in survival (p = .022). Forest plot analysis showed a trend toward poor survival across all subgroups in patients with PNI. Aggressive treatment of the primary cancer with the coincident management of the neck is important in the presence of PNI. The PNI worsens survival and warrants intensification of adjuvant treatment.
Incidence and impact of dysplasia at final resection margins in cancers of the oral cavity
Publisher: Informa UK Limited
Date: 14-07-2020
Oral sex and human papilloma virus-related head and neck squamous cell cancer: a review of the literature
Publisher: Oxford University Press (OUP)
Date: 04-08-2017
DOI: 10.1136/POSTGRADMEDJ-2016-134603
Abstract: Head neck squamous cell carcinomas (HNSCCs) are a significant cause of morbidity and mortality all around the world. Just like tobacco and alcohol, Human papilloma virus (HPV) infection is now recognized to play a role in the pathogenesis of a subset of HNSCCs. Unprotected sexual behaviours with the HPV carrier plays an important role in transmission of this virus. The global incidence of head and neck cancers is declining, but the incidence of HPV related head and neck cancers is rapidly increasing over the last few decades. However, most institutions do not mandate documentation of sexual history or counselling of patients regarding sexual practices like they do for tobacco and alcohol addictions in HNSCC patients. The aim of this review of literature is to analyse if there is a strong evidence to correlate oral sex with HPV related HNSCC and counsel the patient’s regarding sexual behaviours.
Incidence, predictors and impact of positive bony margins in surgically treated T4 stage cancers of the oral cavity
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.ORALONCOLOGY.2019.01.011
Abstract: A sea of literature addressing the adequacy of mucosal/soft tissue surgical margins in oral cavity cancers is available, but no mention exists regarding bony margins. We aim to study the predictors and impact on survival of positive bony margins and propose a safe margin distance. This is a retrospective study of 400 consecutive surgically treated pT4 oral cavity squamous cell carcinoma patients between January 2012 and December 2015. The factors predicting positive bony margins were determined using chi-square test. Kaplan Meier and Cox regression hazard models were used for survival analysis. The median follow up was 36 months. The only factor that significantly predicted positive bony margins was lymphovascular emboli. The 3-year OS with bony margin positivity was 36.9%, compared to 67.5% for patients with adequate margins. When the tumor infiltrated the bone beyond mucosa (20.25%) the survival outcomes were significantly worse than the other patterns. Microscopic spread was seen in 10% cases, at a distance of 8 mm, the presence of which significantly impacted survival outcomes. Analysis of the receiver operating curve identified a cutoff of more than 15 mm as appropriate for classifying adequate bony margins. When the margins were taken above this, a significant positive impact on survival outcomes was present. The presence of lymphovascular emboli may impact the status of bony margins. Based on our results, to achieve an "adequate margin in bone" we propose taking the bony cut at least 15 mm away from the clinically discernible tumor when treating advanced oral cancers.
Adequacy of surgical margins in oral cancer patients with respect to various types of reconstruction
Publisher: Georg Thieme Verlag KG
Date: 2020
Abstract: Bacground: Surgical margin is an important prognostic factor for oral cancers (oral squamous cell carcinoma [OSCC]). The correlation of margin with the type of reconstruction has never been studied. Aim: This study aimed to correlate surgical margins with the type of reconstruction. Methods: This was a retrospective study of 410 treatment-naïve OSCC patients. As per the methods of reconstruction, three groups were made when reconstruction was performed using pedicled flap (PF) or local flap, free flap, and primary closure (PC). Statistical Analysis: Chi-square test was used for comparison of margin status as per the method of reconstruction. Mann–Whitney test was used to find the difference between the mean margin width with respect to the type of reconstruction. Results: The overall incidence of close ositive margins was 7.8%. The incidence of close ositive margins was not significantly different in free flap group compared to PF (P = 0.06) or PC (P = 0.835) group. However, there was a significant difference in the incidence of close ositive margins between PC and PF groups (P = 0.021). Whether the reconstruction is performed by the primary surgeon or by a another surgeon, it did not have an impact on adequacy of margins (P = 0.334). Margins were wider when the reconstruction is performed by a different team (P = 0.015) or when reconstruction is performed as compared to PC. Conclusion: Margins are not affected by the type of reconstruction (pedicled vs. free flap) and the team doing reconstruction (same vs. another team). Margins are significantly compromised when a surgeon performs PC himself/herself compared to PF.
