Emerging evidence indicates that granzyme K expressing tumor infiltrating CD8 + T-cells play a critical role in mediating anti-tumor T-cell immunity and immunotherapy treatment response. However, precise characterization and cell surface markers for the viable isolation of these cells from tumor samples are lacking. We constructed a tumor-infiltrating CD8 + T cell subpopulation atlas (n = 286,827 cells) by integrating single-cell RNA sequencing datasets from two immunotherapy-treated patient cohorts with aerodigestive tract malignancies. This unified dataset facilitated detailed mapping of transcriptional trajectories and stringent identification of distinctive cell surface markers across major CD8 + tumor-infiltrating lymphocyte (TIL) compartments. Analysis of the CD3 + CD8+ TIL transcriptional landscape revealed three predominant populations across all tumor types and treatment conditions: stem-like cells, dysfunctional effector cells, and GZMK+ effector cells. Notably, the GZMK+ effector population displayed a distinctive transcriptional profile lacking positive enrichment of pre-defined gene sets, suggesting a previously poorly characterized subpopulation without established cell surface markers. We performed high-dimensional flow cytometry on primary human tumor samples to validate candidate CD8 + TIL subpopulations. Through validation in primary human tumors, we established that cell surface KLRG1 reliably identifies and enables viable isolation of the GZMK+ effector TIL population. Concurrently, we demonstrated that dysfunctional and stem-like populations can be effectively isolated as KLRG1-CD39 + and KLRG1-CD39- CD55 + subsets, respectively. Importantly, accurate enrichment occurs despite decreased starting cell type proportion. Our characterization of CD8 + TIL subpopulations and validation of their distinguishing surface markers establishes a robust platform for isolation and protein-level granzyme assessment of these key cells in patient samples.

BACKGROUND:GLP-1 receptor agonists carry an FDA boxed warning for medullary thyroid carcinoma (MTC) risk, though conflicting clinical evidence has generated tremendous controversy regarding this association. METHODS:We analyzed SEER and FAERS databases to compare MTC and papillary thyroid cancer (PTC) reporting proportions (RP) between the general population and GLP-1RA users (n = 109 168), controlling for surveillance bias by comparing against other endocrine and non-endocrine drugs. Negative binomial regression was used to estimate the incidence rate ratios (IRR) in the FAERS dataset among patients with reported AEs. RESULTS:The 10-year mean MTC RP in SEER/FAERS was 0.0002%/0.0014%, while PTC was 0.012%/0.0087%. Strikingly, GLP-1RA users showed increased RPs as compared to the total FAERS RPs: MTC 0.071% (50.7-fold increase) and PTC 0.164% (18.9-fold increase) with significantly elevated IRRs (p = 0.0001) compared to reference groups. CONCLUSION:GLP-1RAs showed a higher RP for MTC compared to other drug classes, warranting prospective studies to investigate further.

Background Microvascular free tissue transfer is a common tool for the reconstruction of oncologic head and neck defects. Adequate preoperative assessment can aid in appropriate risk stratification and peri-operative optimization. The modified five-item frailty index (mFI-5) is a validated risk-assessment scale; however, its utility in head and neck free-flap reconstruction is unknown when compared with other common risk factors. Methods A retrospective, single-institution chart review (2017-2020) was performed. Patient demographics, defect and repair characteristics, pre- and peri-operative factors, and flap outcomes were recorded. A high mFI-5 score was defined as greater than 2. The total score, as well as other patient factors, was correlated to postoperative flap complications. Results A total of 214 patients were deemed appropriate for conclusion. The mean age was 63.9 +/- 12.8 years. There were an even number of males (52.8%) and females (47.2%). A fifth of subjects (20.8%) underwent preoperative radiotherapy. There were 21 cases (9.8%) of complete flap loss. A total of 34 patients (29.4%) experienced any postoperative complication related to flap outcomes. An elevated mFI-5 was significantly associated with a higher overall rate of postoperative complications (39.7 vs. 29.4%, p < 0.019) and total flap loss (16.7% vs. 6.6%, p < 0.033). Preoperative radiation was found to be associated with an increased complication rate (p < 0.003). Conclusion The mFI-5 score may be a potentially significant tool in the risk stratification of patients undergoing head and neck free-flap reconstruction as opposed to commonly utilized risk factors. Preoperative radiotherapy is significantly associated with postoperative complications. Appropriate preoperative assessment may help tailor patient care preoperatively.

