Download - American Head and Neck Society

American Head and Neck Society 

2010 Annual Meeting 

During the Combined Otolaryngology Spring Meetings 

MEETING PROGRAM 

April 28 - 29, 2010 

Bally’s/Paris Las Vegas 

Las Vegas, Nevada 

The American Head & Neck Society (AHNS) 

11300 W. Olympic Blvd., Suite 600 

Los Angeles, CA 90064 

Phone: (310) 437-0559 

Fax: (310) 437-0585 

www.ahns.info

Table of Contents 

4 General Information 

5 About The American Head & Neck Society 

6 AHNS President 

6 2010 Program Chair 

7 Hayes Martin Lecture 

8 John J. Conley Lecture 

9 Jatin P. Shah Symposium 

10 Guest of Honor 

10 Distinguished Service Award 

11-12 Presidential Citations 

13-15 AHNS Leadership 

15 Past Presidents 

17 Best Paper Awards 

17 Robert Maxwell Byers 

17 Alando J. Ballantyne Resident Research Pilot Grant 

18 Christopher O’Brien Traveling Fellowship 

20 AHNS Accreditation 

AHNS 2010 Annual Meeting 

Corporate Supporters 

The American Head & Neck Society gratefully acknowledges 

generous unrestricted educational grants in support of the 

AHNS 2010 Annual Meeting by the following companies: 

Platinum Level 

Bristol-Myers Squibb 

Ethicon Endo-Surgery, Inc. 

Gold Level 

Stryker 

Bronze Level 

Gyrus ENT, LLC 

Karl Storz Endoscopy-America 

KayPentax 

Medtronic 

Additional Support: 

Lilly 

OmniGuide 

21 Commercial Bias Reporting Form 

22 Bally’s Las Vegas Floorplan 

23 Scientific Program 

31 Faculty Listing 

32 Faculty, Presenter & Leadership Disclosures 

33 Oral Papers 

48 Poster Papers 

81 AHNS Certificate of Incorporation 

83 AHNS Constitution & Bylaws 

88 Index 

The programs and lectures presented 

at the AHNS 2010 Annual Meeting are 

copyrighted products of the 

American Head & Neck Society. 

Any reproduction or broadcasting 

without the express consent of the AHNS 

is strictly prohibited. 

SAVE THE DATE! – AHNS FUTURE 

MEETING SCHEDULE 

AHNS 2010 Research Workshop on Biology, 

Prevention & Treatment of Head & Neck Cancer 

October 28 - October 30, 2010 

Hyatt Regency Crystal City 

Arlington, VA 

AHNS 2011 ANNUAL MEETING 

during the Combined Otolaryngology Society Meetings 

(COSM) 

April 27 - 28, 2011 

Sheraton Chicago Hotel & Towers 

Chicago, IL 

8 th International Conference 

on Head & Neck Cancer 

July 21 - 25, 2012 

Metro Toronto Convention Center 

Toronto, ON, Canada 

www.ahns.info 

3

General Information 

The American Head and Neck Society’s 

2010 Annual Meeting 

April 28 - 29, 2010 

Bally’s Las Vegas 

3645 Las Vegas Boulevard South 

Las Vegas, NV 89109 

COSM On-site Registration Hours 

Grand Salon, Casino Level, Bally’s North Tower 

Tuesday, April 27 4:00 PM - 7:00 PM 

Wednesday, April 28 7:00 AM - 5:00 PM 

Thursday, April 29 7:00 AM - 5:00 PM 

Friday, April 30 

7:00 AM - 5:00 PM 

Saturday, May 1 7:00 AM - 4:00 PM 

Sunday, May 2 

7:00 AM - 10:00 AM 

COSM Exhibit Hall Hours 

Event Center, Casino Level of Bally’s North Tower 



9:00 AM - 4:00 PM 


COSM Speaker Ready Room Hours 

Bronze 1, Casino Level in Bally’s North Tower 

Tuesday, April 27 3:00 PM - 7:00 PM 




6:00 AM - 6:00 PM 


Sunday, May 2 

7:00 AM - 10:00 AM 

COSM Spouse Lounge Hours 

Palace 2, Casino Level, Bally’s North Tower 




8:00 AM - 2:00 PM 


Sunday, May 2 

8:00 AM - 2:00 PM 

AHNS Meeting Educational Objectives 

The conference is designed to facilitate discussion regarding the 

approaches used in the diagnosis, treatment, and rehabilitation 

of head and neck neoplasms throughout the world. Participants 

should accomplish the following at the conclusion of this event: 

• Understand the role of surgery, radiation therapy, 

chemoradiation, and combined modality therapy in the 

treatment of head and neck cancer as defined by results 

from randomized control trials 

• Understand the clinical uses of new novel molecular agents 

in the management of head and neck cancer 

• Understand the Role of surgery in the management of thyroid 

“laboratory” cancer 

• Understand the impact of treatment on functional outcome 

of head and neck cancer patients 

• Understand novel approaches to head and neck 

reconstruction 

AHNS 2010 CME Credit Claim Process 

Please use the worksheet on page 20 to 

track the number of CME hours you attend 

for each activity. After the meeting, an email 

will be sent to attendees with an on-line link 

to the survey and claim form. 

To Receive Your CME Credit: 

AHNS has instituted a new process 

for claiming CME credits and printing 

certificates. All attendees wishing to receive 

a CME certificate for activities attended at 

the AHNS 2010 Annual Meeting must first 

complete an on-line meeting evaluation form. 

Attendees will have access to the on-line 

meeting evaluation and credit claim form 

via a link on the AHNS website after the 

meeting. 

Please allow 4-6 weeks for processing 

before your certificate arrives. 

4 American Head and Neck Society 2010 Annual Meeting

About the American Head & Neck Society 

History of the Society 

On May 13, 1998, The American Head and Neck Society (AHNS) 

became the single largest organization in North America for 

the advancement of research and education in head and neck 

oncology. The merger of two societies, the American Society 

for Head and Neck Surgery and the Society of Head and Neck 

Surgeons, formed the American Head and Neck Society. 

The contributions made by the two societies forming the AHNS 

are significant in the history of surgery in the United States. 

Dr. Hayes Martin conceived the Society of Head and Neck 

Surgeons in 1954, a surgeon considered by many to be the 

“father of modern head and neck tumor surgery.” The purpose 

of the society was to exchange and advance the scientific 

knowledge relevant to the surgery of head and neck tumors 

(exclusive of brain surgery) with an emphasis on cancer of the 

head and neck. Two years later, The American Society for Head 

and Neck Surgery was organized with the goal to “facilitate and 

advance knowledge relevant to surgical treatment of diseases of 

the head and neck, including reconstruction and rehabilitation; 

promote advancement of the highest professional and ethical 

standards as they pertain to the practice of major head and neck 

surgery; and to honor those who have made major contributions 

in the field of head and neck surgery, or have aided in its 

advancement”. 

The new Society remains dedicated to the common goals of its 

parental organizations. 

Mission Statement 

The purpose of this society is to promote and advance 

the knowledge of prevention, diagnosis, treatment 

and rehabilitation of neoplasms and other diseases of 

the head and neck, to promote and advance research 

in diseases of the head and neck, and to promote 

and advance the highest professional and ethical 

standards. 

Why Join the AHNS? 

The American Head and Neck Society is an organization of 

physicians, scientists and allied health professionals dedicated 

to improving the understanding of Head and Neck Cancer and 

the care of patients afflicted with that disease. Membership 

is open to a wide variety of interested individuals in several 

categories that differ both in terms of responsibility and level of 

involvement in the society. 

For more information about AHNS 

membership and to apply on-line, please 

visit www.ahns.info/membercentral, 

call +1-310-437-0559, ext. 110 or ask at 

the AHNS desk for additional information. 

The Benefits of AHNS Membership: 

• Interaction with colleagues dedicated to promoting 

and advancing the knowledge of prevention, diagnosis, 

treatment, and rehabilitation of neoplasms and other 

diseases of the head and neck 

• Member rates on all meeting registration fees 

• The honor of being a part of our worldwide network 

of surgeons, physicians and health care professionals 

dedicated to the prevention and treatment of head and neck 

cancer 

• Opportunities to partake in educational offerings, including 

those planned by the society and those co-sponsored by the 

society 

• Opportunity to post regional meetings and courses on the 

AHNS “Related Meetings” web page 

• Access to the AHNS member contact information in the 

“Members Only” section of our web site 

• Monthly e-newsletter and annual paper newsletter with 

updates about the society and head & neck surgery 

• Ability to apply for research grant awards offered yearly 

• Opportunity to participate on committees and to vote at the 

annual business meeting 

Qualifications for Active Fellowship: 

Surgical Applicants must be Diplomats of the American Board 

of Otolaryngology, Plastic Surgery, or Surgery or OTHER 

EQUIVALENT CERTIFICATION BOARD. Additionally, all 

applicants must be Fellows of the American College of 

Surgeons, Fellows in the Royal College of Surgeons (FRCS) or 

equivalent non-surgical organization. 

Qualifications for Associate Fellowship: 

An applicant for Associate Fellowship must be a physician, 

dentist, or scientist who has special interest contributions in the 

field of neoplastic or traumatic diseases of the head and neck. 

Qualifications for Candidate Fellowship: 

The trainee currently enrolled in an approved residency program 

in Otolaryngology, Plastic Surgery, or General Surgery or in a 

Fellowship program approved by the Advanced Training Council 

may become a Candidate Fellow. 

Qualifications for Corresponding Fellowship: 

An Applicant for Corresponding Fellowship must be a physician 

who specializes in the treatment of head and neck cancer, 

who by their professional associations and publications, would 

appear in the judgment of Council to be qualified to treat head 

and neck cancer. 

Corresponding Fellows must reside in a country other than the 

United States or Canada. 

www.ahns.info 

5

Meeting Leaders 

AHNS President 

2010 Program Chair 

John A. Ridge, MD 

John Andrew “Drew” Ridge was born 

in 1950. After attending the University 

of Chicago he received the Ph.D. in 

Biochemistry from Stanford University in 

1978 and the M.D. in 1981. He pursued residency training in 

General Surgery at the University of Colorado and both Surgical 

Research and Surgical Oncology fellowships at the Memorial 

Sloan-Kettering Cancer Center. 

From 1989 to 1991 he was Assistant Professor in Residence 

at the University of California at San Francisco before moving 

to the Fox Chase Cancer Center in Philadelphia when 

presented with an opportunity to limit his practice to head and 

neck oncology. At Fox Chase, he became chief of the Head 

and Neck Surgery Section and joined the faculty of Temple 

University. Currently he holds appointments as Senior Member 

and Professor of Surgical Oncology and of Molecular and 

Translational Medicine at Fox Chase and as Professor of Surgery 

and of Otolaryngology-Head & Neck Surgery at Temple. He 

loves to teach. A surgical oncology fellowship position has been 

endowed in his name. 

Dr. Ridge has devoted his academic career to multidisciplinary 

treatment of head and neck cancer, with a strong commitment 

to clinical research. He has been influential in the design 

and execution of several clinical trials evaluating “organ 

preservation,” the non-surgical management of advanced 

squamous cancers of the head and neck. He served as Co-Chair 

of the Head and Neck Committee of the Eastern Cooperative 

Oncology Group and is a member of the Head and Neck 

Steering Committee of the Radiation Therapy Oncology Group. 

He has been a member of the NCCN Head and Neck and 

Thyroid panels since their inceptions and has been a writing 

member of both committees. Currently, he is Co-Chair of the 

NCI Previously Untreated and Locally Advanced Disease Task 

Force for the CTEP Head and Neck Steering Committee. He is a 

Governor of the American College of Surgeons. 

After they met at Sloan-Kettering, he married Elin Sigurdson 

in 1989. A prominent academic surgical oncologist interested 

primarily in colorectal cancer, she too works at the Fox Chase 

Cancer Center. Their son, Lukas, and twin daughters, Kelsey 

and Hannah, are in college. None of them show the slightest 

interest in medical or scientific careers. A fencer, Drew holds an 

“A” classification in Epee and competes internationally. He has 

been a member of two US Fencing Association Veteran World 

Championship Teams and has had respectable results on the 

World Cup circuit. Though he enjoys the Rockies, he fences 

much better than he skis. 

Active in many professional organizations, he was part of the 

first Council of the American Head and Neck Society. 

Bhuvanesh Singh, MD, PhD 

Bhuvanesh Singh completed his medical 

degree from the State University of New York 

- Health Science Center at Brooklyn in 1991 

with Distinction in Research. He went on to 

train in Otolaryngology - Head and Neck Surgery at the State 

University of New York - Health Science Center at Brooklyn and 

completed an advanced fellowship in Head and Neck Surgery 

at Memorial Sloan Kettering Cancer Center. Dr. Singh received 

his Ph.D. form the University of Amsterdam/Netherlands Cancer 

Institute. Dr. Singh is currently a tenure track Associate Professor 

and Associate Member on the Head and Neck Service in the 

Department of Surgery and the Director of the Laboratory of 

Epithelial Cancer Biology at Memorial Sloan-Kettering Cancer 

Center. Dr. Singh has dedicated his career to the improvement 

of outcome for patients with head and neck cancer, actively 

participating in clinical care, education and research. Dr. Singh’s 

research work focuses on the functional characterization of a 

novel oncogene (SCCRO) that was cloned in his laboratory. 

Using cell biological, biochemical and animal models, his lab 

has shown that SCCRO is activated in head and neck cancer 

and suggests that it is an excellent therapeutic target. His work 

has been recognized by receipt of numerous awards including 

the Young Investigator Award from American Society of Clinical 

Oncology and the George H.A. Clowes, Jr., MD, FACS, Memorial 

Research Career Development Award from the American College 

of Surgeons. Dr. Singh has lectured at meeting throughout the 

world and has authored over 150 peer review papers and 25 

book chapters and is a co-author on a soon to be released 

textbook on head and neck cancer. He is married to Dr. Mitu 

Saggar with whom he has three sons. 


Hayes Martin Lecture 

Hayes Martin Lecturer 

Hayes Martin Biography 

www.ahns.info 

Adel El-Naggar, MD 

Adel El-Naggar, M.D., Ph.D., is an 

internationally renowned head and neck 

pathologist with 20 years experience in 

this field. He contributed extensively to 

the histopathology, clinicopathologic, flow cytometric, and 

molecular diagnostics of head and neck tumors with over 

400 peer-reviewed publications. He has made a significant 

contribution integrating molecular and biological markers in 

the diagnosis and management of head and neck cancer. One 

of his major contributions was in 1990 with the establishment 

of the first comprehensive tissue acquisition programs in the 

nation. Through genomic analysis, his group has, for the first 

time, identified a set of genes that distinguishes conventional 

squamous carcinoma from other phenotypic squamous 

carcinoma variants. He was the first to identify loss of imprinting 

at the IGF-2 gene in head and neck squamous cell carcinoma, 

and the t(11:19) translocation as a sole cytogenetic alteration 

in mucoepidermoid carcinoma of salivary gland. Dr. El-Naggar 

is also a leader in head and neck surgical pathology and was 

selected to outline the molecular alterations in salivary gland 

tumors for WHO classifications of head and neck tumors. In 

2002 he established and directs the head and neck cancer 

pathology training program at M. D. Anderson Cancer Center. 

In 1997, Dr. El-Naggar was awarded The B. Rothschild Senior 

Research Scholarship at the Curie-Institute in France, and he 

holds the Kenneth D Műller Endowed Professorship. He is the 

recipient of the Presidential Citation of The American Head 

and Neck Surgical Society, the highest honor bestowed by this 

society. Nationally, Dr. El-Naggar led the Correlative Science 

Subcommittee of the SWOG Head and Neck Committee from 

2002-2006, is the only pathologist on the NCI-Head and Neck 

Steering Committee, and is a member of the RTOG Steering, 

Pathology and Surgery Committees. 

Hayes Martin, MD 

Hayes Martin was born in Dayton, a small town 

in north central Iowa. He attended the University 

of Iowa at Iowa Falls before being accepted to 

the medical school in 1913 on the same campus, 

finishing 4 years later in a class of 20. 

World War I began in April 1917 while Hayes was in his final year of 

medical school. Many of his classmates at the medical school were in 

the Army ROTC units; however, Dr. Martin opted for the Navy, which he 

joined on the day America entered the war. He traveled to Europe on 

the USS Arkansas and was assigned to his permanent duty station at 

the U.S. Navy Air Station, La Trinite Sur Mer, France – a small seaside 

village on the southern coast of Brittany. The purpose of this base was 

antisubmarine warfare using blimps and kite balloons. Dr. Martin was 

made commanding officer of the air station for a brief period of time 

when the line officer in charge had become ill; it was a unique position 

for a medical officer in the Navy to take command during wartime. 

After the war, Dr. Martin returned to the U.S and sought out an 

internship at the old Poly Clinic Hospital in New York City, which was 

temporarily made into a Veteran’s Administration hospital. Part of his 

internship was spent at Bellevue in the fourth surgical division, where 

he felt he would have the best possible training in general surgery. 

The chief of the second division was John A. Hartwell, MD, the 

distinguished surgeon memorialized by the Fellow’s Room in the library 

of the New York Academy of Medicine. Dr. Hartwell suggested that Dr. 

Martin go to Memorial Hospital to learn about cancer. 

Dr. Martin received an internship at Memorial in the summer of 1922 

and stayed on as a resident until 1923. He then had two years at the 

second surgical service at Bellevue, where he operated to his heart’s 

content and got the surgical education he so strongly desired. Once 

he finished his residency, Dr. Martin returned to Memorial where he 

joined as clinical assistant surgeon on the staff. 

Dr. Martin made the use of aspiration biopsy on all solid tumors popular 

throughout Memorial. Now, this procedure is done throughout the 

world. Dr. Martin co-authored the first report on the subject published 

in the Annals of Surgery. Numerous other articles followed, including 

Dr. Martin’s two most famous publications, “Cancer of the Head and 

Neck,” published in two issues of the Journal of the American Medical 

Association in 1948, and “Neck Dissection,” appearing in Cancer 

in 1951. These two papers were so extensively requested that the 

American Cancer Society made reprints by the thousands available to 

those who requested them as many as 20 years after publication. Dr. 

Martin’s bibliography encompasses more than 160 articles. 

In 1934, Dr. Martin was appointed Chief of the Head and Neck Service at 

Memorial Hospital. It wasn’t until 1940 that surgery began to take over as 

the treatment of choice for the majority of cancers of the head and neck. 

In that year, the beginnings of improved anesthesia permitted advances 

in surgery. Later, during World War II, antibiotics became available and 

surgery began to dominate much of head and neck cancer management. 