SARS-Cov2: a meta-analysis of symptom distribution by continent in 7310 adult COVID-19 infected patients
Publisher: Springer Science and Business Media LLC
Date: 09-06-2021
Comparison of PET-CT, CT and MRI scan in initial staging and management of head and neck cancers
Publisher: Springer Science and Business Media LLC
Date: 21-09-2021
DOI: 10.1007/S00405-021-07087-8
Abstract: To evaluate the utility of positron-emission tomography (FDG PET) in initial staging and management of head and neck cancers. This is a retrospective study of 99 treatment naïve head and neck cancer patients treated between January 2017 and December 2020 at a tertiary teaching centre. Change in initial staging and management was noted based on PET scan compared to cross-sectional imaging (CT and MRI). There were 73 (73.7%) males and 26 (26.2%) females with male-to-female ratio of 2.8:1.Overall, change in management was seen in 36/99 (36.4%) patients due to PET scan. With regards to initial staging, T, N and M stage was changed in 14/99 (14.1%), 19/99 (19.1%) and 3/99 (3%) patients, respectively. These changes were significantly higher in patients with unknown primary (63.3%, p value -0.001) and N3 (41%, p -0.045) nodal disease. PET-CT plays an important role in appropriate initial staging and subsequent treatment planning of head and neck cancers. Initial staging PETCT changes management in 36.4% cases. Accuracy of various different imaging modalities have been compared.
Pemphigus Vulgaris and Bullous Pemphigoid of the Upper Aerodigestive Tract: A Review Article and Novel Approaches to Management
Publisher: S. Karger AG
Date: 2021
DOI: 10.1159/000515229
Abstract: b i Background: /i /b Autoimmune bullous diseases are rare conditions characterized by blistering of the skin and mucous membranes. The 2 commonest forms are pemphigus vulgaris and bullous pemphigoid. The oral cavity or oropharynx may be the initial site of presentation or often the only site involved. b i Summary: /i /b These conditions are often misdiagnosed or overlooked leading to poorer patient outcomes. Due to the chronic nature of these conditions and the systemic effects of treatment, there is a significant associated morbidity and mortality. As such, an understanding of the fundamentals of autoimmune bullous diseases is vital to those working in otolaryngology. The mainstay of management in both conditions is topical and systemic corticosteroids. There is also a role for immunomodulating and non-steroidal anti-inflammatory drugs as adjunct or alternative therapies. Surgical intervention may be required to protect the airway. Often multimodality treatment is required involving multidisciplinary input from otolaryngologists, oral surgeons, dermatologists, and rheumatologists. This review article will highlight the aetiology, pathology, clinical features, investigations, and management of both pemphigus vulgaris and bullous pemphigoid including recent advances in management.
Diagnostic efficacy of combined CT and MRI in detecting nodal metastasis in patients with oral cancer
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.OOOO.2021.09.003
Abstract: The objective of this study was to assess the diagnostic efficacy of combined computed tomography (CT) and magnetic resonance imaging (MRI) in detecting metastases of oral cancers to lymph nodes in the neck. In total, 105 patients with previously untreated oral squamous cell carcinoma underwent both CT and MRI within 6 weeks before tumor excision and selective neck dissection. The diagnostic efficacy of combined CT and MRI was compared with published data on the efficacy of CT and MRI alone. The sensitivity, specificity, positive and negative predictive values, and accuracy of diagnosis based on CT and MRI were 80%, 90%, 80%, 90%, and 87%, respectively. These values were similar to or higher than those reported in a meta-analysis for CT or MRI alone. The highest and lowest sensitivities were found for metastatic nodes at levels I (75%) and III (33%). The highest and lowest specificities were discovered for nodes at levels IV (99%) and I (88%). Combined CT and MRI may be superior to a single modality alone in detecting metastatic neck nodes. This may have an advantage in both preoperative planning and neck surveillance in superficial oral cancers.