OBJECTIVE:We aim to compare the diagnostic accuracy of the different methodologies used in the detection of cell-free human papillomavirus (HPV) DNA in HPV-associated head and neck squamous cell carcinoma detection using bivariate analysis methods. DATA SOURCES:Pubmed, Embase, and Scopus were queried using a broad search strategy to search for relevant studies. REVIEW METHODS:Test characteristics were extracted from 33 studies following literature screening, and underwent analyses utilizing a bivariate approach. Summary statistics were identified for each type of methodology, and forest plots and summary receiver operating characteristic curves were constructed. Bias was estimated using Deek's Funnel Plot and the QUADAS-2 tool. RESULTS:In terms of diagnostic accuracy, digital droplet polymerase chain reaction (ddPCR) based testing exhibited the highest diagnostics odds ratio at 138 (59.5, 318), followed closely by next-generation sequencing (NGS) at 120 (39.7, 362), then by polymerase chain reaction (PCR) at 31.4 (14.4, 68.6), and quantitative PCR at 8.74 (4.63, 16.5). CONCLUSION:NGS and ddPCR are comparable in overall diagnostic accuracy, bringing into question their relative roles in diagnosis and screening. Cost-effective ddPCR assays may serve as useful diagnostic and screening tests in the clinic with their low false positive rates and high sensitivity. However, NGS assays also offer high sensitivity and companion metrics, suggesting they may have a more precise role in disease monitoring. Importantly, assay development and benchmarking need further standardization to improve comparison between assays. Finally, saliva-based testing needs to be further investigated using NGS and ddPCR to further understand its limitations in disease detection and monitoring.

Introduction: Osteoradionecrosis is a rare and debilitating risk of definitive chemoradiotherapy for head and neck squamous cell carcinoma. It is difficult to distinguish between osteoradionecrosis and recurrent or progressive disease, as clinical and radiologic features may be similar. Our aim was to compare the clinical presentation and radiologic features of osteonecrosis with those of recurrent or progressive cancer. Methods: We conducted a single-center case series of 19 patients with head and neck squamous cell carcinoma diagnosed between 2011 and 2019 who subsequently developed clinical and/or radiological suspicion of osteoradionecrosis. The population was a referred sample from head and neck cancer physicians at Northwell Health Cancer Institute. Clinician notes and imaging reports were reviewed to assign a final diagnosis of either cancer, osteonecrosis, or indeterminate. Results: No differences were found in the clinical presentation or radiologic features between groups. Median time between treatment and development of symptoms was longer in patients with a final diagnosis of osteoradionecrosis than recurrent or progressive disease (5 vs. 3 months), but this difference was not statistically significant. Radiation dose and type were not associated with diagnosis. Mean standard uptake value maximums on positron emission tomography/computed tomography were significantly higher in the cancer group (median 14.8 vs. 9.1, p < 0.0152). At 1 year after first suspicion of osteoradionecrosis, 100% of osteoradionecrosis patients were alive, versus 28.6% of cancer patients. Discussion/Conclusion: There is significant overlap in clinical and radiologic features of osteoradionecrosis and cancer. Standard uptake maximums may be helpful in predicting diagnosis. Occurrence of symptoms within 6 months of completing chemoradiotherapy should raise the concern for malignancy.

Oropharyngeal squamous cell cancer (OPC) accounts for 3% of all cancers and greater than 1.5% of all cancer deaths in the United States, with marked treatment-associated morbidity in survivors. More than 80% of OPC is caused by HPV16. Tumors induced by HPV have been linked to impaired immune functions, with most studies focused on the local tumor microenvironment. Fewer studies have characterized the effects of these tumors on systemic responses in OPC, especially innate responses that drive subsequent adaptive responses, potentially creating feed-back loops favorable to the tumor. Here we report that elevated plasma levels of PGE2 are expressed in half of patients with OPC secondary to overexpression of COX-2 by peripheral blood monocytes, and this expression is driven by IL-1α secreted by the tumors. Monocytes from patients are much more sensitive to the stimulation than monocytes from controls, suggesting the possibility of enhanced immune-modulating feed-back loops. Furthermore, control monocytes pre-exposed to PGE2 overexpress COX-2 in response to IL-1α, simulating responses made by monocytes from some OPC patients. Disrupting the PGE2/IL-1α feed-back loop can have potential impact on targeted medical therapies.