Dr. Martin wrote extensively on many subjects, most within the realm of 

head and neck surgery. His ideal was to be the complete head and neck 

surgeon and he treated a wide variety of head and neck abnormalities. 

His book, Surgery of the Head and Neck Tumors, was published in 1957. 

Dr. Martin retired from active practice in 1957 at the age of 65. He 

performed his last operation at Memorial Hospital, assisted by Dr. 

Elliot Strong, in October 1959, but continued to see patients in his 

office until he passed away in 1977. 

7

John J. Conley Lecture 

John J. Conley Lecturer 

John J. Conley Biography 

Robert L. Comis, MD 

Robert L. Comis, MD, President and 

Chairman of the Coalition of Cancer 

Cooperative Groups, is Professor of Medicine 

and Director of the Drexel University Clinical 

Trials Research Center, Philadelphia, and the Group Chair of the 

Eastern Cooperative Oncology Group (ECOG). 

A leader in international clinical trials research since 1977, Dr. 

Comis is also a champion for patient access to cancer clinical 

trials, spearheading national efforts to raise awareness about 

the pivotal role of cancer clinical trials in cancer prevention, 

detection and treatment. 

Dr. Comis was elected to the Board of Directors of the American 

Society of Clinical Oncology, National Coalition for Cancer 

Research and the American Radium Society. He has served on 

the Editorial Board of the Journal of Clinical Oncology, Cancer 

Research and Clinical Cancer Research. He is Chair of the 

Clinical Trials Team of C-Change. He has served ASCO in a 

variety of capacities including Chair of the Program, Nominating 

and Audit Committees, as well as a member of the Executive 

Committee. 

A graduate of Fordham University in New York City, he received 

his medical degree from SUNY Health Science Center School of 

Medicine in Syracuse, NY, where he also completed his medical 

internship and medical residency. He served as a Staff Associate 

at the National Cancer Institute, Bethesda, Maryland and 

completed a Medical Oncology Fellowship at The Sidney Farber 

Cancer Center at Harvard Medical School in Boston, MA. Dr. 

Comis is a Diplomat of the American Board of Internal Medicine, 

and a member of the American College of Physicians-American 

Society of Internal Medicine. 

John J. Conley, MD 

Although he looked and sounded like an 

English nobleman, Dr John Conley was born in 

Carnegie, Pennsylvania, a small steel mill town 

just outside of Pittsburgh. He graduated from the 

University of Pittsburgh and later its school of medicine. He interned 

at Mercy Hospital in Pittsburgh. During that year, the nuns who ran the 

hospital suggested that Dr. Conley take a residency in cardiology and 

come back to Mercy as their cardiologist. He went to Kings County 

Hospital in Brooklyn, a very busy city hospital with a huge patient 

population. Shortly after he began his training, he had an arrhythmia 

diagnosed as paroxysmal atrial tachycardia. Little was known about 

this benign condition at that time. Dr. Conley was told that cardiology 

was too stressful and that he should go into an easier, less-stressful 

field with better working hours, like ENT. He did an otolaryngology 

residency at Kings County Hospital. This was followed by four years 

of military service during World War II, which included experience 

in otolaryngology and plastic and reconstructive and maxillofacial 

surgery in the U.S. Army Medical Corps, both in this country and in the 

South Pacific theater. Exposure to the reconstruction of war wounds 

would prove invaluable to him later on in applying these principles to 

reconstruction following ablative head and neck surgery. 

Dr. Conley returned to New York City after the war. He became an 

assistant and then an associate of Dr George T. Pack, a technically 

superb general oncologic surgeon at Memorial Hospital who taught Dr. 

Conley major ablative surgery of the head and neck. They worked day 

and night catching up with the backlog of surgery that was neglected 

during the war years. The combination of his training in otolaryngology, 

the exposure to ablative surgery, and the World War II experience in 

reconstructive surgery set the stage for Dr Conley to evolve his unique 

approach to head and neck surgery. 

Ironically, despite the admonition of the cardiologists about hard 

work, Dr. Conley did a prodigious amount of major head and neck 

reconstructive surgery. This proved to be more than ample to provide 

training to many fellows. His commitment to education is further 

attested to by the position he held for many years as Clinical Professor 

of Otolaryngology at the College of Physicians and Surgeons at 

Columbia University. He loved his appointment at Columbia and 

particularly his involvement in teaching the residents. 

Dr. Conley’s vast surgical experience, together with active research 

interests, led to the authorship of almost 300 contributions to the 

scientific literature, and eight books. As a result of his productivity and 

rhetorical eloquence, he was very much in demand as a speaker in this 

country and abroad. He gave many prestigious eponymous lectures in 

our field and received many awards for his work, including the Philip 

H. Hench Award as the Distinguished Alumnus of the University of 

Pittsburgh School of Medicine, and the DeRoaldes and Newcomb 

Awards of the American Laryngological Association. 

Dr. Conley’s contributions to the scientific literature, many technical 

innovations and surgical experience placed him in the position 

to receive many honors and important leadership positions, such 

as President of the American Academy of Otolaryngology and 

Ophthalmology, member of the Board of Governors of the American 

College of Surgeons, founding member of the Society of Head and 

Neck Surgeons, and founding member and first President of the 

American Society for Head and Neck Surgery. During those years, Dr 

Conley used, to the great benefit of us all, his wisdom and diplomacy 

in carrying out such high-level responsibilities. 


Lectures 

Jatin P. Shah Symposium 

Jatin P. Shah, MD 

Professor Jatin P. Shah graduated from the 

Medical College of MS University in Baroda, 

India, and received his training in Surgical 

Oncology and Head and Neck Surgery at 

Memorial Sloan Kettering Cancer Center. He is Professor of 

Surgery, at the Weil Medical College of Cornell University, and 

Chief of the Head and Neck Service, Leader of the Head and 

Neck Disease Management Team, and holds The Elliott W. 

Strong Chair in Head and Neck Oncology at Memorial Sloan- 

Kettering Cancer Center in New York City. 

Dr. Shah is a national and international leader in the field of head 

and neck surgery, having served as President of The New York 

Cancer Society, The New York Head and Neck Society, The 

Society of Head and Neck Surgeons, The North American Skull 

Base Society and the International Academy of Oral Oncology. 

He is Founder of The International Federation of Head and Neck 

Oncologic Societies, in 1986. He currently serves as Chairman 

of the AJCC task force on Head and Neck. He was Chairman 

of the Joint Council for advanced training in head and neck 

oncologic surgery in the USA. He was also Chairman of The 4th 

International Conference on Head and Neck Cancer in Toronto 

in 1996. He has served in varying capacities for The American 

Board of Surgery, and The American College of Surgeons. 

Professor Shah has been the recipient of numerous awards 

from various parts of the world, and is the recipient of honorary 

fellowships from The Royal College of Surgeons of Edinburgh, 

London and Australia. He holds Honorary PhD, degrees from 

the Catholic University of Louvain, in Belgium and the University 

of Athens, in Greece. He is recipient of the Blokhin Gold medal, 

the highest Honor in Oncology in Russia. He has been elected 

as an honorary member of several head and neck societies in 

Europe, Asia, Australia, Africa and Latin America. He has been 

continuously listed in the “Best Doctors in America” directories 

for several years. He serves on the Editorial and Review Boards 

of 18 scientific journals and has published over 300 peerreviewed 

articles, 50 book chapters and 7 books. His textbook 

of Head and Neck Surgery and Oncology won First Prize from 

The British Medical Association and The Royal Society of 

Medicine and was awarded the George Davey Howells Prize 

from the University of London, for the best published book in 

otolaryngology in the preceding five years. 

He is a much sought after speaker who has delivered over 1000 

scientific presentations including, 59 eponymous lectures and 

keynote addresses, and visiting professorships in the United 

States, Canada, United Kingdom, Scotland, Sweden, Belgium, 

Germany, Italy, Spain, Poland, Russia, Croatia, Turkey, Egypt, 

South Africa, India, China, Korea, Japan, Hong Kong, Taiwan, 

Singapore, Phillipines, Australia, Argentina, Brazil, Chile, Peru, 

Equador, Venezula, Panama, and Mexico. 

In recognition of his outstanding contributions, and World 

Leadership in Head and Neck Surgery, Memorial Sloan Kettering 

Cancer Center, has established The “Jatin Shah Chair in Head 

and Neck Surgery and Oncology”, The International Federation 

of Head and Neck Oncologic Societies has established “The 

Jatin Shah Lecture”, at it’s world congresses, and the American 

Head and Neck Society has established the “Jatin Shah 

Symposium” at it’s annual meeting. 

www.ahns.info 

9

Guest Of Honor 

Distinguished Service Award 

Andy Trotti, III, MD 

Dr. Trotti is a Professor and Director of 

Clinical Trials in Radiation Oncology at the 

Moffitt Cancer Center. He is recognized for 

his expertise in Head and Neck (H&N) cancer 

and in the measuring, reporting and mitigating the adverse 

effects of H&N cancer treatment. His interests include improving 

the efficacy of radiotherapy in head and neck cancer clinical 

trials through integration of fractionation, cytotoxic agents and 

biologics. He has a special interest in human papilloma virus 

(HPV)-related cancers and is developing a large multicenter trial 

for reducing toxicity in this population. He currently serves as 

the Co-Chair of the NCI H&N Steering Committee responsible 

for development and approval of Phase II and III trials. He is also 

Co-Chair of the Head and Neck Committee for the Radiation 

Therapy Oncology Group (RTOG), and leads the radiotherapy 

subgroup for the NCCN H&N Committee. Honors include the 

annual Wharton Lecturer at Princess Margaret Hospital on the 

“Evolution of Adverse Event Reporting in Oncology.” He has coauthored 

several landmark RTOG studies of fractionation and 

organ preservation. He is recognized for his work in developing 

the NCI adverse event (AE) grading dictionaries (NCI-CTCAE) 

now widely used in oncology. 

Mark K. Wax, MD 

Mark K. Wax graduated from the University 

of Toronto Otolaryngology, Head and Neck 

Surgery Program in 1985. He then went 

into private practice at the Oshawa Clinic 

for five years. Wishing to pursue more of an academically 

oriented career, he completed a Joint Council Oncologic and 

Reconstructive Fellowship under David Bryant in Toronto, 

Ontario. Following this, he moved to West Virginia University 

where for five and a half years he contributed to development 

of a Head and Neck Oncologic Program. Following a brief stint 

in SUNY at Buffalo, he relocated in 1990 to Oregon Health 

and Sciences University. There he became the Director of 

Microvascular and Reconstructive Surgery. Since that time, 

Dr. Wax has helped to build a busy multidisciplinary and 

multifaceted reconstructive program. 

Dr. Wax has published many articles over the last decade. He 

has 160 publications in the peer reviewed literature, has coauthored 

greater than 20 chapters, and is the co-editor of two 

textbooks. Currently he sits on the editorial board of three major 

otolaryngology journals and contributes review articles to many 

others. 

Dr. Wax is a professor of otolaryngology, and has been program 

director at OHSU for eight years. During this time he has 

successfully seen the program reaccredited for the full 5 year 

compliment. 

Dr. Wax has had a fellowship in Microvascular and 

Reconstructive training that has been accredited through the 

AAFPRS. He has trained 10 fellows, the majority of whom 

are now in academic head and neck practices. Dr. Wax has 

been active in the American Head and Neck Society serving 

on multiple committees until he became treasurer in 2004. He 

currently serves on the executive committee of the society and 

the foundation. One of his major accomplishments has been to 

streamline the financial structure of the society and foundation 

with the integration of a professional management group. At 

the same time he has brought financial stability to the society 

through a precise savings plan. 

In 2007 Dr. Wax became the coordinator for education for 

the AAOHNS. In this position he has helped to oversee the 

educational activities of the overall society. He has helped 

develop a collaborative program of education between the 

societies that seeks to educate residents in head and Neck 

Oncologic and ablative surgery. 


Presidential Citations 

Thomas F. Pajak, MD 

Thomas F. Pajak, Ph.D., served as the RTOG 

Group (lead) Statistician for 23 years, from 

1981 to 2004. He continues to work with 

RTOG investigators as a Senior Statistician. 

Dr. Pajak has focused on head and neck 

cancer clinical trials since his first day at RTOG. He was involved 

in the design, conduct, and analyses of two RTOG landmark 

studies: the laryngeal preservation trial and the postoperative 

chemoradiation trial. 

Dr. Pajak received his doctoral degree from the State University 

of New York at Buffalo. While in the program, he worked as a 

statistical intern in the Southwest Oncology Group (SWOG) 

Statistical Center at M. D. Anderson Cancer Hospital. After 

earning his doctorate, Dr. Pajak worked as a statistician for 

the Cancer and Leukemia Group B (CALGB), the Western 

Cancer Study Group (WCSG), and the Cancer Center at the 

Bowman Gray School of Medicine. In the late 1990s, Dr. Pajak 

worked as the Group (lead) statistician with Dr. Samuel Wells 

and other surgeons from the American College of Surgeons in 

both creating a new surgical cooperative group (ACoSOG) and 

obtaining the initial National Cancer Institute (NCI) grant to fund 

its activities. 

Besides being an RTOG Senior Statistician, Dr. Pajak is an 

adjunct Associate Professor in the Department of Radiation 

Oncology at Thomas Jefferson University Hospital, and has been 

an editor on the American Editorial Board for the International 

Journal of Radiation Oncology Biology Physics since 1988. Dr. 

Pajak serves on various data monitoring and safety boards and 

is an external consultant for head and neck cancer trials. He also 

serves as a reviewer or consultant for various NCI committees. 

He is presently a member of the NCI steering committee 

for head and neck trials. He also has served as the elected 

spokesman for his fellow cooperative Group Statisticians. 

While his publications have encompassed all major adult 

cancers, his current research interests are head and neck 

cancers, pathology, and tumor markers. Dr. Pajak has been 

involved in research testing proposed pathology systems 

and tumor markers to classify disease for their independent 

prognostic value and then with implementing the markers in 

clinical trials. Dr. Pajak is currently involved in designing trials 

for patients with human papillomavirus-positive oropharyngeal 

tumors. In particular, he is collaborating with clinicians and other 

statisticians in defining a very favorable patient group in whom 

de-intensified treatments can be tested against the standard of 

care chemoradiation regimen. 

Walter J. Curran, MD 

Walter J. Curran was appointed Executive 

Director of Winship Cancer Institute in 

September, 2009. He joined Emory in 

January, 2008, as the Lawrence W. Davis 

Chair of Radiation Oncology and Chief 

Medical Officer of Winship Cancer Institute. 

Prior to joining Emory, Dr. Curran was Chairman of Radiation 

Oncology at Thomas Jefferson University in Philadelphia, 

Pennsylvania. He currently serves as Group Chairman and 

Principal Investigator of the Radiation Therapy Oncology Group 

(RTOG), a National Cancer Institute-funded cooperative group, a 

position he has held since 1997. 

Dr. Curran, who is a Georgia Cancer Coalition Distinguished 

Scholar, has been a principal investigator on several National 

Cancer Institute grants and is considered an international expert 

in the management of patients with locally advanced lung 

cancer and malignant brain tumors. He has led several landmark 

clinical and translational trials in both areas and is responsible 

for defining a universally adopted staging system for patients 

with malignant glioma. He has authored or co-authored more 

than four hundred abstracts and scholarly papers, as well as 

numerous presentations, reviews and book chapters. He has 

been chairman or co-chairman of more than 40 clinical trials and 

a reviewer for twelve national/international journals. He serves 

as the Founding Secretary/Treasurer of the Coalition of Cancer 

Cooperative Groups and a Board Member of the Georgia Center 

for Oncology Research and Education (GA CORE). Dr. Curran 

is the only radiation oncologist to serve as Director of a National 

Cancer Institute Designated Cancer Center. 

Dr. Curran is a Fellow in the American College of Radiology 

and has been awarded honorary memberships in the European 

Society of Therapeutic Radiology and Oncology and the 

Canadian Association of Radiation Oncology. In 2006, he was 

named the leading radiation oncologist/cancer researcher in a 

peer survey by the journal Medical Imaging. Under Dr. Curran’s 

leadership Emory’s Radiation Oncology Department has been 

recently selected as a “Top Five Radiation Therapy Centers 

to Watch in 2009” by Imaging Technology News. This review 

recognizes the most forward-thinking, U.S.-based cancer 

treatment centers, which have adopted advanced technology to 

optimize treatment and make a difference in patient care. 

Dr. Curran graduated cum laude from Dartmouth College, 

received his MD degree from the Medical College of Georgia 

and is a Board Certified Radiation Oncologist. Curran completed 

his residency in the Department of Radiation Therapy at the 

University of Pennsylvania Medical Center and his internship 

in internal medicine at Presbyterian University of Pennsylvania 

Medical Center in Philadelphia. Chief Medical Officer, Emory 

Winship Cancer Institute 

www.ahns.info 

11


Corey J. Langer, MD 

Corey J. Langer is the Director of Thoracic 

Oncology at the Abramson Cancer Center 

of the University of Pennsylvania and a 

Professor of Medicine in the Hematology- 

Oncology Division since June of 2008. Previously he served as 

the Director of Thoracic Medical Oncology at the Fox Chase 

Cancer Center and as an Associate Professor in the Department 

of Medicine at Temple University in Philadelphia, Pennsylvania. 

Dr. Langer earned his combined Bachelor of Arts and Doctor 

of Medicine degrees from Boston University in Boston, 

Massachusetts in 1981. After completion of his internship and 

residency at Graduate Hospital of the University of Pennsylvania 

in Philadelphia, Dr. Langer completed a fellowship in 

Hematology/Oncology at Presbyterian University of Pennsylvania 

Medical Center and an oncology fellowship at AOH/Fox Chase 

Cancer Center. 

Through his academic and cooperative group affiliations, Dr. 

Langer is the principal investigator in several ongoing clinical 

research protocols focusing on the management of non-small 

cell and small cell lung cancers as well as head and neck cancer. 

Specifically, Dr. Langer’s research focus is in the area of salvage 

therapy, concurrent chemotherapy and radiation regimens, and 

oncologic therapy for the elderly and those with compromised 

functional status. 

Dr. Langer has been published in numerous peer-reviewed 

journals including Cancer, Journal of the National Cancer 

Institute, New England Journal of Medicine, Journal of Clinical 

Oncology, and Journal of Thoracic Oncology. He has served on 

the editorial board of the Journal of Clinical Oncology, Japanese 

Journal of Clinical Oncology, Clinical Lung Cancer and Clinical 

Advances in Hematology and Oncology. Additionally, Dr. Langer 

serves as a reviewer for several journals including Journal of 

Clinical Oncology, Lung Cancer, Cancer Investigation, Annals 

of Oncology, Clinical Cancer Research, Lancet, and Cancer 

Chemotherapy and Pharmacology. 