Intraoperative frozen section for detection of occult metastasis in clinically N0 neck does not improve outcome in oral cavity carcinomas
Publisher: Springer Science and Business Media LLC
Date: 30-05-2019
DOI: 10.1007/S00405-019-05484-8
Abstract: The objective of this study was to evaluate the utility of frozen section (FS) in detecting occult nodal metastasis in cN0 OSCC and its impact on regional failure and survival. Clinical records of patients of OSCC operated from January 2013 to December 2014 were retrospectively reviewed. These patients were ided into two groups-Group A comprised of patients who underwent selective neck dissection (SND) (level III/IV) and FS based completion (level IV ± V) Group B included patients who underwent SND I-III/IV without FS. The sensitivity and specificity of FS in detecting occult metastasis was calculated. The regional failure rates and overall survival (OS) between the two groups were compared. The sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) of FS in detecting occult metastasis were 64.06%, 100%, 100%, and 92.15%, respectively. There was no significant difference in regional failure rates (p = 0.219) and OS (p = 0.08) between the two groups. FS has a poor sensitivity in detecting occult nodal metastasis. FS-guided neck dissection does not have a significant impact in reducing regional failure or improving OS in clinically node-negative neck in oral cavity carcinomas.
Prevalence and Impact of Human Papillomavirus on Head and Neck Cancers: Review of Indian Studies
Publisher: Springer Science and Business Media LLC
Date: 03-09-2018
Depth of invasion, size and number of metastatic nodes predicts extracapsular spread in early oral cancers with occult metastases
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.ORALONCOLOGY.2018.04.015
Abstract: Presence of extracapsular spread (ECS) significantly decreases survival in oral cancer patients. Considering its prognostic impact, we have studied the incidence and factors predicting ECS in clinically node negative early oral cancers. We performed a retrospective chart review of 354 treatment naïve clinically node negative early oral cancer patients operated between 2012 and 2014. Chi-square test and logistic regression were used for identifying predictors of ECS, while cox-regression test was used for survival analysis. The incidence of occult nodal metastasis was 28.5% (101/354). Among them, ECS was seen in 15.3%(54/354) patients. The incidence of ECS in T1 and T2 lesion was 13.4% (21/157) and 16.8% (33/197), respectively. The overall incidence of ECS was 48% and 29% in lymph nodes smaller than 10 mm and 5 mm respectively. We found that tumor depth of invasion (>5 mm p-0.027) and node (metastatic) size >15 mm (p-0.018) were significant predictors of ECS. p N2b disease was seen in 41/354 (11.6%) of which 31/354 (8.7%) had ECS, i.e. 75.6% of pN2b patients been ECS positive (p-0.000). The 3-year OS of patients without nodal metastasis, nodal metastasis without ECS and nodal metastasis with ECS was 88.4%, 66.9% and 59.2% (p-0.000) respectively. A significant number of patients with metastatic nodal size less than 1 cm have ECS which suggests aggressive behavior of the primary tumor. Thus, elective neck dissection is the only way of detecting ECS in these patients which may warrant treatment intensification.
Incidence of synchronous contralateral tonsillar malignancy in a known case of unilateral tonsillar carcinoma
Publisher: Springer Science and Business Media LLC
Date: 14-01-2022
DOI: 10.1007/S00405-021-07213-6
Abstract: The literature is ided with regards to contralateral tonsillectomy in a known/suspected case of ipsilateral tonsillar malignancy. In this study, we evaluate the incidence of indolent synchronous contralateral tonsillar malignancy (SCTC) in patients with known ipsilateral tonsillar malignancy. All patients diagnosed with ipsilateral tonsillar carcinoma (TC) at a tertiary teaching center between January 2016 and December 2019 were screened. None of the patients were suspected to have bilateral TC. All patients underwent appropriate imaging in the form of Magnetic resonance imaging and computed tomography of head and neck region and then underwent bilateral tonsillectomy. The prevalence of bilateral tonsillar malignancy and the factors predicting them were analyzed. In all 59 patients were included in the study. The mean and median age of the patient population was 60.8 and 59 years, respectively, with a male to female ratio of 3.2:1. The incidence of bilateral tonsillar malignancy in carcinoma of unknown primary (CUP) was 3/10 (33.3%). Among the remaining 49 patients, incidence of synchronous contralateral tonsillar carcinoma (SCTC) was 2/49 (4.08%). Overall, 5/59 (8.5%) patients had synchronous bilateral tonsillar malignancy. Furthermore, dysplasia was found in the contralateral tonsil in 4/10 (40%) CUP patients. Among the remaining 49 patients, dysplasia was seen in the contralateral tonsil in 20/49 (40.8%) patients. The absence of p16 expression predicted higher probability of SCTC. Factors like gender, T stage, nodal status or smoking did not predict SCTC. We recommend bilateral tonsillectomy in all patients with suspected or proven TC (unilateral or bilateral) and CUP as it helps identify indolent SCTC and it does not add any significant morbidity to the patients. III.