Background Patients with head and neck cancer (HNC) frequently experience disease-related symptoms and treatment adverse effects that impact their overall quality of life. Cancer-specific mobile health apps for patient-related outcomes allow patients to communicate with their clinicians and proactively track their symptoms, which have been shown to improve clinical management and disease outcomes. Objective The purpose of this study was to evaluate the feasibility of LogPAL, a novel iPhone-based mobile health app designed to help HNC survivors track and manage their posttreatment symptoms. Methods Patients who completed curative treatment for HNC in the preceding 24 months were recruited from 2 clinical sites within a single institution. Upon enrollment, participants completed a brief sociodemographic survey, downloaded the app onto their iPhone devices, and were asked to complete a series of biweekly questionnaires (based on the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events) via the app for an 8-week study period. The primary feasibility endpoints included retention (retaining >80% of the enrolled participants for the duration of the study period), adherence (>50% of the participants completing 100% of the questionnaires over the study period), and usability (a mean system usability scale [SUS] score >68). Additional postintervention questions were collected to assess perceived usefulness, acceptance, and overall satisfaction. Results Between January and October 2019, 38 participants were enrolled in the study. Three participants dropped out, and 3 were classified as nonusers. The remaining 32 (87%) were eligible for analysis. Their mean age was 57.8 (SD 12.3) years (range 24-77 years, 81% [26/32] male). Overall, 375 of 512 (73.2%) questionnaires were completed, with 17 (53%) of the 32 participants adherent. Participant-reported usability was acceptable; the mean SUS score was 71.9 (95% CI 64.3-79.5) with high satisfaction of LogPAL usefulness and likelihood to recommend to other cancer survivors. Conclusions This single-arm prospective pilot study showed that LogPAL is a feasible, regularly used, accepted app for HNC survivors, justifying a full-scale pilot. Based on the findings from this study, future iterations will aim to improve usability and test intervention efficacy.

The positive predictive value (PPV) of 12‑week post‑therapy FDG‑PET/CT is low in patients with Human Papillomavirus (HPV)‑associated Oropharyngeal Squamous Cell Carcinoma (OPSCC) after treatment with definitive chemoradiation (CRT). Moreover, the diagnostic performance of post‑CRT fine needle aspiration (FNA) in detecting persistent disease is unknown in this population. Given these important shortcomings in post‑CRT treatment assessment, head and neck oncologists are limited in appropriately selecting patients for consolidative neck dissection, which results in over‑treatment of a favorable risk population. Using the PubMed database, we performed a literature review of published series in HPV‑associated OPSCC to investigate potential strategies for improvement of post‑CRT neck assessment. Several different approaches were found, including continued surveillance with PET/CT, delayed timing of restaging PET/CT, initial response evaluation with multimodality or alternative imaging, and detection of circulating HPV DNA. At present, the optimal approach to post‑CRT treatment assessment is unclear; further investigation and incorporation of new technologies and surveillance protocols will be highly beneficial for patients with HPV‑associated OPSCC.

Aim: To compare patterns and rates of recurrence in patients with oropharyngeal squamous cell carcinoma by human papilloma virus (HPV) status. Patients & methods: Retrospective chart review of 155 patients diagnosed with oropharyngeal squamous cell carcinoma between 2012 and 2014 at a single center. Results: Two-year recurrence-free survival was higher in patients with HPV-positive tumors compared with negative (85.2% [standard error = 0.03] versus 59.3% [standard error = 0.09]; p < .001) with the former proportionally less likely to have locoregional recurrence. HPV-positive patients had proportionally higher incidence of second primary malignancies outside of head, neck and lung compared with HPV-negative (74.2 vs 37.5%; p = 0.09). Conclusion: The differences in failure by HPV status indicates a need for modified surveillance guidelines. The differences in second primary malignancies patterns are interesting, warranting further evaluation in larger studies.