He is a member of ASCO, AACR, IASLC, and the GOC, as 

well as a member of the core head and neck and thoracic 

committees of both the ECOG and Radiation Therapy Oncology 

Group (RTOG). He is also the Chair of the Medical Oncology 

Committee of the RTOG and its Vice Chair; and he serves as 

the Chair of the Head and Neck Cancer NCDB (National Cancer 

Database of the American College of Surgeons. He also serves 

on the Scientific Advisory Board of the Geriatric Oncology 

Consortium and previously served on the NCCN. He has also 

served as the Chair of the Research Strategy Committee of 

Oncology Physician’s Network, a research consortium in the 

Delaware Valley, and will help spearhead a similar process 

through the University of Pennsylvania Oncology Network. 

Dr. Langer is married, with a daughter age 25 and a son age 19. 

He is also immediate past President of Delaware Valley Poets, 

for which he helps to conduct monthly readings. 


AHNS Leadership 

Officers of the AHNS 

President: John A. Ridge, MD, PhD 

President-Elect: David W. Eisele, MD 

Vice-President: Carol R. Bradford, MD 

Secretary: Dennis H. Kraus, MD 

Treasurer: Mark W. Wax, MD 

Past Presidents: Wayne M. Koch, MD 

Gregory T. Wolf, MD 

Randal S. Weber, MD 

Fellows-At-Large: 

Jay O. Boyle, MD 

Pierre Lavertu, MD 

Brian B. Burkey, MD 

C. René Leemans, MD, PhD 

Marion E. Couch, MD, PhD Jeffrey N. Myers, MD, PhD 

Ramon Esclamado, MD Peter C. Neligan, MD 

Jonathan Irish, MD, FACS 

Committees of the AHNS 

Ad Hoc Reconstructive Committee 

Eben L. Rosenthal MD (Chair) 2009-2012 

Joseph J. Disa, MD 2009-2011 

Neil D. Futran, MD, DMD 2009-2011 

Derrick Lin, MD 2009-2010 

Mark K. Wax, MD 2009-2012 

Donald T. Weed, MD 2009-2010 

Advanced Training Council (ATC) 

Ashok R. Shaha, MD (Chair) 2002-2012 

William M. Lydiatt, MD (Secretary) 2007-2012 

Joseph A. Califano, MD 2007-2012 

Ara A. Chalian, MD 2007-2012 

Douglas B. Chepeha, MD 2007-2012 

Barry L. Wenig, MD 2007-2012 

Jeffrey M. Bumpous, MD 2008-2013 

Ramon Esclamado, MD 2008-2013 

Kerstin M. Stenson, MD 2009-2014 

Neal Topham, MD 2009-2014 

Awards Committee 

Marilene B. Wang, MD (Chair) 2007-2010 


William R. Carroll, MD 2007-2010 

David L. Schwartz, MD 2007-2010 

Duane A. Sewell, MD 2007-2010 

James Rocco, MD, PhD 2008-2011 

M. Boyd Gillespie, MD 2009-2012 

CME Compliance Committee 

Ellie Maghami, MD (Chair) 2007-2011 

Dennis H. Kraus, MD (Ex Officio) 2007-2010 

D. Gregory Farwell, MD, FACS 2008-2010 

Paul L. Friedlander, MD 2008-2010 

Neil D. Futran, MD, DMD 2008-2010 

Douglas A. Girod, MD 2008-2010 

Wesley L. Hicks, Jr., MD 2008-2010 

Robert Ferris, MD, PhD (Ad hoc) 2009-2011 

Jeffrey D. Spiro, MD 2009-2011 

Constitution and By-Laws Committee 

David W. Eisele, MD (Chair) 2004-2010 


Elizabeth A. Blair, MD 2004-2010 

Brandon G. Bentz, MD 2007-2010 

www.ahns.info 


Shelley McQuone, MD 2009-2012 

Credentials Committee 

John A. Ridge, MD, PhD (Chair) 2009-2010 


Gregory T. Wolf, MD 2008-2010 

Wayne M. Koch, MD 2009-2011 

Eben L. Rosenthal, MD 2007-2010 

John W. Werning, MD 2009-2012 

Data Base Committee 

Marc D. Coltrera, MD (Chair) 2007-2011 

Daniel G. Deschler, MD 2007-2011 

Miriam Lango, MD 2007-2011 

Ellie Maghami, MD 2007-2011 

William B. Armstrong, MD 2008-2010 

Education Committee 

Floyd “Chris” Holsinger, MD (Chair) 2007-2010 

Anna Maria Pou, MD 2004-2010 

David Myssiorek, MD 2005-2011 

Rui Fernandes, MD, DMD 2007-2010 

David Goldenberg, MD 2007-2010 

David I. Rosenthal, MD 2007-2010 

Joseph A. Brennan, MD 2008-2011 

Brian B. Burkey, MD 2008-2011 


Kelly M. Malloy, MD 2009-2012 

Mark Prince, MD 2009-2012 

Uttam K. Sinha, MD 2009-2012 

Erich M. Sturgis, MD 2009-2012 

Theodoros N. Teknos, MD 2009-2012 

Endocrine Committee 

Gary L. Clayman, MD, DDS (Chair) 2007-2010 

Ashok R. Shaha, MD (Ex Officio) 2007-2010 

Quan-Yang Duh, MD 2007-2010 

Keith S. Heller, MD 2007-2010 

Christopher R. McHenry, MD 2007-2010 

Gregory L. Randolph, MD 2007-2010 

Maisie Shindo, MD 2007-2010 

Robert A. Sofferman, MD 2007-2010 

David J. Terris, MD 2007-2010 

Ralph P. Tufano, MD 2007-2010 

Kevin T. Brumund, MD 2009-2012 

Russell B. Smith, MD, FACS 2009-2012 

Finance Committee 

Amy Chen, MD, MPH (Chair) 2008-2011 

Mark K. Wax, MD (Ex Officio) 2004-2010 


Scott E. Strome, MD 2009-2011 

History Committee 

Randal S. Weber, MD (Chair) 2006-2010 

Jeremy L. Freeman, MD 2008-2010 

Bruce H. Haughey, MD 2008-2010 

Henry T. Hoffman, MD 2008-2010 

Pierre Lavertu, MD 2008-2010 

William J. Richtsmeier, MD, PhD 2008-2010 

Jesus E. Medina, MD 2009-2011 

Stephen Y. Lai, MD, PhD 2009-2011 

13


Humanitarian Committee 

Wayne M. Koch, MD (Chair) 2009-2012 

Carol R. Bradford, MD 2009-2012 

Salvatore M. Caruana, MD 2009-2011 

Mark D. DeLacure, MD 2009-2011 

Douglas A. Girod, MD 2009-2012 

Dennis H. Kraus, MD 2009-2012 

James P. Malone, MD 2009-2011 

Andrew J. Nemechek, MD 2009-2011 

James L. Netterville, MD 2009-2012 

Randall P. Owen, MD 2009-2012 

K. Thomas Robbins, MD 2009-2011 

Carol G. Shores, MD, PhD 2009-2012 

James D. Smith, MD 2009-2011 

Nominating Committee 

Wayne Koch, MD (Chair) 2009-2010 

Randal S. Weber, MD 2007-2010 

Gregory T. Wolf, MD 2008-2011 

Robert L. Ferris, MD, PhD 2009-2010 

Richard J. Wong, MD 2009-2010 

Prevention and Early Detection Committee 

Gady Har-El, MD (Chair) 2007-2010 

Christine G. Gourin, MD 2003-2010 

Anna Maria Pou, MD 2003-2010 

Wendell G. Yarbrough, MD 2003-2010 

M. Boyd Gillespie, MD, MS 2004-2010 

Jonathan Irish, MD 2004-2010 


Ann M. Gillenwater, MD 2007-2010 

Daniel D. Lydiatt, MD, DDS 2007-2010 

Ivan El-Sayed, MD 2008-2011 

Amy C. Hessel, MD 2008-2011 

Donald T. Weed, MD 2008-2011 

Nishant Agrawal, MD 2009-2012 

Annual Meeting Program Committee 

Bhuvanesh Singh, MD, PhD (Chair) 2009-2010 

Carol M. Bier-Laning, MD 2009-2010 


Jay O. Boyle, MD 2009-2010 


Thomas E. Carey, PhD 2009-2010 

Claudio R. Cernea, MD 2009-2010 

Terry A. Day, MD, FACS 2009-2010 

Daniel G. Deschler, MD 2009-2010 


Gerry F. Funk, MD 2009-2010 

Matthew Fury, MD 2009-2010 

Neal D. Futran, MD, DMD 2009-2010 

David Goldenberg, MD 2009-2010 


Jennifer R. Grandis, MD 2009-2010 

Neil Gross, MD 2009-2010 

Paul M. Harari, MD 2009-2010 

Gady Har-El, MD 2009-2010 

Floyd “Chris” Holsinger, MD 2009-2010 

Michael Kupferman, MD 2009-2010 

Stephen Y. Lai, MD, PhD 2009-2010 

Nancy Lee, MD 2009-2010 

William M. Lydiatt, MD 2009-2010 

14 American Head and Neck Society 2010 Annual Meeting 

Ellie Maghami, MD 2009-2010 

Bharat Mittal, MD 2009-2010 

Kepal N. Patel, MD 2009-2010 

Snehal Patel, MD 2009-2010 

Mark Prince, MD 2009-2010 


David L. Schwartz, MD 2009-2010 

Michiel van den Brekel, MD, PhD 2009-2010 

Marilene B.Wang, MD 2009-2010 

Richard J. Wong, MD 2009-2010 

Bevan Yueh, MD 2009-2010 

Publications Committee 

Bevan Yueh, MD (Chair) 2006-2010 

Paul A. Levine, MD (Ex Officio) 2006-2010 

Elliot Abemayor, MD, PhD 2008-2010 

Peter E. Andersen, MD 2008-2010 

Brandon G. Bentz, MD 2008-2010 

Bruce J. Davidson, MD 2008-2010 

Egbert De Vries, MD 2008-2010 


M. Boyd Gillespie, MD, MS 2008-2010 

David Goldstein, MD 2008-2010 


Christopher Klem, MD 2008-2010 

William I. Kuhel, MD 2008-2010 

Derrick Lin, MD 2008-2010 

Judith C. McCaffrey, MD 2008-2010 

Frank R. Miller, MD 2008-2010 

Karen T. Pitman, MD 2008-2010 

Anna Marie Pou, MD 2008-2010 

Mike Yao, MD 2008-2010 


Dennis H. Kraus, MD 2009-2011 

Steven Y. Lai, MD, PhD 2009-2011 

Amy-Anne Donatelli Lassig, MD 2009-2011 


Eduardo Mendez, MD 2009-2011 

Frank Ondrey, MD 2009-2011 

William J. Richtsmeier, MD, PhD 2009-2011 

John A. Ridge, MD, PhD 2009-2010 

K. Thomas Robbins, MD 2009-2011 


Russell B. Smith, MD, FACS 2009-2011 


Quality Committee 

Amy Chen, MD (Chair) 2006-2012 

Bruce H. Campbell, MD 2006-2012 


Amy C. Hessel, MD 2006-2012 

Wayne M. Koch, MD 2006-2012 



Snehal Patel, MD, MS, FRCS 2006-2012 


Ralph P. Tufano, MD 2006-2012 

Randal S. Weber, MD 2006-2012 

Robert L. Witt, MD, FACS 2006-2012 



Peter M. Hunt, MD 2009-2012 

Michael Kupferman, MD 2009-2012


Relative Value and CPT Advisory Committee 

Wayne M. Koch, MD (Chair) 2006-2012 




Richard V. Smith, MD 2006-2012 

Bert W. O’Malley, Jr., MD 2007-2010 

Scharukh Jalisi, MD 2009-2012 

Michael J. Kaplan, MD 2009-2012 

Jason Newman, MD 2009-2012 

John M. Truelson, MD 2009-2012 

Robert A. Weisman, MD 2009-2012 

Research Committee 

Cherie Ann Nathan (Chair) 2009-2012 

Robert L. Ferris, MD, PhD (Co-Chair) 2006-2012 

Francisco J. Civantos, MD (Co-Chair) 2008-2011 

Eric Genden, MD 2007-2010 

Hernan E. Gonzalez, MD 2007-2010 


Richard L. Scher, MD 2008-2011 

Brian L. Schmidt, MD, PhD, FACS 2008-2011 

Duane A. Sewell, MD 2008-2011 

Steven J. Wang, MD 2008-2011 

Ayman Amin, MD 2009-2012 

Miriam Lango, MD 2009-2012 

Kepal N. Patel, MD 2009-2012 

Vicente Resto, MD, PhD 2009-2012 

Website Committee 

Karen T. Pitman, MD (Chair) 2009-2012 

Richard J. Wong, MD (Co-Chair) 2009-2012 


Brian B. Burkey, MD 2006-2012 

Peter E. Andersen, MD 2009-2012 

Brian Nussenbaum, MD 2009-2012 

Mark A.S. Varvares, MD 2009-2012 

REPRESENTATIVES 

American College of Surgeons Board of Governors 


American Board of Otolaryngology Liaison 

Floyd “Chris” Holsinger, MD 2007-2010 

American College of Surgeons Commission on Cancer 

Amy Chen, MD 2006-2010 

Archives of Otolaryngology Associate Editor 


Archives of Otolaryngology News Editor 


American Joint Committee on Cancer 


AAO-HNSF Legislative Liaison 


AAO-HNSF Board of Governors 

Theodoros Teknos, MD 2009-2012 

AAO-HNSF PR Liaison 

Peter Andersen, PhD 2007-2010 

Past Presidents 

The American Head and Neck Society 

K. Thomas Robbins, MD 1999 

Ashok R. Shaha, MD 1999 

Jesus E. Medina, MD 2000 

Ernest A. Weymuller, Jr., MD 

2001 

Keith S. Heller, MD 2002 

Paul A. Levine, MD 2003 

John J. Conley, MD* 1959-61 

Paul H. Holinger, MD* 1961-63 

Joseph H. Ogura, MD* 1963-65 

John F. Daly, MD* 1965-67 

W. Franklin Keim, MD* 1967-69 

George A. Sisson, MD* 1969-70 

John S. Lewis, MD* 1970-71 

Burton J. Soboroff, MD* 1971-72 

Edwin W. Cocke, Jr., MD* 

1972-73 

Charles M. Norris, MD* 1973-74 

Daniel Miller, MD* 1974-75 

Emanuel M. Skolnick, MD* 

1975-76 

George F. Reed, MD* 1976-77 

John A. Kirchner, MD 1977-78 

William M. Trible, MD* 1978-79 

Loring W. Pratt, MD 1979-80 

J. Ryan Chandler, MD* 1980-81 

The Society of Head and Neck Surgeons 

Hayes Martin, MD* 1954 




Grant Ward, MD * 1958 

Danely P. Slaughter, MD* 1959 

Arnold J. Kremen, MD 1960 

Arnold J. Kremen, MD 1961 

H. Mason Morfit, MD* 1962 

H. Mason Morfit, MD* 1963 

Calvin T. Kloop, MD* 1964 

Harry W. Southwick, MD* 1965 

Edgar L. Frazell, MD* 1966 

Oilver H. Beahrs, MD* 1967 

Arthur G. James, MD* 1968 

William S. MacComb, MD* 1969 

Ralph R. Braund, MD* 1970 

Harvey W. Baker, MD* 1971 

Charles C. Harrold, MD* 1972 

Robin Anderson, MD* 1973 

Alfred Ketcham, MD 1974 

Richard H. Jesse, MD* 1975 

Condict Moore, MD 1976 

Jonas T. Johnson, MD 2004 

Patrick J. Gullane, MD 2005 

John J. Coleman, III, MD 2006 

Randal S. Weber, MD 2007 

Gregory T. Wolf, MD 2008 

Wayne M. Koch, MD 2009 

The American Society for Head and Neck Surgery 

*Deceased 

Douglas B. Bryce, MD* 1981-82 

Jerome C. Goldstein, MD 

1982-83 

Paul H. Ward, MD 1983-84 

Hugh F. Biller, MD 1984-85 

Robert W. Cantrell, MD 1985-86 

John M. Lore, Jr., MD* 1986-87 

Charles J. Krause, MD 1987-88 

Eugene N. Myers, MD 1988-89 

Willard N. Fee, Jr., MD 1989-90 

Helmuth Goepfert, MD 1990-91 

Michael E. Johns, MD 1991-92 

Bryon J. Bailey, MD 1992-93 

James Y. Suen, MD 1993-94 

Gary L. Schechter, MD 1994-95 

Charles W. Cummings, MD 

1995-96 

Nicholas J. Cassisi, MD 1996-97 

Dale H. Rice, MD 1997-98 

Donald P. Shedd, MD 1977 

William A. Maddox, MD 1978 

John C. Gaisford, MD 1979 

Robert G. Chambers, M.D.* 1980 

Elliot W. Strong, MD 1981 

John M. Moore, MD 1982 

Alvin L. Watne, MD 1983 

Darrell A. Jaques, MD 1984 

Alando J. Ballantyne, MD* 1985 

Frank C. Marchetta, MD* 1986 

William R. Nelson, MD 1987 

Robert D. Harwick, MD 1988 

James T. Helsper, MD* 1989 

M.J. Jurkiewicz, MD 1990 

Jatin P. Shah, MD 1991 

Oscar Guillamondegui, MD 1992 

Stephen Ariyan, MD 1993 

J. Edward M. Young, MD 1994 

Michael B. Flynn, MD 1995 

Robert M. Byers, MD 1996 

John R. Saunders, Jr., MD 1997 

Ronald H. Spiro, MD 1998 

www.ahns.info 

15

AHNS Past Lectures & Awards 

Past Hayes Martin Lecturers 

William S. MacComb, MD 1972 

Oliver H. Beahrs, MD 1973 

Arthur G. James, MD 1974 

Charles C. Harrold, MD 1975 

Edgar L. Frazell, MD 1976 

Harry W. Southwick, MD 1977 

Harvey W. Baker, MD 1978 

Edward F. Scanlon, MD 1979 

Condict Moore, MD 1980 

Richard H. Jesse, MD 1981 

Milton Edgerton, MD 1982 

John J. Conley, MD 1983 

William A. Maddox, MD 1984 

Alfred S. Ketcham, MD 1985 

Donald P. Shedd, MD 1986 


M.J. Jurkiewicz, MD 1988 

George A. Sisson, MD 1989 

Alando J. Ballantyne, MD 1990 

Ian Thomas Jackson, MD 1991 

John M. Lore, MD 1992 

Ronald H. Spiro, MD 1993 

John G. Batsakis, MD 1994 

Helmuth Goepfert, MD 1995 

Joseph N. Attie, MD 1996 

Blake Cady, MD 1997 


Jean-Louis H. LeFebvre, MD 1999 

Robert M. Byers, MD 2000 

William Wei, MS 2001 

Eugene Myers, MD 2002 

Michael Johns, MD 2003 

Christopher J. O’Brien, MD 2004 

Richard K. Reznick, MD, MEd 2005 


Jesus E. Medina, MD, FACS 2007 

Waun Ki Hong, MD 2008 

Charles W. Cummings, MD 2009 

Past John J. Conley Lecturers 

Edward Hughes, MD 2001 

Rabbi David Saperstein 2002 

Jonathan D. Moreno, MD 2003 

David C. Leach, MD 2004 

James F. Battey Jr., MD 2005 

John Stone, MD, MACP 2006 

Kenneth I. Shine, MD 2007 

Carolyn Dresler, MD 2008 

James D. Smith, MD 2009 

Distinguished Service Awards 


Stephan Ariyan, MD 1990 

Ashok R. Shaha, MD 1991 


John J. Coleman, III MD 1999 

David L. Larson, MD 1999 

Harold J. Wanebo, MD 1999 

Jonas T. Johnson, MD 2001 


Marc D. Coltrera, MD 2004 

Wayne Koch, MD 2005 

John A. Ridge, MD, PhD 2006 

Ernest A. Weymuller, Jr., MD 2007 



Special Recognition Awards 

Paul B. Chyetien, MD 1984 

John M. Lore, Jr., MD 1985 

William S. MacComb, MD 1986 

Calvin T. Klopp, MD 1987 

Edgar L. Fazell, MD 1988 

Harvey W. Baker, MD 1989 

Vahram Y. Bakamjian, MD 1991 

Jean-Louis Lefevbre, MD 1995 


AHNS Awards 

Alando J. Ballantyne Resident 

Research Pilot Grant 

Alando J. Ballantyne, MD 

Alando J. Ballantyne, M.D., a giving teacher, 

dedicated surgeon, and a devoted husband 

and father, is memorialized by the Alando J. 