Impact of radical treatments on survival in locally advanced T4a and T4b buccal mucosa cancers: Selected surgically treated T4b cancers have similar control rates as T4a
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.ORALONCOLOGY.2018.04.019
Abstract: In the absence of any robust data supporting the TNM classification of T4 buccal mucosa cancers, we did this prospective study to compare the oncologic outcomes of T4a and T4b buccal mucosa cancer patients. This is a prospective study of 210 treatment naïve T4 buccal mucosa cancer patients. All patients underwent upfront radical surgery followed by adjuvant radiotherapy (RT)/chemoradiotherapy (CCRT). This is the largest prospective series in the literature on T4 buccal cancers. T4a disease was seen in 135(64.3%) patients and T4b in 75(35.7%) patients. On comparison between all T4a and T4b cases, a significant difference was observed with regard to 3-year local control (49.6% vs. 41.1%: p-0.025) and disease-free survival (DFS) (65.3% vs. 42%: p-0.035) with a slightly higher incidence of distant metastasis in T4b patients (17.3% vs. 9.6%). Inadequate cut margin (<5 mm) was seen only in 7.4% patients with T4a disease and 12% patients with T4b disease. When patients with adequate cut margins were considered for analysis, local recurrence rate was similar for T4a (26/135 19.3%) and T4b (15/66 22.7%) disease suggesting the importance of radical surgery in infra-notch T4b buccal cancers. While the 3-year survival for T4a patients who received adjuvant RT alone was 72.2%, it was only 42.1% for similar T4b patients suggesting a need to intensify adjuvant treatment for these patients. Surgery should be considered as the primary modality of treatment for T4b patients, where clear margins are achievable. The benefit of treatment intensification with adjuvant CCRT should be explored in T4b buccal cancers.
Comparative analysis of paediatric and adult surgically drained dental infections at a university teaching hospital
Publisher: Elsevier BV
Date: 12-2020
Intraoperative gross examination vs frozen section for achievement of adequate margin in oral cancer surgery
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.OOOO.2016.11.018
Abstract: Surgical margin status is an important prognostic factor in oral squamous cell carcinoma. The primary aim of the surgeon is to achieve a microscopically complete surgical resection during initial surgery. As there are no definite guidelines, a few surgeons use frozen section (FS) for margin assessment whereas others use gross examination (GE). This is a retrospective analysis of prospectively collected data from the electronic medical records of 435 oral cavity cancer patients. As per the operating surgeon's preference, margin assessment was done using GE in 239 (54.94%) specimens, and FS was used in 196 (45.05%) specimens. Surgery was the primary modality of treatment for all patients, followed by adjuvant therapy. Close ositive margins were seen in 6.63% of patients in the FS group and in 6.69% of patients in the GE group (P = .855). The sensitivity and specificity were 45.45% and 98.8%, respectively, for FS and 61.9% and 88.32% for GE. We found no survival benefit when FS was used for margin assessment (disease-free survival: P = .469 overall survival: 0.325). Incidence of inadequate margins was similar in both the groups (P = .608) even in patients with some form of previous treatment. We propose the judicious use of FS rather than routine use for margin assessment. The study reports that GE is an well-tolerated oncologic alternative to FS.
Delays in surgery for cholesteatoma due to COVID-19: is there an impact on rates of recidivism and major complications?