The positive predictive value (PPV) of 12-week post-therapy FDG-PET/CT is low in patients with Human Papillomavirus (HPV)-associated Oropharyngeal Squamous Cell Carcinoma (OPSCC) after treatment with definitive chemoradiation (CRT). Moreover, the diagnostic performance of post-CRT fine needle aspiration (FNA) in detecting persistent disease is unknown in this population. Given these important shortcomings in post-CRT treatment assessment, head and neck oncologists are limited in appropriately selecting patients for consolidative neck dissection, which results in over-treatment of a favorable risk population. Using the PubMed database, we performed a literature review of published series in HPV-associated OPSCC to investigate potential strategies for improvement of post-CRT neck assessment. Several different approaches were found, including continued surveillance with PET/CT, delayed timing of restaging PET/CT, initial response evaluation with multimodality or alternative imaging, and detection of circulating HPV DNA. At present, the optimal approach to post-CRT treatment assessment is unclear; further investigation and incorporation of new technologies and surveillance protocols will be highly beneficial for patients with HPV-associated OPSCC.

Aim: Current guidelines recommend p16 immunohistochemistry (IHC) for testing human papillomavirus (HPV) in oropharyngeal carcinoma (OPSCC). We evaluated the value of adding DNA in situ hybridization (ISH) to p16 IHC. Methods: Fifty patients with OPSCC were analyzed. Concordance between HPV–DNA ISH and p16 IHC was measured by Gwet's agreement coefficient. Results: p16 IHC was positive in 35/48 (72.9%), negative in 8/48 (16.7%) patients. Wide spectrum DNA–ISH was positive in 9/23 (39%) and negative in 14/23 (60.9%) patients. High-risk 16/18 (HR) HPV DNA–ISH was positive in 11/23 (47.8%) and negative in 12 (52.2%) patients. The agreement between HPV DNA–ISH and p16 IHC is fair (Gwet's AC1 = 0.318). Conclusion: The agreement between p16 IHC and HPV–DNA ISH was fair. However, ISH sensitivity was low. Our findings add to the current data that p16 IHC testing is reliable and may be enough as a stand-alone test for HPV detection in OPSCC.

Purpose: To investigate the multidisciplinary management of patients with Human Papilloma Virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) and an incomplete nodal response on restaging PET/CT after definitive chemoradiation (CRT). Materials and methods: A retrospective chart review was performed of patients diagnosed with node-positive HPV-associated OPSCC from 2012 to 2017, who underwent definitive upfront CRT, and had an incomplete response on post-therapy PET/CT according to NCCN criteria. Post-CRT PET/CT results, management decisions, and clinical outcomes were recorded. Results: Seventy-four patients with node-positive HPV-associated OPSCC were identified; 20 patients with incomplete neck response on PET/CT according to NCCN criteria were included in the final case series. Median follow-up time was 33 months. Patients were managed as follows: 8 underwent observation and surveillance imaging, 6 underwent ultrasound-guided fine needle aspiration (FNA), and 6 had immediate neck dissection. All the observed patients were disease-free at most recent follow-up. None of the patients who underwent immediate neck dissection had residual neck disease on pathological examination; two patients in this group ultimately developed metastatic disease. Among the 6 who underwent FNA, 1 individual had positive pathology, along with residual primary disease, for which the patient underwent salvage surgery. The 5 remaining individuals had negative FNA results, were subsequently observed, and remained free of disease. Conclusions: This institutional experience supports the notion of a high threshold for neck dissection in this low-risk population; only 1 of 20 patients with suspicious PET/CT findings had residual disease in the neck. Moreover, these patients should be managed by a multidisciplinary tumor board (MTB) since current algorithms do not universally include HPV status. Finally, the use of restaging PET/CT to guide management of the neck can be improved with changes in terminology and consideration of FDG-avidity at the primary site and on pre-therapy scans.