Ballantyne Resident Research Pilot Grant. 

This award, in the amount of $10,000, is for the best grant 

application by a resident. 

Alando, known simply as Jay, grew up in a loving Mormon home 

that taught him the values of family, excellence, integrity and 

hard work. Jay graduated Phi Beta Kappa from the University 

of Arizona and was then awarded a scholarship to Columbia 

Medical School. During World War II, Jay served as an army 

captain and medical doctor and had the good fortune to 

meet his wife, Maria, in San Antonio. In 1947, Dr. Ballantyne 

became the first resident at the new M.D. Anderson Hospital 

in Houston. After his year-long residency, he went for further 

training at the Mayo Clinic in Rochester, Minnesota. He returned 

to the Anderson staff in 1952, where he quickly advanced from 

Assistant Surgeon in the Head and Neck Service to Associate 

Surgeon, and then from 1974 until his retirement in 1994, held 

the title of Surgeon and Professor of Surgery in the Department 

of Head and Neck Surgery as well as the title of Ashbel Smith 

Professor. 

Dr. Ballantyne is credited as the first surgeon in the United States 

to pioneer modified radical neck dissection. His contributions to 

his subspecialty, the result of an undying curiosity and uncanny 

powers of observations, have been published in numerous 

scientific papers and book chapters. Jay lectured at local, 

national, and international forums and loved his travels. He 

held memberships in many distinguished medical and surgical 

societies and served as President and Hayes Martin Lecturer of 

the Society of Head and Neck Surgeons and President of the 

Texas Surgical Society. 

To honor the contributions of this world-renowned surgeon, the 

Cynthia and George Mitchell Foundation established the Alando 

J. Ballantyne Distinguished Chair in Head and Neck Surgery at 

the University of Texas M.D. Anderson Cancer Center. 

Dr. Ballantyne’s contributions to the subspecialty of Head and 

Neck cancer surgery have been the result of an undying curiosity 

and uncanny powers of observation. He was the father of 

conservative surgery, removing the cancer while preserving the 

function. He had a relentless desire to eradicate his patients’ 

disease, yet was able to balance this fervor with a desire to 

maintain quality of life for all his patients. 

Always an advocate of reconstruction and preservation of 

cosmesis as well as function, those fortunate enough to have 

worked with him and been taught by him are forever indebted to 

his wisdom, surgical expertise, and devotion to his patients. He 

was beloved by his patients, admired by his peers and idolized 

by his family. 

The Alando J. Ballantyne Resident Research Pilot Grant is 

funded by the generous contributions of members of the 

Ballantyne family, including Dr. Gilchrist L. Jackson, a respected 

member of the American Head and Neck Society. 

www.ahns.info 

Robert Maxwell Byers 

The Robert Maxwell Byers Award, in the amount 

of $1000, is for the best clinical or basic science 

research paper submitted for presentation at the 

annual meeting of the American Head and Society. 

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, he was certified by the American Board of Surgery. 

After discharge from the Navy in 1970, Dr. Byers 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. 

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 is the author or co-author of 

over 200 published papers, book chapter and monographs. He has 

given invited lectures all over the world. Most recently (1999), he 

was selected to give the Hayes Martin Memorial Lecture at the 5th 

International Conference on Head and Neck Cancer. He has been 

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 have been 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 is 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 is 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 

has participated in the surgical education of over 300 residents and 

fellows, many of who have gone on to become prominent members of 

the specialty. The youth community of Houston has benefited from his 

coaching expertise in baseball and basketball while he has indulged in 

the hobbies of hunting, travel, and collecting toy soldiers. 

17

AHNS Awards 

Christopher O’Brien Traveling Fellowship Award 

Christopher O’Brien, MD 

The American Head and Neck Society 

is mourning the loss of one of our 

members and a great leader in our 

discipline, Professor Chris O’Brien AM. 

Professor O’Brien was diagnosed with 

glioblastoma multiforme in 2006 and 

although his initial treatment was successful, after a valiant and 

courageous battle, he passed away on June 4, 2009. 

Professor O’Brien led a life unparalleled by many. He graduated 

in medicine from the University of Sydney in 1976 and then 

completed his residency and surgical training at Royal Prince 

Alfred Hospital. He decided to specialize in head and neck 

surgery and undertook clinical fellowships in head and neck 

surgery and oncology at the Royal Marsden Hospital, in England 

and at the University of Alabama, USA, returning to Australia in 

1987 to join the staff of RPAH as a consultant head and neck 

surgeon. There he contributed to the expansion of the clinical 

service, making it one of the largest in the country, and also 

established a comprehensive head and neck database. That 

database is the largest in Australasia and one of the largest in 

the world. 

He also established a basic research program and an 

international clinical fellowship program under the umbrella of 

the Sydney Head and Neck Cancer Institute, which he founded 

in 2002. 

Professor O’Brien has two postgraduate degrees from the 

University of Sydney – a Masters of Surgery for his basic 

research in microvascular surgery and a Doctorate in Medicine 

for his work on the management of metastatic cancer in the neck. 

He is the author of over one hundred scientific papers and 

17 book chapters and he has been honoured with invitations 

to many countries and institutions as a visiting professor and 

guest lecturer, including invitations to give numerous prestigious 

named lectures: the Hayes Martin Lecture in Washington in 

2004, the Eugene Myers International Lecture in Los Angeles 

2005, the inaugural Jatin P Shah Lecture in Prague 2006and 

the Semon Lecture in London 2008. He was also made an 

Honorary Fellow of the Royal College of Surgeons of England 

in recognition of his contribution to the training of young British 

surgeons. His published works contributed significantly to our 

understanding of the patterns of metastatic spread of cutaneous 

malignancies and their management. 

In 1998, Professor O’Brien founded the Australian and New 

Zealand Head and Neck Society, a multidisciplinary society 

comprising of surgeons of all disciplines, radiation and medical 

oncologists and allied health professionals. He was President 

in 2004. He served on Council of the AHNS from 2005-2008. 

He was a founding member of the International Federation of 

Head and Neck Oncologic Societies, and served on its council 

throughout his active career. 

In 2003 Professor O’Brien became Director of the Sydney 

Cancer Centre, based at Royal Prince Alfred Hospital and 

the University of Sydney, while maintaining all of his clinical, 

teaching and research responsibilities. He has developed a 

proposal to transform the Sydney Cancer Centre into a $250 

million world-class comprehensive cancer centre, supported 

by the Government and philanthropic funds raised by him. 

This dedicated Head and Neck Cancer centre will be called, 

“Life House – The Chris O’Brien Cancer Centre”. This project is 

moving forward with great momentum and is scheduled to open 

in 2012. 

Professor O’Brien is widely known to the people of Australia 

for his many appearances over the last 12 years on the award 

winning reality TV program RPA. He was made a Member the 

Order of Australia (AM) for his services to medicine, on Australia 

Day in 2005. He was to receive the highest civilian Honor, AO, 

(Officer of the Order of Australia), from the Prime Minister of 

Australia, on the Queen’s Birth Day celebrations, in the first 

week of June, but unfortunately, he passed away, only hours 

before the ceremony. This Honor was bestowed upon him 

posthumously, and was received by Mrs. Gail O’Brien. 

His book entitled Never Say Die depicted his personal battle 

with cancer and also served as an inspiration to those suffering 

from all forms of cancer. 

In 2008, AHNS established the Professor Chris O’Brien Fund, 

which in part, sponsors the AHNS/ANZHNS Chris O’Brien 

Travelling Fellowship Award, an award to encourage international 

exchange of information concerning surgical science, practice, 

and education and to establish professional and academic 

collaborations and friendships. The first recipient of this award 

is Professor Carsten Palme. The International Federation of 

Head and Neck Oncologic Societies has established “The Chris 

O’Brien Symposium” at it’d quadrennial congresses, the first of 

which will be presented, this year in Seoul, Korea, during the 4th 

World Congress of IFHNOS. 

If you would like to make a donation to the AHNS Chris O’Brien 

Fund, please go to http://www.ahns.info/foundation/pledge.php. 

Professor O’Brien, fondly called by his family and friends “Dr. 

Gorgeous” is survived by his wonderful wife, Gail, and their three 

children, Adam, Juliette and James, who dearly loved him. 


AHNS Research and Education Foundation 

The Research and Education Foundation of the American Head and Neck Society gratefully 

acknowledges those who have completed or are working on pledges to the Foundation: 

The Foundation is grateful 

to Jatin P. Shah for his 

generous $100,000 pledge 

commitment. 

Patrons 

John J. Coleman 

Ellie Maghami 

Sponsors 

Rui Fernandes 

Jonas T. Johnson 

Supporters 

Stephen Bayles 

Carol Bradford 

Robert Byers 

Joseph Califano 

Marion Couch 

Charles Cummings 

Terry Day 

David Eisele 

Christine Gourin 

Patrick Gullane 

Gady Har-El* 

Keith Heller 

Wanye Koch 

William Lydiatt 

Eugene Myers 

Jeffrey Myers 

Andrew Nemechek 

*Completed one pledge commitment and has initiated new pledge 

John O’Brien, Jr. 

Daniel Pinheiro 

Karen Pitman 

John Ridge 

Thomas Robbins 

Richard Smith 

James Suen 

Mark Varvares 

Marline Wang 

Mark Wax 

Randal Weber 

Barry Wenig 

Ernest Weymuller 

Gregory Wolf 

Bevan Yueh 

Associates 

William Armstrong 

Claudio Cernea 

Marc Coltrera 

Robert Ferris 

Saurin Popat 

Elliot Strong 

Mark Weissler 

Other 

Robert Johnson 

Daniel Nuss 

Randall Owen 

The Research and Education Foundation of the American Head and Neck Society gratefully acknowledges our 

supporter who gave $250 or more January 1, 2009 through March 5, 2010: 

Carol Bradford 

John Brockenbrough 

Bruce Campbell 

Chin-Yen Chien 

Daniel Deschler 

Robert Ferris 

John Hardin 

Dennis Kraus 

Payal Lakhani 

Cherie-Ann Nathan 

Peter Neligan 

Liana Puscas 

Jan Rider 

James Rocco 

Ruth Schleeweis 

Russell Smith 

Robert Witt 

The Foundation extends a special thank you to the Australia/New Zealand Head and Neck Society for their 

generous contribution in support of the Chris O’Brien Fund. 

Additional Chris O’Brien Fund supporters include: 

Lysiane Adolphe 

Patrick Bradley 

Dale Brown 

Robert Byers 

Claudio Cernea 

Fernando Dias 

Jeremy Freeman 

Margaret Gidley-Baird 

Ralph Gilbert 

Patrick Gullane 

Ehab Hanna 

Keith Heller 

Jonas Johnson 

Catherine Kelly 

Suren Krishnan 

Pierre Lavertu 

Jesus Medina 

Eugene Myers 

Peter Neligan 

Brian Nussenbaum 

Gail O’Brien 

John O’Brien 

Lester Peters 

Peter Rhys-Evans 

John Ridge 

Lorne Rotstein 

John Saunders 

Jatin Shah 

Ashok Shaha 

Khee-Chee Soo 

Ralph Tufano 

Mark Urken 

Michael Van den Brekel 

Vincent Vander Poorten 

John Watkinson 

Randal Weber 

William Wei 

Ernest Weymuller 

N. Zanardo 

Don’t see you name on the list? Pick up a donation form at the AHNS Desk 

or go on-line to www.ahns.info/foundation to make your donation. 

If you have contributed to the Foundation, stop by the AHNS desk 

to pick-up a special Donor ribbon. 

www.ahns.info 

19

AHNS Accreditation 

The American Head & Neck Society (AHNS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to 

sponsor Continuing Medical Education for physicians. The AHNS designates this activity for a maximum of 14.5 AMA PRA Category 

1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. 

CME WORKSHEET 

This is not your CME credit form. Please use the worksheet below to track the number of CME hours you attend for each activity. After 

the meeting, an email will be sent to attendees with an on-line link to the survey and claim form. 

WEDNESDAY, APRIL 28, 2010 

Time 

Activity 


Credits 

Available 

8:00 AM - 8:15 AM Welcome and Introduction of Guest of Honor 0 

8:15 AM - 9:00 AM Plenary Session #1: Clinical .75 

9:00 AM - 9:45 AM 

John J. Conley Lecture: 

“Cancer Clinical Trials - The Engine for Progress” 

.75 

9:45 AM - 10:00 AM Clinical Poster Discussion .25 

10:00 AM - 10:20 AM Morning Break 0 

10:20 AM - 11:15 AM Scientific Session #1 .75 

11:15 AM - 12:00 PM Panel: Optimal Adjuvant Treatment For High-Risk Oral Cancer .75 

12:00 PM - 1:00 PM Lunch on Own OR AHNS Business Meeting for Members 0 

1:00 PM - 2:00 PM Scientific Session #2 1 

2:00 PM - 3:00 PM 

Jatin P. Shah Symposium on Clinical Controversies in Head and 

Neck Surgery: “Update of Clinical Trials in Head & Neck Oncology” 

1 

3:00 PM - 3:20 PM Afternoon Break 0 

3:20 PM - 3:55 PM Scientific Session #3 - Reconstruction .5 

3:55 PM - 4:30 PM Panel: New Horizons in Head and Neck Reconstruction .75 


Total Credits Available for Wednesday, April 28, 2010: 7.5 

THURSDAY, APRIL 29, 2010 

Time 

Activity 

Credits 

Available 

8:00 AM - 8:45 AM Plenary Session #2: Basic Science .75 

8:45 AM - 9:00 AM Basic Science Poster Discussion .25 

9:00 AM - 9:45 AM 

Hayes Martin Lecture: “Pathogenetic Stratification of Salivary 

Gland Malignancies: Promise and Potential” 

.75 

9:45 AM - 10:00 AM AHNS Awards Ceremony 0 

10:00 AM - 10:20 AM Morning Break with Exhibitors 0 

10:20 AM - 10:25 AM Introduction of the AHNS President 0 

10:25 AM - 11:00 AM AHNS Presidential Address and Presidential Citations .5 

11:00 AM - 12:00 PM Scientific Session #5 1 

12:00 PM - 1:00 PM Lunch with Exhibitors 0 


2:00 PM - 3:10 PM 

Panel: Role of Surgery in Laboratory Thyroid Cancer - Supported 

by Clinical Data? 

1.25 

3:10 PM - 3:30 PM Afternoon Break with Exhibitors 0 

3:30 PM - 4:00 PM NCCN Guidelines Discussion .5 


5:00 PM - 5:45 PM Fellowship Information Session 0 

5:30 PM - 7:00 PM PRESIDENT’S POSTER DISCUSSION SESSION 0 

7:15 PM - 8:30 PM AHNS PRESIDENT’S RECEPTION 0 

Total Credits Available for Thursday, April 29, 2010: 7 

TOTAL CREDITS 14.5 

Hours 

Attended 

Hours 

Attended 

To receive your CME credit: AHNS has instituted a new process for claiming CME credits and printing certificates. All attendees 

wishing to receive a CME certificate for activities attended at the AHNS 2010 Annual Meeting must first complete an on-line meeting 

evaluation form. Attendees will have access to the on-line meeting evaluation and credit claim form via a link on the AHNS website 

after the meeting. Please allow 4-6 weeks for processing before your certificate is mailed to you.

Commercial Bias Reporting Form 

You are encouraged to … 

1) Document (on this form) any concerns about commercially-biased presentations/ materials during educational sessions, 

2) Make suggestions about how bias might have been avoided/minimized, and 

3) Immediately take your completed form to the AHNS staff at the Registration Desk. 

Your feedback will be shared with a member of the CME Compliance Committee, who will make the faculty aware of the concerns 

and/or suggestions. 

Commercial Bias 

The AHNS CME Compliance Committee has defined “bias” as an existing predisposition that may interfere with objectivity in 

judgment. Bias may be minimized through prior declaration of any source of conflict of interest, reference to evidence-based literature 

and expert opinions, and/or an independent peer-review process. 

If an educational presentation certified for CME includes bias of any commercial interests*, please provide the following details: 

(*Commercial interest is defined by the ACCME as an entity producing, marketing, re-selling, or distributing health care goods or 

services consumed by, or used on, patients.) 

Presentation: Commercial Bias by: Promotion via: 

(eg session name, etc) (ie faculty name, company rep) (eg handouts, slides, what they said, actions) 

Commercial Bias about: 

(check all that apply) 

Patient treatment/management recommendations were not based on strongest levels of evidence available. 