Publisher: Springer Science and Business Media LLC
Date: 10-10-2020
Comparison of tumor volume, thickness, and T classification as predictors of outcomes in surgically treated squamous cell carcinoma of the oral tongue
Publisher: Wiley
Date: 07-05-2018
DOI: 10.1002/HED.25161
Abstract: As per TNM classification, superficial tumors with a favorable prognosis are fallaciously clubbed together with unfavorable, deeply infiltrating lesions in the same classification. This is a retrospective study of 588 patients with treatment-naive oral tongue cancers. Binary logistic regression was used to identify predictors of nodal metastasis and extracapsular spread (ECS) using tumor volume and thickness as separate models. The C-index was generated to quantify predictive accuracy of T classification, thickness, and tumor volume for survival. Compared to T classification, tumor volume and thickness were better predictors of nodal metastasis and ECS. Predictive accuracy for disease-free survival (DFS) and overall survival (OS) given by C-index was equal and better for thickness (0.60 and 0.69) and tumor volume (0.61 and 0.69) as compared to T classification (0.59 and 0.64, respectively). For early-stage T1 to T2 oral tongue cancer, thickness is a better predictor of nodal metastasis as compared to tumor volume and T classification. Concordance between the tumor thickness and volume proves that tumor thickness can be taken as a surrogate and reliable predictor of outcomes instead of calculating the tumor volume.
COVID ‐19 Cross‐Infection Rate After Surgical Procedures: Incidence and Outcome
Publisher: Wiley
Date: 05-06-2021
DOI: 10.1002/LARY.29667
Abstract: Severe acute respiratory syndrome coronavirus 2 (SARSCoV‐2) is transmitted by droplet as well as airborne infection. Surgical patients are vulnerable to the infection during their hospital admission. Some surgical procedures are classified as aerosol generating (AGP). Retrospective observational study of four specialties associates with known AGP's during the 4 months of the first wave of UK COVID‐19 epidermic to identify post‐surgical cross‐infection with SARSCoV‐2 within 14 days of a procedure. Retrospective observational study in a tertiary healthcare center of four specialties associates with known AGP's during the 4 months of the first wave of UK COVID‐19 epidermic to identify post‐surgical cross‐infection with SARSCoV‐2 within 14 days of a procedure. There were 3,410 procedures reported during this period. The overall cross‐infection rate from tested patients was 1.3% (4 patients), that is, 0.11% of all operations over 4 months. Ear, nose, and throat carried slightly higher rate of infection (0.4%) than gastroenterology (0.08%). The mortality rate was 0.3% (one gastroenterology patient from 304 positive cases) compared to 0% if surgery performed after recovery from SARSCoV‐2 and 37.5% when surgery was conducted during the incubation period of the disease. Routine preoperative rapid screening tests and self‐isolation are crucial to avoid the risk of cross‐infection. Patients with underlying malignancy or receiving chemotherapy were more prone to pulmonary complications and mortality. The risk of SARS‐COV‐2 cross‐infection after surgical procedure is very low. Preoperative screening and self‐isolation together with personal protective measures should be in place to minimize the cross‐infection. 4 Laryngoscope , 131:E2749–E2754, 2021
Diagnostic accuracy of magnetic resonance imaging in detecting depth of invasion of tongue cancers
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.BJOMS.2021.06.008
Abstract: The recent eighth edition of the American Joint Committee on Cancer (AJCC) staging system has introduced depth of invasion (DOI) as one of its important components. DOI is also important for deciding neck management in superficial tongue cancers. Magnetic resonance imaging (MRI) is mainly used to assess DOI, and in this study we have evaluated the efficacy of MRI to detect it. This is a retrospective study consisting of 60 treatment-naïve tongue cancer patients operated on between July 2017 and June 2019. Patients underwent MR imaging on an Optima MR450W 1.5T unit, and MRI was reported by two experienced head and neck radiologists. Postoperative histological DOI was considered the gold standard. The correlation coefficient was derived for postoperative DOI and MRI-detected DOI. A subgroup analysis of superficial tongue cancer was also done. The mean MRI DOI was 13.7 mm and the mean histological DOI 12.45 mm. The shrinkage factor was 0.6 mm. Pearson's correlation coefficient was 0.80 (p=<0.001) for Radiologist 1 and 0.85 (p=<0.001) for Radiologist 2. The interobserver variation was low, with a correlation coefficient between the two radiologists of 0.965 (p=<0.001). For superficial tongue cancers there was moderate correlation for MRI and histologically-detected DOI with a kappa value of 0.681 (p=0.03). As per the ROC curve, the cut-off value for MRI DOI to predict nodal metastasis was 4.6 mm. MRI has high reliability to predict the DOI of tongue cancers. The interobserver variation was low. The diagnostic accuracy in cases of superficial tongue cancer was moderate.