6074 Background: In head and neck squamous cell carcinoma (HNSCC) patients (pts) who completed curative-intent definitive treatment (tx), close surveillance is important. Across all centers, pts are closely monitored for symptoms and undergo frequent dedicated head and neck evaluation. Role of surveillance imaging after the initial 12 week post-treatment PET/CT however is less clear. Our institutional practice is to follow pts with regular interval imaging for two years after treatment. However this carries a financial cost, and risk for false positives and unnecessary biopsies. Methods: This is a retrospective chart review of pts treated definitively for HNSCC at our institution from 2012 to 2016. Pts who had a biopsy (bx) post-tx due to suspicion for recurrence were included. Pts belonged to 3 groups: In the first group (A), biopsy was prompted by findings on surveillance imaging (SI); in the second (B), biopsy was prompted by symptom triggered imaging (STI) and in the third (C), biopsy was based on physical exam (PE). We recorded the aggregate results of bx in each group and calculated the positive predictive value (PPV) for each. Results: Of 353 HNSCC pts, 66 underwent post-tx bx for suspected recurrence of which 46 were positive. Of the 30 pts in group A, 21 had positive bx (PPV = 70%). Within this group, PPV was highest with PET/CT (81.82%) followed by magnetic resonance imaging (66.67%) and CT (62.5%). 20 out of 20 pts in group B had bx-proven recurrence (PPV = 100%). 27 out of 36 pts in group C had positive bx (PPV = 75%). While there was no overlap between groups A and B, there was some overlap between groups A and C; and B and C. 45.45% of all recurrences were captured because of SI. When both imaging and PE conducted were positive simultaneously, 54.35% of recurrences were detected first by PE and 45.65% by imaging. Conclusions: Bx triggered by STI has the highest PPV. SI has the lowest PPV, but 45.65% of recurrences were diagnosed because of SI alone. Our study suggests that routine SI for at least two years post treatment for HNSCC patients may add to the surveillance value of frequent PE but larger studies are needed to determine the optimal frequency and type of SI modality.

Juvenile aggressive ossifying fibromas (JAOF) are rare, typically benign pediatric tumors that are locally aggressive and have high recurrence rates. A 7-year old male presented with a palatal mass and a 3D printed model was created and used as a visual aide to highlight the importance of management in terms of functional, cosmetic, and disease-free outcomes with the family. The patient ultimately underwent successful enucleation with final pathology consistent with JAOF. To our knowledge, this is the first description of the use of 3D printing to help in the shared decision-making process for the treatment of this aggressive tumor.

BACKGROUND Lichen planus is an inflammatory disorder of immune dysregulation that affects the skin and mucosa. Oral lichen planus (OLP) is a chronic variant characterized by white mucosal lesions,1 most commonly with bilateral buccal mucosa involvement and frequently involving the tongue and gingiva as well.2 Although the underlying cause remains obscure, OLP is thought to have an autoimmune etiology and has been linked with genetic factors, hypertension, diabetes mellitus, hepatitis C virus, and thyroid dysfunction.3 OLP onset involves the activation of immune pathways leading to migration and activation of T cells and the destruction of keratinocytes.4 It is thought that oral mucosal keratinocytes are activated by the expression of unknown antigens, which recruit lymphocytes. This T-cell-mediated response is coupled with the simultaneous nonspecific response of matrix metalloproteases, chemokines and mast cells, together causing apoptosis of the basal keratinocytes by various mechanisms. OLP can undergo malignant transformation to oral squamous cell carcinoma (OSCC) in a small subset of OLP patients (1%), more commonly in smokers, alcoholics, and hepatitis C patients.5 It is thus considered an OSCC precursor lesion. Topical steroids are the first-line treatment, but systemic steroids and topical calcineurin inhibitors can be used to manage recalcitrant cases.6 Oral and oropharyngeal SCC are commonly treated with surgery and/ or radiation and chemotherapy, which cause adverse reactions including mucositis, xerostomia, dysphagia, dysgeusia, and thrush. These toxicities can persist weeks to months following treatment, and severity is correlated with the chemoradiation (CRT) dose.7 Pharyngoesophageal stenosis, a late effect, can significantly compromise quality of life, often necessitating parenteral nutrition.8 In this report, we present a case of a patient with active OLP for 26 years who was diagnosed with HPV-associated oropharyngeal SCC and treated with CRT. Following treatment, nasopharyngeal stenosis and dysphagia developed.