Emphasis was placed on one drug or device versus competing therapies, and no evidence was provided to support its increased 

safety and/or efficacy. 

Trade/brand names were used. 

Trade names versus generics were used for all therapies discussed. 

The activity was funded by industry and I perceived a bias toward the grantors. 

The faculty member had a disclosure and I perceived a bias toward the companies with which he/she has relationships. 

Other (please describe): _____________________________________________________ 

Suggestions for avoiding or minimizing bias: 

EXTRA COPIES ARE AVAILABLE AT THE AHNS DESK 

Please return this form to the AHNS Desk or mail it to: 

AHNS CME, 11300 W. Olympic Blvd, Suite 600, Los Angeles, CA 90064 

www.ahns.info 

21

Bally’s Las Vegas Floorplan 


Scientific Program Wednesday, April 28, 2010 

8:00 AM - 8:15 AM Welcome and Introduction of Guest of Honor PLATINUM ROOM 

John A. Ridge, MD, PhD, AHNS President and Bhuvanesh Singh, MD, PhD, AHNS 

Program Chair 

Guest of Honor: Andy Trotti, MD 

8:15 AM - 9:00 AM PLENARY SESSION #1: CLINICAL PLATINUM ROOM 

Moderators: Jeffrey Scott Magnuson, MD, Andy Trotti, MD and Bevan Yueh, MD 

8:15 AM S001: QUALITY AND PERFORMANCE INDICATORS FOR AN ACADEMIC HEAD AND NECK SURGICAL 

ONCOLOGY DEPARTMENT. Randal S Weber, MD, Scott Eastman, MBA, Ehab Y Hanna, MD, Olubumi Akiwumi, MS, 

Amy Hessel, MD, Stephen Y Lai, MD PhD, Leslie Kian, MBA, Michael Kupferman, MD, Dianna Roberts, PhD; Department 

of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas. 

Discussant: Bevan Yueh, MD 

8:35 AM S002: TRANSORAL ROBOTIC SURGERY (TORS): A MULTICENTER STUDY TO ASSESS SAFETY, 

FEASIBILITY AND EFFICACY. Gregory S Weinstein MD FACS, Professor and Vice Chairman, J. Scott Magnuson 

MD FACS, Associate Professor of Surgery, Eric J Moore MD FACS, Associate Professor, William R Carrol MD FACS, 

Professor, Kerry D, Olsen MD FACS, Bert O’Malley, Professor and Chairman, F. Christopher Holsinger, Associate 

Professor, F. Christopher Holsinger, Associate Professor; Department of Otorhinolaryngology: Head and Neck Surgery, 

The University of Pennsylvania; Department of Otorhinolaryngology, Mayo Clinic, Minnesota; Department of Head and 

Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston. Discussant: Jeffery Scott Magnuson, MD 

8:55 AM S003: EVALUATION OF GRADE 3/4 MUCOSITIS AND DYSPHAGIA FOR THREE DIFFERENT 

RADIOTHERAPY REGIMENS, WITH AND WITHOUT CETUXIMAB, IN LOCOREGIONALLY ADVANCED HEAD 

AND NECK CANCER. J A Bonner, MD, P M Harari, MD, J Giralt, MD, H Youssoufian, MD, J Zhu, PhD, K K Ang, MD; 

The University of Alabama at Birmingham, Birmingham, AL, USA; University of Wisconsin, Madison, WI, USA; Vall 

D’Hebron University Hospital, Barcelona, Spain; ImClone Systems Corporation, Branchburg, NJ, USA. 

Discussant: Andy Trotti, MD 

9:00 AM - 9:45 AM JOHN J. CONLEY LECTURE PLATINUM ROOM 

“Cancer Clinical Trials - The Engine for Progress” 

Introduction by John A. Ridge, MD, PhD 

Robert L. Comis, MD, Professor of Medicine and Director, Drexel University 

Clinical Trials Research Center, Philadelphia, PA 

AHNS acknowledges generous educational grants from 

BRISTOL-MYERS SQUIBB 

ETHICON ENDO-SURGERY, INC. 

9:45 AM - 10:00 AM CLINICAL POSTER DISCUSSION PLATINUM ROOM 

Moderator: Gady Har-El, MD 

10:00 AM - 10:20 AM Morning Break GRAND BALLROOM FOYER 

www.ahns.info 

23


10:20 AM - 11:15 AM SCIENTIFIC SESSION #1 PLATINUM ROOM 

Moderators: Elizabeth A. Blair, MD, Snehal Patel, MD and Erich M. Sturgis, MD 

10:00 AM S004: FIRST REPORT OF VALIDATION OF THE SYDNEY SWALLOW QUESTIONNAIRE (SSQ) IN A HEAD 

AND NECK CANCER POPULATION. Raghav Dwivedi, MRCS DOHNS MS, Suzanne St. Rose, PhD, Afroze S 

Khan, MRCS, Christopher Pepper, MRCS DOHNS, Christopher M Nutting, MD FRCR, Peter M Clarke, FRCS, Cyrus 

J Kerawala, FRCS FDSRCS, Peter H Rhys-Evans, FRCS, Kevin J Harrington, FRCR PhD, Rehan Kazi, MS FRCS 

PhD; Head and Neck Unit, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK and The Institute of Cancer 

Research, 123 Old Brompton Road, London SW7 3RP, UK. 

10:08 AM S005: HEAD AND NECK CANCER PATIENTS REFERRED TO A TERTIARY CENTER AFTER PRIOR 

TREATMENT: COMPLIANCE WITH OR DEVIATION FROM NATIONAL COMPREHENSIVE CANCER 

NETWORK TREATMENT GUIDELINES. Carol M Lewis, MD MPH, Amy C Hessel, MD, Dianna B Roberts, PhD, 

Yunxia Z Guo, BSE, F Christopher Holsinger, MD, Lawrence E Ginsberg, MD, Adel K El-Naggar, MD, Randal S Weber, 

MD; UT MD Anderson Cancer Center. 

10:16 AM S006: DISPARITIES IN HEAD AND NECK CANCER TREATMENT BASED ON AGE. Alexander Langerman, MD, 

Lauren Hensley, BA, Kerstin M Stenson, MD, Ezra E W Cohen, MD, Elizabeth A Blair, MD; The University of Chicago 

Medical Center. 

10:24 AM Discussion – 6 minutes 

10:30 AM S007: SALVAGE SURGERY AFTER ORGAN PRESERVATION REGIMENS. Rachel M Brock, MD, Nathan 

Hales, MD, Greg Krempl, MD, Jesus E Medina, MD; Oklahoma University Health Sciences Center, Department of 

Otorhinolaryngology. 

10:38 AM S008: IMPACT OF TIME INTERVAL FROM BIOPSY TO START OF TREATMENT. Gregory J Kubicek, MD, 

Seungwon W Kim, MD, Umanmaheswar Duvvuri, MD, Robert Ferris, MD, Jonas Johnson, MD, Dwight E Heron, MD 

FACRO; University of Pittsburgh Medical Center. 

10:46 AM S009: MANAGEMENT OF EARLY T-STAGE TONSILLAR CARCINOMAS - RETROSPECTIVE COMPARISON 

OF RADICAL TONSILLECTOMY VERSUS RADIATION FROM A SINGLE INSTITUTION. Eric D Lamarre, MD, 

Rahul Seth, MD, Robert R Lorenz, MD, Ramon Esclamado, MD, David J Adelstein, MD, Christina P Rodriguez, MD, 

Jerrold Saxton, MD, Joseph Scharpf, MD; Cleveland Clinic. 


11:15 AM - 12:00 PM PANEL: OPTIMAL ADJUVANT TREATMENT FOR PLATINUM ROOM 

HIGH-RISK ORAL CANCER 

Panel Moderator: Bhuvanesh Singh, MD, PhD 

Case-based discussion on use of chemo-radiation or an adjunct to surgery in patients with advanced oral cancer. 

Panelists: Arlene A. Forastiere, MD, John A. Ridge, MD, PhD, 

Andy Trotti, MD and David G. Pfister, MD 

At the conclusion of this session, participants will be able to: 

• Determine who benefits from adjuvant chemo-radiation after surgery. 

• Decide who should not receive chemo-radiation. 

• Define need for future studies. 

• Define need of new approaches. 

12:00 PM - 1:00 PM Lunch on Own 

OR 

AHNS BUSINESS MEETING FOR MEMBERS 

PLATINUM ROOM 



1:00 PM - 2:00 PM SCIENTIFIC SESSION #2 PLATINUM ROOM 

Moderators: Claudio R. Cernea, MD, David Kutler, MD and Kepal N. Patel, MD 

1:00 PM S010: POSTOPERATIVE RADIOTHERAPY IN MUCOSAL MELANOMA OF THE HEAD AND NECK. A FRENCH 

GETTEC MULTICENTRIC STUDY. Adil BENLYAZID, MD, Juliette Thariat, MD, Thomas Filleron, PhD; GETTEC. 

1:08 PM S011: COMPARTMENTAL SURGERY IN TONGUE TUMORS: LONG TERM ONCOLOGIC EVALUATION OF A 

NEW SURGICAL TECHNIQUE VS. CONVENTIONAL DEMOLITIVE TONGUE SURGERY. A FOURTEEN-YEAR 

CLINICAL EXPERIENCE. Luca Calabrese, MD, Gioacchino Giugliano, MD, Mohssen Ansarin, MD, Roberto Bruschini, 

MD, Angelo Ostuni, DDS MD, Valeria Navach, MD, Maria Angela Massaro, PhD, Lorenzo Preda, MD, Fausto Maffini, MD, 

Luigi Santoro, PhD, Daniela Alterio, MD, Fausto Chiesa, MD; European Institute of Oncology. 

1:16 PM S012: TPF INDUCTION THERAPY WITH RADIOIMMUNOCHEMOTHERAPY FOR THE TREATMENT OF HEAD 

& NECK CANCER. Wolf Oliver Jordan, Ingeborg Wildfang, Dr, Hans-Jürgen Welkoborsky, Prof, Jürgen Borghardt, 

Dr, Hayssam Zakaria, Dr, Sepideh Fanaei, Dr, Heiko Niebuhr, Barbara Tschechne, Dr; Praxis Tschechne / Luft / Jordan, 

Onkologie, Lehrte, Germany; Gemeinschaftspraxis für Radioonkologie und Strahlentherapie, Hannover, Germany; AWO 

GSD, Onkologie, Bad Münder, Germany. 

1:24 PM Discussion – 6 minutes 

1:30 PM S013: TARGETING CK2 BY SMALL MOLECULE INHIBITOR DMAT MODULATES NF-KAPPAB AND TP53 

SIGNALING, SURVIVAL AND MIGRATION IN HEAD AND NECK CANCER. Matthew S Brown, MD, Vishnu R 

Kannabiran, BS, Hai Lu, MD PhD, Zhong Chen, MD PhD, Carter Van Waes, MD PhD 1. Tumor Biology Section, Head and 

Neck Surgery Branch, NIDCD, NIH. 2. Clinical Research Training Program supported jointly by NIH and Pfizer, Inc. 

1:38 PM S014: MICRORNA-21 SPECIFIC TARGETS IN HEAD AND NECK SQUAMOUS CELL CARCINOMA. Wojciech 

K Mydlarz, MD, Patrick T Hennessey, MD, Semra Demokan, PhD, Steven Chang, MD, David Sidransky, MD, Joseph A 

Califano, MD; Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, 

MD; Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, MD. 

1:46 PM S015: AKT PHOSPHORYLATION AS A MARKER OF RESISTANCE TO ZD6474 (VANDETANIB) IN HEAD AND 

NECK SQUAMOUS CELL CARCINOMA. Genevieve A Andrews, MD, Mitchell J Frederick, PhD, Mei Zhao, MD, David 

R Fooshee, Zvonimir L Milas, MD, Maria K Gule, MD, Chad E Galer, MD, Jeffrey N Myers, MD PhD; MD Anderson Cancer 

Center. 


2:00 PM - 3:00 PM JATIN P. SHAH SYMPOSIUM ON CLINICAL PLATINUM ROOM 

CONTROVERSIES IN HEAD AND NECK SURGERY 

UPDATE OF CLINICAL TRIALS IN HEAD & NECK ONCOLOGY 

Panel Moderator: Gregory T. Wolf, MD 

Update of RTOG 91-11 

Arlene A. Forastiere, MD and 

European Organ Preservation Trials 

Jan B. Vermorken, MD, PhD 

The VA Larynx Trial - Revisited 

Gregory T. Wolf, MD 

This session will provide expert opinion and interpretation of recent clinical trials in view of emerging biomarker data. 


• Discuss the relevant advances in treatment incorporating chemotherapy and radiation. 

• Better understand the selection of patients for chemoradiation. 

3:00 PM - 3:20 PM Afternoon Break GRAND BALLROOM FOYER 

AHNS acknowledges our Gold Level Donor for their support of the Afternoon Break 

STRYKER 

www.ahns.info 

25


3:20 PM - 3:55 PM SCIENTIFIC SESSION #3 - RECONSTRUCTION PLATINUM ROOM 

Moderators: Gerry F. Funk, MD, Neal D. Futran, MD, DMD and Derrick Lin, MD 

3:20 PM S016: A BLOOD TRANSFUSION PREDICTION MODEL IN PATIENTS UNDERGOING MAJOR HEAD & NECK 

SURGERY INVOLVING FREE FLAP RECONSTRUCTION. Manish D Shah, MD MPhil FRCSC, David P Goldstein, 

MD FRCSC, Stuart McClusky, MD FRCPC, Patrick Gullane, MB FRCSC FACS FRACS Hon, Dale H Brown, MD FRCSC, 

Jonathan C Irish, MD MSc FRCSC FACS, Ralph W Gilbert, MD FRCSC; University Health Network, University of Toronto, 

Toronto, Canada. 

3:28 PM S017: A CLASSIFICATION SYSTEM FOR RECONSTRUCTION OF VERTICAL 

HEMIPHARYNGOLARYNGECTOMY FOR HYPOPHARYNGEAL SQUAMOUS CELL CARCINOMA. Min-Sik Kim, 

MD PhD, Young-Hoon Joo, MD, Dong-Il Sun, MD PhD, Kwang-Jae Cho, MD PhD, Jun-Ook Park, MD; The Catholic 

University of Korea. 

3:36 PM S018: THE NATURE AND EXTENT OF BODY IMAGE CONCERNS AMONG SURGICALLY TREATED 

PATIENTS WITH HEAD AND NECK CANCER: NEW FINDINGS TO PROMOTE IMPROVED PSYCHOSOCIAL 

CARE. Michelle C Fingeret, PhD, Ying Yuan, MD, June Weston, Randal S Weber, MD; M. D. Anderson Cancer Center. 

3:44 PM S019: SUBMENTAL FLAP VERSUS RADIAL FOREARM FLAP FOR ORAL CAVITY RECONSTRUCTION: 

COMPARISON OF OUTCOMES. Joseph A Paydarfar, MD, Urjeet A Patel, MD; Dartmouth Hitchcock Medical Center, 

Lebanon, NH, USA; Northwestern University Medical Center, Chicago, IL, USA. 


3:55 PM - 4:30 PM PANEL: NEW HORIZONS IN HEAD AND NECK RECONSTRUCTION PLATINUM ROOM 

Panel Moderator: Joseph J. Disa, MD 

Panelists: Matthew M. Hanasono, MD, Eben L. Rosenthal, MD and Mark K. Wax, MD 

The panel will present a current controversy in head and neck reconstruction. A second member of the panel will then propose a 

clinical trial and lead a discussion addressing some of the complexities surrounding a trial. 


• List basic options for reconstruction of lateral mandibular defects. 

• Understand potential options to address reconstructive controversies using a clinical trial. 

• Understand potential barriers to a clinical trial in head and neck reconstruction. 


Moderators: Sandeep Samant, MS, Richard V. Smith, MD and Richard J. Wong, MD 

4:30 PM S020: LOCAL RESPONSE TO CHEMORADIOTHERAPY FOR T4 LARYNGEAL/HYPOPHARYNGEAL 

CARCINOMA WITH CARTILAGE INVASION. Urjeet A Patel, MD, Lori K Howell, MD; Northwestern University; 

University of Illinois at Chicago. 

4:38 PM S021: DETERMINANTS OF LONG-TERM SPEECH AND SWALLOWING OUTCOMES FOLLOWING 

CHEMORADIOTHERAPY FOR LOCOREGIONALLY ADVANCED HEAD AND NECK CANCER. K W Mouw, PhD, 

D J Haraf, MD, K M Stenson, MD, E E Cohen, MD, E Blair, MD, M E Witt, RN MS, E E Vokes, MD, J K Salama, MD; The 

University of Chicago. 

4:46 PM S022: RESIDUAL DISEASE IN POST-CHEMORADIOTHERAPY NECK DISSECTIONS FOR ADVANCED 

SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK: DOES IT AFFECT PROGNOSIS? Hilliary White, 

MD, Jeffrey Magnuson, MD; University of Alabama at Birmingham. 


5:00 PM S023: RETROSPECTIVE ANALYSIS OF MINOR SALIVARY GLAND CARCINOMAS OF THE OROPHARYNX 

AND FACTORS PREDICTIVE OF OUTCOME. N Gopalakrishna Iyer, MD PhD, Leslie Kim, BA, Iain J Nixon, MD, Frank 

Palmer, BA, Jatin P Shah, MD PhD, Snehal G Patel, MD, Ian Ganly, MD PhD; Memorial Sloan-Kettering Cancer Center. 

5:08 PM S024: THE INCIDENCE AND OUTCOME OF HEAD AND NECK SQUAMOUS CELL CARCINOMA PATIENTS 

WITH SUSPICIOUS PULMONARY FINDINGS ON PET/CT. Steven Shinn, Bradley A Schiff, MD, Janine Feng, MD, 

Keivan Shifteh, MD, Missak Haigentz, MD, Madhur Garg, MD, Richard Smith, MD; Albert Einstein College of Medicine. 

5:16 PM S025: INDUCTION CHEMOTHERAPY FOR ADVANCED SQUAMOUS CELL CARCINOMA OF THE 

PARANASAL SINUSES. Ehab Y Hanna, MD, M Kupferman, MD, R Weber, MD, M Kies, MD; MD Anderson Cancer 

Center. 