A Meta‐Analysis of 67 Studies with Presenting Symptoms and Laboratory Tests of COVID ‐19 Patients
Publisher: Wiley
Date: 06-11-2020
DOI: 10.1002/LARY.29207
Abstract: The objective of this meta‐analysis was to look at the pooled prevalence of symptoms, laboratory tests, and imaging of all COVID‐19 infected patients. This will allow better identification of potential COVID‐19 patients and take appropriate precautions. Meta analysis. We searched three databases, PubMed, EMBASE, and Ovid to identify studies published between Dec‐2019 and May‐2020. All studies reporting upper‐aerodigestive symptoms of COVID‐19 infection were included. The meta‐analysis was conducted following meta‐analyses of observational studies in epidemiology (MOOSE) guidelines, which have evaluated the pooled prevalence of 14 symptoms and nine laboratory investigations. Based on inclusion criteria, 67 publications consisting of 8302 patients were included. Among adults, the pooled proportion of hypertensive and diabetic patients was 18% and 7%. Cough (53% [0.46–0.61]), anosmia (38% [0.19–0.58]), loss/distortion of taste (31% [0.17–0.45]), and nasal obstruction (26% [0.12–0.39]) were the most common ear, nose & throat (ENT) symptoms. Fever (69% [0.62–0.76]) and fatigue (31% [0.26–0.37]) were the commonest generalized symptoms. C‐reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were raised in 56% (0.41–0.71) and 49% (0.21–0.77), respectively. Interestingly, lymphopenia (41% [0.30–0.53]) and leucopenia (22% [0.16–0.29]) were more common than lymphocytosis (33% [0.02–0.64]) and leucocytosis (12% [0.09–0.16]). Fever (69% vs. 44%), cough (53% vs. 33%), and dyspnea (20% vs. 4%) were more common in adults as compared to the pediatric population. Diarrhea was more common among the pediatric cases (12%) versus (9%). The pooled estimate of fatality was 4%. The most commonly experienced ENT symptom was cough followed by anosmia and dysguesia. Raised ESR and CRP with leukopenia and lymphopenia are common laboratory findings. Majority of the infected patients had abnormal computed tomography findings. COVID infection is less severe in pediatric patients. Laryngoscope , 131:1254–1265, 2021
Narrow band imaging observed oral mucosa microvasculature as a tool to detect early oral cancer: an Indian experience
Publisher: Springer Science and Business Media LLC
Date: 09-01-2021
Longitudinal and cross-sectional assessment of quality of life in surgically treated advanced (T4) cancer of the buccal mucosa
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.OOOO.2017.09.006
Abstract: Quality of life (QOL) has become an important aspect of today's health care management. This study performed longitudinal assessment of QOL in patients with advanced cancers of the buccal mucosa (T4). We compared the QOL between patients who received adjuvant chemoradiation therapy (CTRT) and that of patients who received radiation therapy alone and assessed whether baseline QOL can predict disease recurrence. This was a prospective study of 225 patients with T4 buccal mucosal cancer. Health-related QOL was assessed at baseline and at 3, 6, 9, and 12 months after completion of treatment by means of the European Organization for Research and Treatment of Cancer Core QOL Questionnaire and the HN35 questionnaire. There was persistent improvement in global QOL and pain. Emotional functioning improved at 12 months. Most of the head and neck-specific symptoms deteriorated at 3 months, with subsequent improvement at 12 months except in swallowing, senses, speech, social eating, social contact, and sexuality. Patients who received adjuvant CTRT had poorer QOL. Poorer baseline global QOL (P = .049), dyspnea (P = .04), appetite loss (P = .015), and weight loss (P = .08) may predict recurrence. Although there is an improvement in global QOL and pain, most of the head and neck-specific symptoms worsened in the immediate postoperative period. Adjuvant CTRT has a persistent effect on specific domains compared with adjuvant radiation therapy alone. Poor baseline QOL scores are associated with a higher risk of recurrence.
Related Organisations
University Hospital Of Leicester NHS Trust
Location: United Kingdom of Great Britain and Northern Ireland
University Hospitals Of Leicester NHS Trust
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
No related grants have been discovered for manish Mair.