Treatment of Nasopharyngeal Carcinoma (NPC) has been based on the Intergroup 0999 trial with chemoradiation (CRT) and consolidation chemotherapy (CT). While effective, toxicities are significant. As a result, many oncologists use induction chemotherapy (IC) followed by CRT, citing better tolerance with anecdotally no worse outcome. We reviewed 95 NPC patients treated between 2005 and 2015 at MDACC with IC followed by CRT. Median age was 49 years. Fifty-seven were T3/T4 and 62 were N2-3. The most common IC regimen was a platinum-taxane doublet (N = 72). 83 patients completed IC. Grade 3–4 toxicities with IC occurred in 10 patients. There were 15 primary site complete responses (CR), 68 partial responses (PR),6 stable disease (SD), and 2 progressed. There were 10 nodal CR, 73 PR, 4 SD, and 3 progressed. 92 patients received RT, 74 with CRT. At completion of treatment, there were 81 CR and 8 PR patients.Post radiation toxicities included mucositis and skin rash (37), oto- toxicity (25), PEG placement (12), and osteonecrosis (2). Three-year progression free survival (PFS) and distant metastasis free survival (DMFS) were 77.3% and 78%. CRT for advanced NPC is standard, but IC remains controversial. Early trials failed to show a benefit but used older chemotherapy and pre-intensity modulated radiation therapy (IMRT) methods. Modern trials with platinum-taxane regimens and IMRT have shown reasonable PFS and OS results with acceptable toxicity. This retrospective review of IC followed by CRT showed acceptable toxicity and good response and survival outcomes. This approach has, for many oncologists, become a standard.

e18059 Background: HPV pos OPSCC is clinically and biologically distinct from tobacco/alcohol-related cancer. HPV-positive (pos) tumors have favorable prognosis and respond better to treatment. Studies suggest that pattern of failure differs between HPV-negative (neg) and pos cohorts with loco-regional failure (LRF) being more common with former and distant metastases (DM) with latter. Pts with alcohol/tobacco exposure have increased incidence of SPM in head and neck (HN) or lung due to field cancerization. However, the incidence and sites SPM in pts with HPV pos OPSCC are not well-characterized. Methods: Charts of pts with OPSCC diagnosed between 2012 and 2014 with minimum follow up of 2 years were reviewed. Differences in rate and pattern of synchronous and metachronous SPM as well as recurrent/persistent disease (failure) in HPV pos and neg OPSCC were assessed. Descriptive statistics was used to summarize the data. Results: 157 pts were included. There was male predominance (78%) and median age was 60 years. Common primary sites were base of tongue (64), and tonsil (76). Most pts had advanced disease- 96 with stage IVA/B and 23 with stage III (AJCC 7th). 132 pts were HPV pos and 25 HPV neg. Majority of pts (80.3%) received definitive chemoradiation. Failure was noted in 23 HPV pos (15.15%) and 12 HPV neg pts (40.0%%) [OR 0.229, CI 0.093-0.565, P = 0.001]. 5/23 (22%) of failures in HPV pos were DM, 2 of which were non-pulmonary compared to 2/12 (16.7%) pts in the HPV neg group both of which included lung metastases. 27 HPV pos pts (20.5%) and 8 HPV neg (32.0%) had SPM [OR 0.546, CI 0.213-1.40, P = 0.208 ]. 7/8 SPM (87.5%) in HPV neg group and only 2/27 (7.4%) in HPV pos were of HN or lung [OR 0.011 CI 0.001-0.145, P < 0.001]. 25 HPV pos pts had SPM at other sites, specifically skin, hematologic, thyroid, renal and cervical. Conclusions: Incidence of relapse, patterns of failure and SPM differ in HPV-pos and neg OPSCC. Unlike in the HPV neg group, HPV pos failures and SPM often occur in sites other than HN/lung. These observations may have implications for disease surveillance and should be validated in larger, prospective studies.