Scientific Program Thursday, April 29, 2010 

8:00 AM - 8:45 AM PLENARY SESSION #2: BASIC SCIENCE PLATINUM ROOM 

Moderators: Carol R. Bradford, MD, Joseph A. Califano, MD, 

Robert L. Ferris, MD, PhD and James Rocco, MD, PhD 

8:00 AM S026: CD40 IS REQUIRED FOR AN IMMUNE MEDIATED CLEARANCE OF HPV POSITIVE HEAD AND NECK 

CANCER. William C Spanos, MD, Denise Schwabauer, MS, Daniel W Vermeer, BA, Annie Herrig, BS, John H Lee, MD; 

Sanford Research/USD, Sioux Falls, SD, USA. Discussant: Robert L. Ferris, MD, PhD 

8:11 AM S027: VASCULAR ENDOTHELIAL GROWTH FACTOR C (VEGF-C) IS IMPORTANT IN THE DEVELOPMENT 

AND METASTASIS OF HEAD AND NECK SQUAMOUS CELL CARCINOMA. Rachel L Chard, BA, Hiroshi Yagi, 

MD PhD, Vyomesh Patel, PhD, Alfredo Molinolo, MD PhD, J. Silvio Gutkind, PhD; Oral and Pharyngeal Cancer Branch, 

National Institute of Dental and Craniofacial Research, National Institutes of Health, and Oregon Health & Science 

University School of Medicine. Discussant: Carol R. Bradford, MD 

8:22 AM S028: SIGNIFICANCE OF CIRCULATING TUMOR CELLS IN PATIENTS WITH SQUAMOUS CELL 

CARCINOMA OF THE HEAD AND NECK. Kris R Jatana, MD, Priya Balasubramanian, MS, Jas C Lang, PhD, 

Liying Yang, PhD, Courtney A Jatana, DDS, Elisabeth White, BA, David E Schuller, MD, Theodores N Teknos, MD, Amit 

Agrawal, MD, Enver Ozer, MD, Jeffrey J Chalmers, PhD; The Ohio State University, Arthur G. James Cancer Hospital and 

Solove Research Institute. Discussant: Joseph A. Califano, MD 

8:33 AM S029: ENHANCED INVASIVE AND METASTATIC POTENTIAL OF CANCER STEM CELLS IN HEAD 

AND NECK SQUAMOUS CELL CARCINOMA. Samantha J Davis, BS, Vasu Divi, MD, John H Owen, BA, 

Silvana Papagerakis, MD PhD, Carol R Bradford, MD, Thomas E Carey, PhD, Mark E Prince, MD; Department of 

Otorhinolaryngology, University of Michigan, Ann Arbor, MI; Massachusetts Eye and Ear Infirmary/Harvard Medical 

School, Boston, MA. Discussant: James Rocco, MD, PhD 

8:45 AM - 9:00 AM BASIC SCIENCE POSTER DISCUSSION PLATINUM ROOM 

Moderators: Stephen Y. Lai, MD, PhD 

9:00 AM - 9:45 AM HAYES MARTIN LECTURE PLATINUM ROOM 

“Pathogenetic Stratification of Salivary Gland Malignancies: 

Promise and Potential” 

Introduction by John A. Ridge, MD, PhD 

Adel El-Naggar, MD, PhD, Professor of Pathology and Head and Neck Surgery, 

The University of Texas M.D. Anderson Cancer Center, Texas; Editor-in-Chief, 

Head and Neck Oncology 

AHNS acknowledges generous educational grants from 

STRYKER 

9:45 AM - 10:00 AM AHNS AWARDS CEREMONY PLATINUM ROOM 

Presented by: Cherie-Ann O. Nathan, MD and Marilene B. Wang, MD 

• AHNS Alando J. Ballantyne Resident Research Pilot Grant 

• AHNS Pilot Research Grant 

• AHNS/AAO-HNS Young Investigator Awards 

• AHNS/AAO-HNS Surgeon Scientist Career Development Award 

• Robert Maxwell Byers Award 

• Best Resident Basic Science Research Paper 

• Best Resident Clinical Paper 

• Best Prevention and Early Detection Papers 

10:00 AM - 10:20 AM Morning Break with Exhibitors BALLY’S EVENT CENTER 

www.ahns.info 

27


10:20 AM - 10:25 AM INTRODUCTION OF THE AHNS PRESIDENT PLATINUM ROOM 

Introduction by David W. Eisele, MD, AHNS President-Elect 

10:25 AM - 11:00 AM AHNS PRESIDENTIAL ADDRESS AND PRESIDENTIAL HONORS PLATINUM ROOM 

“We Show Pictures, They Show Curves” 

John A. Ridge, MD, PhD, Chief of Head & Neck Surgery, 

Fox Chase Cancer Center, Philadelphia, PA 

Distinguished Service Award 

• Mark K. Wax, MD 


• Thomas F. Pajak, MD 

• Walter J. Curran, MD 

• Corey J. Langer, MD 

11:00 AM - 12:00 PM SCIENTIFIC SESSION #5 PLATINUM ROOM 

Moderators: Michael Kupferman, MD, Ellie Maghami, MD, Jorge Pinho, MD and David L. Schwartz, MD 

10:40 AM S030: RETROSPECTIVE ANALYSIS OF OUTCOME IN PATIENTS WITH ORAL PREMALIGNANT LESIONS: 

THE RISK FOR ORAL CANCER DEVELOPMENT. Vanda M Stepanek, MD PhD, Dianna B Roberts, PhD, Adel K El- 

Naggar, MD PhD, Martin W Jack, DDS MS, Vassiliki Papadimitrapoukoulou, MD, Ann M Gillenwater, MD; MD Anderson 


10:58 AM S031: FLUORESCENT SPECTROSCOPY FOR NON-INVASIVE EARLY DIAGNOSIS OF ORAL MUCOSAL 

MALIGNANT AND POTENTIAL MALIGNANT LESIONS. Pankaj Chaturvedi, FACS FAIS FICS MNAMS, Pradeep K 

Gupta, Shovan Majumdar; Tata Memorial Hospital, Mumbai and Center for Advanced Technology, Indore. 

11:06 AM S032: ORAL SQUAMOUS CELL CARCINOMA: PREDICTING PROGNOSIS FOLLOWING RECURRENCE. 

Michael Kernohan, Dr, Jonathan Clark, Dr, Kan Gao, Mr, Ceri Hughes, Dr, Ardalan Ebrahimi, Dr; Sydney Head and Neck 

Cancer Institute. 


11:20 AM S033: TARGETING A TREATMENT-RESISTANT, MESENCHYMAL-LIKE SUBPOPULATION WITHIN HEAD 

AND NECK SQUAMOUS CELL CARCINOMAS. Devraj Basu, MD PhD, Thierry-Thien K Nguyen, MS, Kathleen T 

Montone, MD, Anil K Rustgi, MD, Min Xiao, MS, Gregory S Weinstein, MD, Meenhard Herlyn, DVM DSc; The University of 

Pennsylvania, Philadelphia VA Medical Center, The Wistar Institute. 

11:28 AM S034: INTRAVASCULAR HUMAN SALIVARY CELL DELIVERY TO TREAT SALIVARY CELL LOSS IN A 

RODENT MODEL. Millie Surati, MD, Seth Purcell, Shay Soker, PhD, Tamer AbouShwareb, MS MD PhD, James J Yoo, 

MD PhD, Christopher A Sullivan, MD; Department of Otolaryngology-Head and Neck Surgery, Wake Forest University 

School of Medicine; Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC USA. 

11:36 AM S035: SENSITIZATION OF HEAD AND NECK CANCER TO CISPLATIN THROUGH THE INHIBITION OF 

STAT3. Waleed M Abuzeid, MD, Samantha Davis, BS, Alice Tang, BS, Lindsay Saunders, BS, Jiayuh Lin, PhD, James R 

Fuchs, PhD, Carol R Bradford, MD, Thomas E Carey, PhD; University of Michigan and The Ohio State University. 


12:00 PM - 1:00 PM Lunch with Exhibitors BALLY’S EVENT CENTER 




Moderators: Terry A. Day, MD, David Goldenberg, MD and Christine G. Gourin, MD 

1:00 PM S036: DECISION MAKING FOR THE EXTENT OF THYROIDECTOMY IN PATIENTS WITH ATYPICAL 

CYTOLOGY. Manish D Shah, MD MPhil FRCSC, Andrew Conrad, Aadil Ahmed, Spiro Eski, MD, Christina MacMillan, 

MD, Jeremy L Freeman, MD FRCSC FACS; Mount Sinai Hospital, University of Toronto. 

1:08 PM S037: SURGICAL PRACTICE PATTERNS IN THE MANAGEMENT OF PAPILLARY THYROID 

MICROCARCINOMA. Arthur W Wu, MD, Marilene B Wang, MD, Chau Nguyen, MD; UCLA Division of Head and Neck 

Surgery, Los Angeles, CA, USA; Anacapa Surgical Associates, Ventura, CA, USA. 

1:16 PM S038: VOLUME-BASED TRENDS IN THYROID SURGERY. Christine G Gourin, MD, Robert E Bristow, MD, Ralph P 

Tufano, MD, Arlene A Forastiere, MD, Wayne M Koch, MD, Timothy M Pawlik, MD; Johns Hopkins Medical Institutions. 


1:30 PM S039: PROPHYLACTIC CENTRAL LYMPH NODE DISSECTION FOR CLINICALLY NODE-NEGATIVE 

PAPILLARY THYROID MICROCARCINOMA: ITS IMPACT ON POSTOPERATIVE THYROGLOBULIN LEVEL, 

RECURRENCES AND COMPLICATIONS. Yoon Kyoung So, MD, Young-Ik Son, MD, Min Young Seo, MD, Gil Jun Lee, 

MD, Sang Duk Hong, MD; Inje University Paik Hospital, Samsung Medical Center. 

1:38 PM S040: ROUTINE PARATHYROID LOCALIZATION WITH 4-D COMPUTED TOMOGRAPHY/ULTRASOUND IN 

PATIENTS WITH HYPERPARATHYROIDISM. David I Kutler, MD, Rachel A Moquete, BA, William I Kuhel, MD, Eli 

Kazam, MD; Weill Cornell Medical Center. 

1:46 PM S041: INTRAOPERATIVE PARATHYROID HORMONE MONITORING IN PARATHYROIDECTOMY; IS IT 

MANDATORY? Aviram Mizrachi, MD, Gideon Bachar, MD, Tuvia Hadar, MD, Raphael Feinmesser, MD, Thomas Shpitzer, 

MD; Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach 

Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 


2:00 PM - 3:10 PM PANEL: ROLE OF SURGERY IN LABORATORY PLATINUM ROOM 

THYROID CANCER – SUPPORTED BY CLINICAL DATA? 

Panel Moderator: Ashok R. Shaha, MD 

Panelists: Quan-Yang Duh, MD, Bryan McIver, MBChB, PhD, 

Christopher R. McHenry, MD and Lisa A. Orloff, MD 

This panel will discuss issues specifically related to microscopic and laboratory thyroid cancer: 

its implications, prognostic value, and treatment choices supported by clinical data. 


• To discuss the current explosion of thyroid carcinoma. 

• To evaluate diagnostic tests and risk analysis. 

• Identify which nodules to biopsy. 

• Treatment of microcarcinoma- surgery, observation etc. 

• Management of central neck in such patients. 

3:10 PM - 3:30 PM Afternoon Break with Exhibitors BALLY’S EVENT CENTER 

AHNS acknowledges our Gold Level Donor for their support of the Afternoon Break 

STRYKER 

3:30 PM - 4:00 PM NCCN GUIDELINES DISCUSSION PLATINUM ROOM 

Panel Moderator: David G. Pfister, MD 

This session will review the NCCN practice guidelines development process. The management guidelines for poor risk adjuvant 

disease and/or advanced oropharynx cancer will be discussed (time permitting). 

“NCCN Guidelines Development Process” 

David G. Pfister, MD 

“Case Studies: Poor Risk Adjuvant and/or Advanced Oropharynx Cancer” David W. Eisele, MD, William M. Lydiatt, MD, 

Ellie Maghami, MD and Bevan Yueh, MD 


• Explain the NCCN practice guidelines development process. 

• Apply the NCCN practice guidelines in patient management. 

• Optimize treatment selection and performance. 

www.ahns.info 

29



Moderators: Floyd “Chris” Holsinger, MD, Cherie-Ann O. Nathan, MD and Theodoros N. Teknos, MD 

4:00 PM S042: INCREASED TOLL-LIKE RECEPTOR EXPRESSION AND ACTIVITY IN REGULATORY T CELLS IN 

PATIENTS WITH HEAD AND NECK CANCER. Clarissa Wild, Michael T Lotze, MD PhD, Sven Brandau, PhD, 

Thomas K Hoffmann, MD, M Lindemann, PhD, Astrid Westendorf, PhD, Jan Buer, MD, Stephan Lang, MD, Christoph 

Bergmann, MD PhD; Department of Otorhinolaryngology, University of Essen. 

4:08 PM S043: CELLULAR IMMUNITY CORRELATES WIHT HUMAN PAPILLOMA VIRUS-16 (HPV-16) STATUS AND 

OUTCOME IN PATIENTS WITH ADVANCED OROPHARYNGEAL CANCER. D Wansom, E Light, PhD, F Worden, 

MD, M E Prince, MD, S Urba, MD, D B Chepeha, MD, K Cordell, DDS, A Eisbruch, MD, J Taylor, PhD, N D’Silva, DDS, 

J Moyer, MD, C R Bradford, MD, T E Carey, PhD, G T Wolf, MD; Depts. of Otolaryngology-Head and Neck Surgery, 

Periodontics and Oral Medicine, Radiation Oncology, Internal Medicine and Biostatistics, University of Michigan. 

4:16 PM S044: FAS AND FAS LIGAND POLYMORPHISMS AND RISK OF SECOND PRIMARY MALIGNANCY IN 

PATIENTS WITH INDEX SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK. Mark E Zafereo, MD, 

Erich M Sturgis, MD, Dapeng Lei, Qingyi Wei, PhD, Guojun Li, PhD; MD Anderson Cancer Center. 


4:30 PM S045: TRANSORAL SURGERY USING ROBOTIC SURGICAL SYSTEM FOR HYPOPHARYNGEAL 

CARCINOMAS Se-Heon Kim, MD, Young Min Park, MD, Won Shik Kim, MD, Jin Sei Jung, MD, Eun Chang Choi, MD; 

Yonse University College of Medicine. 

4:38 PM S046: TRANSORAL HIGHLY ARTICULATED ROBOTIC SURGERY (THARS) OF THE LARYNX: A NOVEL 

TECHNOLOGY AND APPLICATION. Carlos M Rivera-Serrano, MD, Brett Zubiate, MS, Rick Kuenzler, Howie Choset, 

Marco Zenati, MD, Steve Tully, Ummaheswar Duvvuri, MD PhD; University of Pittsburgh; Cardiorobotics, Inc; Carnegie 

Mellon University. 

4:46 PM S047: TRANSORAL ROBOTIC SURGERY FOR HEAD AND NECK SQUAMOUS CELL CARCINOMA: 1 AND 

2-YEAR SURVIVAL ANALYSIS. Hilliary N White, MD, Eric J Moore, MD, Jeffrey S Magnuson, MD; University of 

Alabama at Birmingham and Mayo Clinic in Rochester, Minnesota. 


5:00 PM Meeting Adjourns 

5:00 PM - 5:45 PM FELLOWSHIP INFORMATION SESSION PLATINUM ROOM 

5:30 PM - 7:00 PM PRESIDENT’S POSTER DISCUSSION SESSION BALLY’S EVENT CENTER 

7:15 PM - 8:30 PM AHNS PRESIDENT’S RECEPTION SKYVIEW 5/6 – 26th FLOOR 

Please join Dr. Drew Ridge and his wife, Dr. Elin Sigurdson, for an evening reception with the AHNS President. 

All registered AHNS attendees and guests are welcome. 

AHNS acknowledges our Platinum Level Donors for their support of the reception: 

BRISTOL-MYERS SQUIBB 

ETHICON ENDO-SURGERY, INC. 


Faculty Listing 

Elizabeth A. Blair, MD - Chicago, IL 

Carol R. Bradford, MD - Ann Arbor, MI 

Joseph A. Califano, MD - Baltimore, MD 

Claudio R. Cernea, MD - San Paulo, Brazil 

Robert L. Comis, MD - Philadelphia, PA 

Terry A. Day, MD - Charleston, SC 

Joseph J. Disa, MD - New York, NY 

Quan-Yang Duh, MD - San Francisco, CA 

David W. Eisele, MD - San Francisco, CA 

Gady Har-El, MD - Hollis, NY 

Adel El-Naggar, MD, PhD - Houston, TX 

Robert L. Ferris, MD, PhD - Pittsburgh, PA 

Arlene A. Forastiere, MD - Baltimore, MD 

Gerry F. Funk, MD - Iowa City, IA 

Neal D. Futran, MD - Seattle, WA 

David Goldenberg, MD - Hershey, PA 

Christine G. Gourin, MD - Baltimore, MD 

Matthew M. Hanasono, MD - Houston, TX 

Floyd “Chris” Holsinger, MD - Houston, TX 

Michael Kupferman, MD - Houston, TX 

David Kutler, MD - New York, NY 

Stephen Y. Lai, MD, PhD - Houston, TX 

Derrick Lin, MD - Boston, MA 

William M. Lydiatt, MD - Omaha, NE 

Ellie Maghami, MD - Duarte, CA 

Jeffrey S. Magnuson, MD, FACS - Birmingham, AL 

Christopher R. McHenry, MD - Cleveland, OH 

Bryan McIver, MBChB, PhD - Rochester, MN 

Cherie-Ann O. Nathan, MD - Shreveport, LA 

Lisa A. Orloff, MD - San Francisco, CA 

Snehal Patel, MD, MS - New York, NY 

Kepal N. Patel, MD - New York, NY 

David G. Pfister, MD - New York, NY 

Jorge Pinho, MD - Recife, Brazil 

John A. Ridge, MD, PhD - Philadelphia, PA 

James Rocco, MD, PhD - Boston, MA 

Eben L. Rosenthal, MD - Birmingham, AL 

Sandeep Samant, MS, FRCS - Memphis, TN 

David L. Schwartz, MD - New Hyde Park, NY 

Ashok R. Shaha, MD - New York, NY 

Bhuvanesh Singh, MD, PhD - New York, NY 

Richard V. Smith, MD - Bronx, NY 

Erich M. Sturgis, MD - Houston, TX 

Theodoros N. Teknos, MD - Columbus, OH 

Andy Trotti, III, MD - Tampa, FL 

Jan B. Vermorken, MD, PhD - Edegem, Belgium 

Mark K. Wax, MD - Portland, OR 

Gregory T. Wolf, MD - Ann Arbor, MI 

Richard J. Wong, MD - New York, NY 

Bevan Yueh, MD - Minneapolis, MN 

www.ahns.info 

31

Faculty, Presenter & Leadership Disclosures 

The following faculty, presenters & leadership do not have any relevant financial relationships or significant commercial interests 

associated with their participation at the AHNS 2010 Annual Meeting. If name is not listed immediately below, please refer to the list 

further below. 

Jay O. Boyle, MD* 

Carol Bier-Lanning, MD 

Joseph A. Califano, MD* 

Thomas E. Carey, PhD* 

Claudio R. Cernea, MD 

Robert Comis, MD 

Daniel G. Deschler, MD* 

Joseph J. Disa, MD 

David Eisele, MD 

Adel El-Naggar, MD 

Robert L. Ferris, MD, PhD* 

Arlene Forastiere, MD 

Neal D. Futran, MD* 

Christine G. Gourin, MD* 

Jennifer R. Grandis, MD* 

Matthew Hanasono, MD 

Gady Har-El, MD* 

David Kutler, MD 

Stephen Y. Lai, MD* 

Nancy Lee, MD* 

Derrick Lin, MD 

William Lydiatt, MD* 

Ellie Maghami, MD* 

Christopher McHenry, MD 

Bryan McIver, MD 

Bharat B. Mittal, MD* 

Cherie-Ann O. Nathan, MD 

Lisa Orloff, MD 

Kepal N. Patel, MD* 

Snehal Patel, MD* 

Jorge Pinho, MD 

Mark Prince, MD* 

James W. Rocco, MD, PhD* 

Eben Rosenthal, MD 

Sandeep Samant, MS 

David L. Schwartz, MD* 

Ashok Shaha, MD 

Bhuvanesh Singh, MD* 

Richard V. Smith, MD 

Erich M. Sturgis, MD 

Theodoros N. Teknos, MD 

Andy Trotti, III, MD 

Marilene B. Wang, MD* 

Mark Wax, MD 

Richard J. Wong, MD* 

Bevan Yueh, MD* 

Quan-Yang Duh, MD 

The following faculty, presenters & leadership provided information indicating they have a financial relationship with a proprietary entity 

producing health care goods or services, with the exemption of non-profit or government organizations and non-health care related 

companies. (Financial relationships can include such things as grants or research support, employee, consultant, major stockholder, 

member of speaker’s bureau, etc.) 

NAME COMMERCIAL INTEREST WHAT WAS RECEIVED FOR WHAT ROLE 

Elizabeth A. Blair, MD* CBCE Honoraria Speaker 

Terry A. Day, MD* Bristol Myers-Squibb Honoraria Speaker 

Gyrus Consulting Fee Consultant 

sanofi-aventis Honoraria Speaker 

Gerry F. Funk, MD* KLS Martin Research Support Research 

Medtronic Consulting Fee Consulting 

Matthew Fury, MD* Gentech Salary Conduct of Clinical Trials 

ImClone Salary Conduct of Clinical Trials 

Novartis Salary Conduct of Clinical Trials 

Sanofi-aventis Salary Conduct of Clinical Trials 

Regeneron (spouse) Salary (spouse) Employment (spouse) 

David Goldenberg, MD Ethicon Consulting Fee Consultant & Promotional 

Speaker’s Bureau 

Smiths Medical Consulting Fee Consultant 

Neil Gross, MD* sanofi-aventis Honoraria Speaker Training 

Paul M. Harari, MD* Amgen Nothing Laboratory Research Contract 

Cellectar Nothing Laboratory Research Contract 

Genetech Nothing Laboratory Research Contract 

ImClone Nothing Laboratory Research Contract 

Floyd “Chris” Holsinger, MD* Intuitive Surgical Honoraria Consulting 

Sanofi-aventis Honoraria Advisory Board 

Michael E. Kupferman, MD* Bioform Honoraria Speaking/Teaching 

Jeffrey Scott Magnuson, MD Intuitive Surgical Consulting Fee Proctor 

David Pfister, MD Sanofi-Aventis Clinical Trial Support Investigator 

Imclone Clinical Trial Support Investigator 

John Ridge, MD, PhD Sanofi-Aventis Honorarium Speaker 

Michiel van den Brekel, MD, PhD* Atos Medical Sweden Research Funding Research & Teaching 

Jan Vermorken, MD Sanofi-Aventis Consulting Fee Membership AB, speaking 

Mereck-Serono Consulting Fee Membership AB, speaking 

Gregory Wolf, MD IRX Therapeutics Honorarium Consultant 

*Indicates a Member of the Program Committee. 


Oral Papers 

S001 

QUALITY AND PERFORMANCE INDICATORS FOR AN ACADEMIC 

HEAD AND NECK SURGICAL ONCOLOGY DEPARTMENT. Randal S 

Weber, MD, Scott Eastman, MBA, Ehab Y Hanna, MD, Olubumi Akiwumi, 

MS, Amy Hessel, MD, Stephen Y Lai, MD PhD, Leslie Kian, MBA, 

Michael Kupferman, MD, Dianna Roberts, PhD; Department of Head 

and Neck Surgery, University of Texas MD Anderson Cancer Center, 

Houston, Texas. 

Introduction: Health care costs are rapidly outstripping a level of 

economic sustainability. Delivery of high quality and effective care will 

be the underpinnings of cost control. Future payments to health care 

providers may be tied to meeting quality and performance benchmarks 

that are adjusted for patient acuity. The study objective was to create 

the methodology for assessing physician performance and quality of 

care delivered in a tertiary surgical oncology practice and to develop 

a monitoring tool for the utilization of global and subspecialty-specific 

quality and performance indicators that positively impact patient care, 

safety, and satisfaction. Methods: Between 2004 and 2008 data was 

collected on the following outcome measures for 10 surgeons. These 

included length of stay (LOS), return to operating room (OR) within 7 

days of surgery, and 30-day: mortality, hospital readmission, transfusion, 

and wound infection. Patients were divided into two groups, high 

and low acuity, based on the extent of their procedure. High acuity 

procedures were: mandibulectomy, pharyngolaryngectomy, and major 

glossectomies, all with major reconstruction. Low acuity procedures 

were: laryngoscopy, lymphadenectomy, minor glossectomies, 

parotidectomy, and thyroidectomies. To assess relative performance by 

surgeon, the number of negative indicators developed by each patient 

was enumerated and the percent of cases for each physician that 

developed one or more negative indicators, for low acuity cases, and 

two or more negative indicators, for high acuity cases was determined. 

2234 low acuity and 384 high acuity procedures were performed. 

Adjustments were made for comorbid conditions that included cardiovascular 

disease, COPD, diabetes, liver disease, prior heart failure, and 

renal disease. The impact of these factors was examined in two ways: 

the presence of any comorbidity and any two or more comorbidities. 

The procedure acuity, comorbid conditions and influence of the surgeon 

were used to develop a risk estimates. Physicians were ranked on each 

positive or negative indicator among cases stratified by procedure acuity. 

Results: The methodology allowed for grouping commonly performed 

head and neck surgical procedures into two major categories based 

upon scope of the procedure. Available comorbidity data permitted an 

adjustment of risk thereby removing this as a bias for examining surgical 

outcomes by provider. Patients undergoing high acuity procedures had 

a significantly higher proportion of 2 or more comorbid conditions than 

patients undergoing low acuity procedures (29% vs. 15%) and high 

acuity procedures, as expected, were associated with greater LOS 

(median of 8 days vs. 1 day), increased blood product usage (41% vs. 

3%), and higher rates of all the other negative indicators. The relative risk 

estimates for two or more negative quality or performance indicators was 

as follows: procedure acuity high vs. low (RR=3.9), operating physician 

(RR=3.4) and co-morbid conditions (RR=1.9). Conclusions: The data 

demonstrated the feasibility of examining the impact of procedure 

type, physician influence and comorbidity on accepted performance 

measures and how this methodology can be used to evaluate physician 

performance. These data may identify best practices and provide 

benchmarks that permit comparison of physician performance.” 

S002 

TRANSORAL ROBOTIC SURGERY (TORS): A MULTICENTER STUDY 

TO ASSESS SAFETY, FEASIBILITY AND EFFICACY. Gregory S 

Weinstein MD FACS, Professor and Vice Chairman, J. Scott Magnuson 

MD FACS, Associate Professor of Surgery, Eric J Moore MD FACS, 

Associate Professor, William R Carrol MD FACS, Professor, Kerry D , 

Olsen MD FACS, Bert O’Malley, Professor and Chairman, F. Christopher 

Holsinger, Associate Professor, F. Christopher Holsinger, Associate 

Professor; Department of Otorhinolaryngology: Head and Neck Surgery, 

The University of Pennsylvania; Department of Otorhinolaryngology, 

Mayo Clinic, Minnesota; Department of Head and Neck Surgery, The 

University of Texas MD Anderson Cancer Center, Houston. 

Background: Single institution series have demonstrated the potential 

for Transoral Robotic Surgery (TORS) for the treatment of head and 

www.ahns.info 

neck cancer. We present here the results of a multicenter study 

to assess safety, feasibility and efficacy of this minimally invasive 

approach. Objectives: To determine the safety, feasibility and efficacy 

of transoral robotic surgery in a multicenter trial. Design and Setting/ 

Interventions: A review of patients undergoing TORS in multicenter 

prospective clinical trial in academic tertiary referral centers. Patients: 

192 patients were initially screened but inadequate exposure did 

not permit TORS in 13 (6.7%). In two additional patients, TORS was 

performed but intraoperatively converted to an “open” procedure. Thus, 

our intent-to-treat population had a total of 177 patients (average age: 

59 yrs; 81% male). 98.3% had a Charlson comorbidity index of >5. 

162 patients had malignant tumors; 15 with benign disease. Patients 

had tumors of the oropharynx (77%), larynx (15%), and other sites, 

including the hypopharynx and oral cavity, (8%). Average follow-up was 

354 days. Results: For all 177 patients undergoing TORS, we found 

an average hospital stay post-operatively was 4.2 days. 12.4 % of all 

patients (22/177) required tracheostomy in the perioperative period, but 

only 2.3% (4/177) had their tracheostomy at last follow-up. Average 

estimated blood loss was 82.8 cc and no patient required transfusion. 

There was no intraoperative mortality or death in the immediate postoperative 

period. However, 30% of patients experienced at least 

on adverse event (AE), including 16% with a serious AE. Nine (5%) 

patients had post-operative hemorrhage, including 5 who required an 

operative procedure to control. Five patients developed post-operative 

pneumonia. The rate of temporary dysphagia was 3.4% (6/177). For 

162 patients undergoing TORS for malignancy, most patients (87%) had 

squamous carcinoma with the following staging: T1 (31.9%); T2 (51.6%); 

T3 (13.6%); T4 (4.9%). In this group, the rate of positive margins was 

4.3% (7/162). Average operative time, including time for exposure and 

robotic docking was 162 minutes. At 12 months following TORS, only 

7.4% of patients required gastrostomy for alimentation. Summary: 

In this multicenter study, we demonstrate that TORS is an safe, 

feasible and effective across institutions and surgeons. There was no 

perioperative mortality and few serious adverse events. We document a 

low rate of positive surgical margins and excellent functional outcomes. 

These findings suggest that TORS should play an important role in the 

multidisciplinary management of head and neck cancer. 

S003 

EVALUATION OF GRADE 3/4 MUCOSITIS AND DYSPHAGIA FOR 

THREE DIFFERENT RADIOTHERAPY REGIMENS, WITH AND 

WITHOUT CETUXIMAB, IN LOCOREGIONALLY ADVANCED HEAD 

AND NECK CANCER. J A Bonner, MD, P M Harari, MD, J Giralt, MD, H 

Youssoufian, MD, J Zhu, PhD, K K Ang, MD; The University of Alabama 

at Birmingham, Birmingham, AL, USA; University of Wisconsin, Madison, 

WI, USA; Vall D’Hebron University Hospital, Barcelona, Spain; ImClone 

Systems Corporation, Branchburg, NJ, USA. 

Background: Patients with locoregionally advanced head and 

neck cancer (LAHNC) benefit form altered fractionated radiotherapy, 

compared to once-daily radiotherapy, when radiotherapy alone is the 

primary treatment. Altered fractionated radiotherapy may not be as 

important when chemotherapy is given in combination with radiotherapy. 

The acute toxicities of mucositis and dysphagia can increase with more 

aggressive radiotherapy regimens. This analysis compared the rates 

of grade 3/4 mucositis and dysphagia for three different radiotherapy 

regimens with or without cetuximab. Methods: Patients (n = 424) with 

(LAHNC) of the larynx, hypopharynx or oropharynx were entered on a 

phase III randomized trial of radiotherapy alone vs. radiotherapy with 

weekly cetuximab. As previously reported, the addition of cetuximab 

resulted in an improvement in locoregional control and survival (NEJM, 

354:567-578). Physicians were allowed to treat patients with one of three 

radiotherapy (RT) regimens: 1) Once-daily radiotherapy (ODR) with 70 

Gy / 35 fractions, 2) Twice-daily radiotherapy (TDR) with 72 – 76.8 Gy / 

60 – 64 fractions or 3) 72 Gy / with 1.8 Gy daily and 1.5 Gy as a second 

daily concomitant boost fraction during the last 12 days of treatment 

(CBR). Patients who received cetuximab underwent a loading dose of 

400 mg/m2 for 6 – 7 weekly treatments during radiotherapy. Toxicities 

were assessed by the Radiation Therapy Oncology Group (RTOG) criteria 

and comparisons of toxicities rates were made by chi square analyses. 

Results: The trial included 424 patients (211 received cetuximab and 

radiotherapy and 213 received radiotherapy alone). Mucositis was 

reported in 397/424 patients and dysphagia was reported in 270/424 

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patients. Grade 3/4 mucositis or dysphagia by treatment is shown below. 

R a d i a t i o n 

Fractionation 

----- Mucositis* ------ Dysphagia* 

RT Alone 

RT + 

Cetuximab 

RT Alone 


RT + 

Cetuximab 

n % n % p n % n % p 

ODR 11 20% 14 28% NS 8 15% 9 17% NS 

TDR 20 54% 21 55% NS 11 30% 14 37% NS 

CBR 79 66% 81 69% NS 44 37% 31 26% NS 

NS = Not significant between RT alone and RT with cetuximab. 

* Grade 3/4. 

Evaluations demonstrated significantly more grade 3/4 mucositis for 

TDR + CBR vs. ODR (p = < 0.0001) and grade 3/4 dysphagia for TDR + 

CBR vs. ODR (p = 0.0008). Conclusions: This study demonstrates that 

cetuximab did not increase grade 3/4 mucositis or dysphagia for any of 

the three radiotherapy regimens. The two altered fractionation regimens 

resulted in significantly more grade 3/4 mucositis and dysphagia 

compared to once-daily radiotherapy. The onset and resolution rates for 

mucositis and dyspahgia will be presented. 

S004 

FIRST REPORT OF VALIDATION OF THE SYDNEY SWALLOW 

QUESTIONNAIRE (SSQ) IN A HEAD AND NECK CANCER 

POPULATION. Raghav Dwivedi, MRCS DOHNS MS, Suzanne St. 

Rose, PhD, Afroze S Khan, MRCS, Christopher Pepper, MRCS 

DOHNS, Christopher M Nutting, MD FRCR, Peter M Clarke, FRCS, 

Cyrus J Kerawala, FRCS FDSRCS, Peter H Rhys-Evans, FRCS, Kevin 

J Harrington, FRCR PhD, Rehan Kazi, MS FRCS PhD; Head and Neck 

Unit, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK and 

The Institute of Cancer Research, 123 Old Brompton Road, London SW7 

3RP, UK. 

Background: Impairment of swallowing function is seen 50-75% of 

head and neck cancer (HNC) survivors. Although there are a number 

of validated swallowing-specific questionnaires, much of their focus is 

on the evaluation of swallowing-related quality of life (QOL) rather than 

swallowing as a specific function. The aim of this study was to validate 

the Sydney Swallow Questionnaire (SSQ) as a swallowing-specific 

instrument in HNC patients. Materials and Methods: Questionnaires- 

The Sydney Swallow Questionnaire consists of 17 well structured 

questions specifically for evaluation of oral and pharyngeal swallowing 

functions. The range of questions included in the SSQ address 

symptoms referable to combinations of 3 broad variables: (1) anatomic 

region; (2) type of dysfunction; and (3) swallowed bolus consistency. 

It is based on 100 mm long visual analog scales scored from 0-100. 

For the purpose of validation, we utilized the MDADI as the goldstandard 

for a swallow scale. Patients-Following local research ethics 

committee approval, sixty-two consecutive English-speaking patients 

in follow-up for oral or oropharyngeal cancers at The Royal Marsden 

Hospital, London, UK were recruited for this study. Administration of 

Questionnaire-Both the questionnaires were given to the patients in 

the outpatient for returning via post. A randomly selected subset of 

thirty-one patients was asked to complete both the questionnaires 

(SSQ & MDADI) again after four weeks in order to assess test-retest 

reliability. Statistical Analysis-Internal consistency and test-retest 

reliability was assessed using Cronbach’s alpha and Spearman’s 

correlation coefficient, respectively. Construct and group validity were 

determined using Spearman’s correlation coefficient and Mann-Whitney 

U-test respectively using the commercially available Statistical Package 

for Social Sciences-15 statistical software (SPSS Inc., Chicago, IL, 

USA). Results: Patient characteristics-Fifty-four out of 62 patients 

(87%) returned fully completed questionnaires. The median age of the 

group was 58.9 years (range: 35.9-80.0) with 35 males and 19 females. 

Reliability-Internal consistency: The internal consistency reliability for 

Total SSQ (mean of Q2-Q16) as calculated by Cronbach’s alpha was 

0.95. Test-retest reliability- Test-retest reliability of Total SSQ and 

General SSQ as calculated by Spearman’s rank correlation coefficient 

were 0.83 and 0.73 respectively. For SSQ QOL the coefficient was 

0.71. Validity-Construct Validity: For construct validity we compared 

Total SSQ scores and scores of General SSQ and QOL SSQ with Global 

and Physical domains of MDADI using Spearman’s rank correlation 

coefficients. The correlation coefficients between Total SSQ, the General 

SSQ and QOL-SSQ scores and Global MDADI scores were 0.72, 0.64 

and 0.78, respectively. Similarly the correlation coefficients for Total SSQ 

and General SSQ with the Physical domain of MDADI were found to be 

0.83 and 0.71, respectively. Direct correlations between similar questions 

of both the questionnaires revealed strong to moderate correlations. 