e18072 Background: Definitive chemoradiotherapy (CRT) is the standard of care treatment for locally advanced head and neck squamous cell carcinoma (SCC) but carries the risk of osteoradionecrosis (ORN), a debilitating complication in bone healing. ORN and recurrent SCC share many clinical and radiologic features, making these conditions difficult to differentiate. However, it is crucial to distinguish between ORN, a benign condition that is managed conservatively, and recurrent SCC, which carries a poor prognosis even with treatment. Methods: We performed a single center retrospective chart review of 13 patients with head and neck SCC treated with CRT who subsequently had clinical suspicion of ORN. Patient demographics, history and physical findings, imaging results and final diagnosis were collected. Results: 6 patients were male, and 7 were female. Median age was 66 years (range 22-90). 7 had a final diagnosis of ORN and 6 had recurrent SCC. Findings on history, physical exam, and imaging are compared in Table 1. The average time interval between completion of CRT and clinical suspicion of ORN was longer in patients with a final diagnosis of ORN than recurrent SCC (21.6 vs. 5.2 months). Mean radiation dose and radiation technique used were not predictive of either outcome. Mean SUV on PET scan was similar for ORN and recurrent SCC (8.1 vs 7.2). Several patients with a final diagnosis of SCC had biopsies that were initially negative for malignancy, but tested positive on repeat biopsy. All 7 patients with ORN are alive but 5 of 6 patients with recurrent cancer have expired. Conclusions: ORN and recurrent SCC share common clinical and radiologic features. Our data suggests that suspicion for ORN within 6 months of CRT is concerning for disease recurrence. A negative biopsy does not rule out SCC recurrence. Repeat biopsy, ideally with direct visualization or via image guidance, should be considered if ORN symptoms progress despite supportive care. Findings Final dx ORN (# of patients) Final dx SCC (# of patients) Trismus 4 4 Oral pain 3 5 Exposed bone 4 5 Soft tissue enhancement on CT 6 6 Bone sclerosis on CT 3 3

Background. Surgeon performed ultrasound-guided fineneedle aspirates (UG-FNAs) reduce delay in diagnosis and allow for surgeon surveillance. We present the first report on a learning curve and impact of head and neck surgical trainees on adequacy rates.Methods. Thyroid UG-FNA biopsies from 2009 to 2013 were reviewed retrospectively. Specimen adequacy, cytologic diagnosis, and surgical pathology were used to calculate adequacy and accuracy.Results. One thousand sixty-seven biopsies were examined in 723 individuals. The adequacy rate from adoption into practice improved from 71% to 78% to 85% over 300 cases. When UG-FNA was subsequently taught to trainees, adequacy rates varied among trainees p < .037), and there were higher nondiagnostic rates earlier in training (p = .04). Adequacy was not related to size or palpability, but cystic lesions yielded more inadequate specimens (p < .001).Conclusion. Surgeon performed UG-FNA biopsy can be performed adequately in an outpatient setting. Adequacy rates reach acceptable levels after 300 cases, whereas trainee involvement impacts adequacy rates. (C) 2015 Wiley Periodicals, Inc.

OBJECTIVE:To determine the outcome of definitive concurrent chemoradiation with platinum for locally advanced sinonasal carcinomas. STUDY DESIGN:Retrospective cohort. METHODS:Twenty-three nonsurgically and definitively treated patients diagnosed between July 1998 and February 2009 were analyzed. Patients with adenoid cystic carcinoma or adenocarcinoma were treated with photons and neutrons; the other histologies received photons alone. The vast majority received chemotherapy. Descriptive statistics were utilized, and Kaplan-Meier estimates were computed. RESULTS:Female (57%) and Caucasian (74%) preponderance were observed. Eighty-seven percent were unresectable; the maxillary and nasoethmoid sites were equally prevalent. Intensity-modulated radiation therapy (IMRT) and photons alone were utilized in 74% and 70%, respectively. Platinum agents were given in 95% of chemotherapy patients. Complete response was observed in 64% of patients. Median progression-free survival (PFS) and overall survival (OS) were 28.8 and 65.3 months, respectively. Three-year PFS and OS rates were 44% and 72%, respectively; 5-year PFS and OS rates were 30% and 60%, respectively. Intensity-modulated radiation therapy and a maxillary site of origin showed a trend toward superior PFS; higher-dose regimens were associated with somewhat shorter PFS. Relapse was observed in 59% of patients, predominantly local. There were few unanticipated adverse effects, and no grade IV/V events were reported. CONCLUSION:Advanced sinonasal carcinomas are chemoradiosensitive tumors, albeit with a high propensity for local relapse. There is a definite indication for IMRT and a potential curative role of platinum-based chemoradiation regimens. LEVEL OF EVIDENCE:4. Laryngoscope, 127:855-861, 2017.