Group Validity-Significant differences (P

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treated off-protocol. Five (38%) of the 13 were NED at last follow-up, 

4 (31%) died within one year of completing therapy, 3 (23%) did not 

complete therapy and died of disease, and 1(8%) was lost to follow-up 

at 1 year. Older patients with advanced head and neck cancer may be 

appropriate for clinical trial enrollment, and further research in needed 

into the barriers to enrollment faced by these patients. 

S007 

SALVAGE SURGERY AFTER ORGAN PRESERVATION REGIMENS. 

Rachel M Brock, MD, Nathan Hales, MD, Greg Krempl, MD, Jesus E 

Medina, MD; Oklahoma University Health Sciences Center, Department 

of Otorhinolaryngology. 

Introduction: Most laryngectomies today are done for persistent or 

recurrent tumor after organ preservation attempts using radiation 

therapy (RT) or chemotherapy and radiation (CRT). The outcomes 

reported by RTOG (RTOG-911) for local regional control (LRC), overall 

survival (OS) and complication rates were encouraging. However recent 

publications report abysmal outcomes. Therefore it seems critical to 

report outcomes from different institutions in order to better define 

the expectations of patients and clinicians following salvage surgery. 

Furthermore, the role of elective neck dissection (END) in these cases 

needs to be defined. Purpose/Objective(s): The purpose of this study 

is to determine the rates of LRC, OS, and complications with salvage 

surgery after previous treatment with radiation +/- chemotherapy and 

also determine the prevalence and location of subclinical cervical 

lymph node metastases in patients undergoing salvage laryngectomy. 

Materials/Methods: Retrospective review of 50 patients who underwent 

salvage total laryngectomy (STL) after organ preservation treatment for 

laryngeal and pharyngeal cancer. 33 patients had definitive RT and 17 

had CRT. Results: At time of salvage tumor staging was T3 or T4 in 

56% of patients in the RT group, 43% in the CRT group. Median time 

to recurrence after initial therapy was 11 mos. in both groups. Median 

follow-up after STL was 29 mos. in the RT group and 20 mos. in the CRT 

group. The median OS after salvage in the RT group was 35 mos. (4- 

94 mos.) while in the CRT group it was 31 mos. (8-97 mos.). At the last 

follow-up OS is 60% after RT and 71% after CRT. Median disease free 

survival (DFS) is 24 mos. in the RT group and 18 mos. in the CRT group. 

LRC in the RT group was 58% after RT and 76% after CRT. Recurrence 

occurred locally in 24% of RT patients and 5.8% of CRT patients. Neck 

recurrence most commonly involved II and III and occurred in 18% and 

11.7% in both groups. Distant metastases occurred in 21% and 5.8% 

respectively. 47 patients were staged clinically N0 and 3 were clinically 

N+ at the time of surgery. END was performed with STL in 36 patients. 

In these patients, metastases in the lymph nodes were found in 15% 

of the RT group and in 7% of the CRT group. A pharyngocutaneous 

fistula occurred in 21% of patients in the RT group and 24% in the CRT 

group. Conclusions: The LRC (58 - 76%) and OS (60 - 71%) observed 

in our study are encouraging. Fistula rates are lower than those reported 

in the literature yet they warrant improvement. The presence of occult 

metastases (7-15%) is low. 

S008 

IMPACT OF TIME INTERVAL FROM BIOPSY TO START OF 

TREATMENT. Gregory J Kubicek, MD, Seungwon W Kim, MD, 

Umanmaheswar Duvvuri, MD, Robert Ferris, MD, Jonas Johnson, MD, 

Dwight E Heron, MD FACRO; University of Pittsburgh Medical Center. 

Purpose: To investigate the relationship of interval from biopsy to start 

of radiotherapy (RT) in head and neck cancer (HNC). Patients and 

Methods: 579 consecutive HNC patients treated between 2002 and 

2006 were retrospectively reviewed; all patients received treatment 

consisting of either surgery and adjuvant RT (249) or definitive RT with 

or without chemotherapy (264). RT was IMRT in all patients. Median 

age was 63 years, the majority patients were stage III (27%) or IV (51%), 

238 (41%) received concomitant chemotherapy. Results: In definitive 

RT and definitive chemoradiotherapy patients the median time from 

biopsy to the start of RT was 41 days. Patients starting definitive RT ≤ 

40 days from biopsy had an improved outcome versus > 40 days (overall 

survival 2.5 vs. 2.1 years p = 0.07). For patients who underwent surgical 

resection, median time from biopsy to surgery was 10 days; there was 

no difference in outcomes for patients with a longer interval in the time 

from biopsy to surgery. Median start to adjuvant RT was 64 days from 

the biopsy (54 days from surgery). Patients with a median start time ≤ 

www.ahns.info 

90 from biopsy had an improved overall survival (3.3 versus 2.4 years, 

p = 0.015). Conclusion: While the effects of overall treatment time are 

well known, less information is available regarding the effects of initiation 

of treatment. We found a detriment in overall survival for patients with a 

longer interval from the time of biopsy to start of RT. 

S009 

MANAGEMENT OF EARLY T-STAGE TONSILLAR CARCINOMAS - 

RETROSPECTIVE COMPARISON OF RADICAL TONSILLECTOMY 

VERSUS RADIATION FROM A SINGLE INSTITUTION. Eric D Lamarre, 

MD, Rahul Seth, MD, Robert R Lorenz, MD, Ramon Esclamado, MD, 

David J Adelstein, MD, Christina P Rodriguez, MD, Jerrold Saxton, MD, 

Joseph Scharpf, MD; Cleveland Clinic. 

Objective: T1 and T2 squamous cell carcinomas of the tonsil can 

be managed with either definitive radiation therapy or a radical 

tonsillectomy, which involves en bloc resection of the tonsil, underlying 

superior constrictor, partial base of tongue, soft palate and pharynx 

with or without reconstruction of the defect. We report a retrospective 

comparison of the Cleveland Clinic survival and functional outcomes 

using both of these approaches. Method: All patients diagnosed with 

T1-2, N0-2, M0 squamous cell carcinoma of the tonsil and treated at 

the Cleveland Clinic between 1994 until 2007 were included in this 

review. The minimum follow-up for survival was 2 years, and patients 

with a second primary upper aerodigestive cancer were not included 

in the functional data. Swallowing was graded on a scale of 1-4 with 1 

being a normal diet and 4 being feeding tube dependence. Results: 

There were 27 patients treated surgically and 84 patients treated with 

radiation. For the surgical patients, 74% of patients were staged as T1, 

33% of patients N2, 30% N1 and 37% N0. For the radiation patients, 

71% of patients were staged as T2, 61% of patients N2, 20% N1 and 

19% N0. 48% of the surgical patients also had postoperative radiation 

and 15% had concurrent chemotherapy secondary to extent of neck 

disease. 61% of the radiation patients had concurrent chemotherapy 

and 25% had staged neck dissections. The 2 year disease free survival 

was 85.7% for the surgical patients and 83.9% for the radiation patients 

(p=0.44). Within the first two months after completion of therapy, 

72% of surgical patients had grade 1 swallowing versus 18.9% of 

radiation group (p

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compared to the S group (40.6% vs 19.9% p= 0.012). The hazard ratio 

for metastases was 3.07 in patients who experienced local or regional 

failure compared to those free of disease (p

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the 3’UTR of messenger RNA (mRNA), causing translational repression 

or degradation. To better understand the potential role of miRNA in 

HNSCC carcinogenesis, miRNA-21 specific gene targets were identified 

and their expression signatures were assessed utilizing the power of 

microarray technology and bioinformatics miRNA target prediction 

tools. Design: Whole genome mRNA expression was analyzed by 

microarrays in HNSCC tumors, normal mucosa and a normal oral 

keratinocyte cell line (NOK-SI) transiently overexpressing miRNA-21. A 

candidate list of miRNA-21 gene targets was generated by identifying 

common downregulated mRNA expression signatures in HNSCC 

tumors and the miRNA-21 overexpressing normal oral keratinocyte cell 

line. The candidate target gene list was further narrowed by evaluating 

each 3’UTR region with bioinformatics tools for miRNA-21 specificity. 

Expression levels of miRNA-21 gene targets were determined by 

reverse transcription quantitative polymerase chain reaction (RTqPCR). 

Specificity of miRNA-21 for each candidate gene target was 

assayed utilizing the luciferase miRNA target expression vector system. 

Subjects: Matched 13 HNSCC tumors and 5 normal mucosa total RNA 

samples, in addition to NOK-SI cell line RNA samples after triplicate 

miRNA-21 and mock lentiviral vector transient transfections were used 

for mRNA microarray analysis. Results: Microarray analysis combined 

with bioinformatics tools for miRNA-21 gene target prediction generated 

a candidate gene list, including Clusterin, Basonuclin 2, and Desmin 

(FAM48a). Expression levels of miRNA-21 gene targets were significantly 

lower in HNSCC tumors and miRNA-21 transfected NOK-SI cell line 

when compared to normal mucosa and mock transfections by RTqPCR. 

Transfection of miRNA-21 significantly suppressed a luciferasereporter 

containing the 3’UTR of the miRNA-21 gene target verifying the 

specificity of miRNA-21 for the candidate. Conclusions: Novel miRNA 

targets can be identified and validated utilizing an integrative approach 

with whole genome expression profiling and bioinformatics target 

prediction methods. MiRNA-21 has several mRNA targets in HNSCC and 

further study is needed to evaluate their functional effects and possible 

use in detection, prognosis, and therapeutic outcome in HNSCC. 

S015 

AKT PHOSPHORYLATION AS A MARKER OF RESISTANCE TO 

ZD6474 (VANDETANIB) IN HEAD AND NECK SQUAMOUS CELL 

CARCINOMA. Genevieve A Andrews, MD, Mitchell J Frederick, PhD, 

Mei Zhao, MD, David R Fooshee, Zvonimir L Milas, MD, Maria K Gule, 

MD, Chad E Galer, MD, Jeffrey N Myers, MD PhD; MD Anderson Cancer 

Center. 

The epidermal growth factor receptor (EGFR) is an attractive target 

for anti-cancer therapy, in head and neck squamous cell carcinoma 

(HNSCC). Yet often HNSCC demonstrates resistance to EGFR inhibition. 

Therefore, drugs that target angiogenesis by inhibiting the VEGFR 

(vascular endothelial growth factor receptor) in addition to EGFR, such 

as ZD6474 (Vandetanib), may be useful for treating HNSCC patients. 

To better understand the mechanisms of resistance to EGFR inhibition, 

as well as examine biomarkers defining EGFR inhibitor resistance, we 

investigated the effect of ZD6474 in a panel of 50 HNSCC lines in vitro, 

where the principal in vitro drug effects are thought to be through the 

EGFR signaling pathway. The GI50 (50% growth inhibition) values for 

cell lines ranged from 0.4 µM to 14 µM between the most sensitive and 

most resistant lines. When sensitive HNSCC cell lines FADU and PCI-13 

were treated for 30 hours with 4 µM ZD6474, there was more than a 70% 

reduction in the phosphorylation of AKT on Ser427. However, there was 

less than a 10% decrease in pAKT Ser427 observed for two resistant 

cell lines examined, SCC61 and JHU 028. There was a parallel reduction 

in constitutive pERK in the two sensitive cell lines following treatment 

with ZD6474 for 30 hours. The reduction in pERK only occurred in one 

of the resistant lines, SCC61. EGF-stimulated phosphorylation of the 

EGFR was similarly inhibited in both resistant and sensitive cells by 4 µM 

ZD6474, indicating that resistance was not due to a difference in drug 

target sensitivity in these cell lines. In conclusion, our preliminary data 

suggest a model wherein HNSCC cells sensitive to EGFR inhibition rely 

heavily upon the EGFR pathway to activate and maintain proliferation 

and survival mechanisms such as phosphorylation of AKT, whereas 

resistant cells may use other receptors or signaling molecules to activate 

critical downstream pathways to survive in the face of EGFR inhibition. 

www.ahns.info 

S016 

A BLOOD TRANSFUSION PREDICTION MODEL IN PATIENTS 

UNDERGOING MAJOR HEAD & NECK SURGERY INVOLVING FREE 

FLAP RECONSTRUCTION. Manish D Shah, MD MPhil FRCSC, David 

P Goldstein, MD FRCSC, Stuart McClusky, MD FRCPC, Patrick Gullane, 

MB FRCSC FACS FRACS Hon, Dale H Brown, MD FRCSC, Jonathan C 

Irish, MD MSc FRCSC FACS, Ralph W Gilbert, MD FRCSC; University 

Health Network, University of Toronto, Toronto, Canada. 

Objectives: Perioperative blood transfusion is commonly required 

for major head & neck procedures and carries significant risks. 

Alternatives to allogenic blood transfusion are becoming available. 

Pre-operative risk stratification of patients allows for appropriate 

patient counseling and resource allocation. Thus, the objective of our 

study was to develop a model to reliably predict the requirement for 

perioperative blood transfusion in patients undergoing major head and 

neck surgery involving free flap reconstruction. Methods: Data was 

prospectively collected on all patients undergoing major head and 

neck surgery requiring free flap reconstruction at the University Health 

Network (Toronto, Canada) between 1999 and 2009. Over 800 patients 

were included in the analysis. Pre-operative variables were tested for 

association with the outcome of interest, perioperative transfusion. 

Stepwise multivariable logistic regression modeling was carried out 

to determine which pre-operative variables were best able to predict 

perioperative transfusion requirement. Results: A predictive model 

of perioperative blood transfusion requirement was obtained from the 

logistic regression analysis. Six pre-operative variables were found to 

be significant—female gender (odds ratio [OR] = 4.1), T-stage (T1/2 vs 

T3/4, OR = 1.4), treatment with pre-operative chemotherapy (OR = 1.9), 

cardiac comorbidity (OR = 1.8), pre-operative hemoglobin level (normal 

vs low, OR = 5.6), and type of free flap reconstruction (non-osseus vs 

osseus, OR = 2.3). Amongst these six variables, gender, pre-operative 

hemoglobin level, and type of free flap were the strongest predictors in 

the model. Using this model, we can predict the probability of a patient 

requiring a perioperative blood transfusion. Conclusions: We have 

developed a reliable model for predicting perioperative blood transfusion 

requirements in patients undergoing major head and neck surgery 

requiring free flap reconstruction. This model can be used for accurate 

pre-operative risk stratification. This is essential for effective patient 

counseling, use of cross and type, and use of alternatives to allogenic 

blood transfusion. 

S017 

A CLASSIFICATION SYSTEM FOR RECONSTRUCTION OF VERTICAL 

HEMIPHARYNGOLARYNGECTOMY FOR HYPOPHARYNGEAL 

SQUAMOUS CELL CARCINOMA. Min-Sik Kim, MD PhD, Young-Hoon 

Joo, MD, Dong-Il Sun, MD PhD, Kwang-Jae Cho, MD PhD, Jun-Ook 

Park, MD; The Catholic University of Korea. 

Objectives: To evaluate microvascular reconstruction of vertical 

hemipharyngolaryngectomy (VHPL) defect for hypopharyngeal 

squamous cell carcinoma. We classified VHPL according to the extent 

of tumor resection to establish guidelines for its clinical application. 

Methods: We have reviewed a 12-year experience with 32 VHPL 

between 1998 and 2009. Based on our retrospective reassessment, the 

classification comprised three types of VHPL according to the extent 

of resection: limited VHPL (type I ), resection at the lateral border of 

the conus elasticus to preserve both vocal cords (n=10); VHPL (type 

II), removal of a vertical section of the thyroid cartilage through the 

anterior commissure to the upper border of the cricoid cartilage with 

preservation of one vocal cord (n=12); and extended VHPL (type III), 

inclusion of a supraglottic laryngectomy (type IIIa) (n=6) and/or partial 

cricoid cartilage resection (type IIIb) (n=4). A radial forearm free flap 

that included the palmaris longus tendon was used for reconstruction 

in 31 patients, and an anterolateral thigh flap was used in one patient. 

Results: There was no perioperative mortality, and there was a 100% 

free flap survival rate. Two (6.3%) patients developed a postoperative 

pharyngocutaneous fistula and 2 (6.3%) patients had a glottic stenosis 

develop during the postoperative period. Oral re-alimentation was 

achieved within a mean of 33 days postoperatively. Twenty eight (88%) 

patients could achieve all of their nutritional needs orally; however, four 

(12%) patients needed the assistance of a PEG tube with type II and IIIa 

defect. Tracheotomy weaning was achieved within a mean of 31.9 days 

37

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postoperatively, except in four (12%) patients who developed glottic 

stenosis associated with type III VHPL. Postoperative radio(chemo) 

therapy was administered in 21 patients (66%). Twenty five patients had 

more than 6 months follow-up with a mean time of 34.6 months. The 

recurrence rate was 28% (7/25) and a 5-year disease-specific survival 

rate was 64%. Conclusion: Microvascular reconstruction of VHPL offers 

a wider resection with promising functional results for hypopharyngeal 

carcinoma. Our proposed classification of VHPL according to the extent 

of the tumor offers guidelines for better functional reconstruction. 

S018 

THE NATURE AND EXTENT OF BODY IMAGE CONCERNS AMONG 

SURGICALLY TREATED PATIENTS WITH HEAD AND NECK CANCER: 

NEW FINDINGS TO PROMOTE IMPROVED PSYCHOSOCIAL CARE. 

Michelle C Fingeret, PhD, Ying Yuan, MD, June Weston, Randal S Weber, 

MD; M. D. Anderson Cancer Center. 

Introduction: Body image is recognized as a critical psychosocial 

issue for individuals with head and neck cancer, as the disease and its 

treatment can have devastating consequences involving disfigurement 

and functional impairment. There are enormous social implications 

for the body image changes experienced by these patients due to 

the visible nature of the facial region and its association with identity, 

communication abilities, and interpersonal functioning. However, limited 

empirical research has been conducted to obtain a comprehensive 

understanding of the nature and extent of body image concerns in 

this patient group. The purpose of this study is to obtain descriptive 

information about the disease-specific body image concerns of 

surgically treated patients, satisfaction with care received regarding 

body image issues, and interest in psychosocial services targeting body 

image disturbance. Methods: The study sample included 256 patients 

with oral cavity, cutaneous, and other cancers affecting the midface 

at various time points relative to the initiation of surgical treatment 

(i.e., preoperatively, within one year of initial surgery, greater than one 

year following initial surgery). Patients were administered a self-report 

questionnaire designed for this study along with the Body Image 

Scale (BIS), which has been developed for cancer patients. Results: 

Preliminary results demonstrate that 77% of the sample acknowledged 

concerns or embarrassment about body image changes at some point 

following diagnosis/treatment, while 57% endorsed such concerns at 

the time of the evaluation. Patients tended to endorse multiple types 

of body image concerns, though these differed slightly for each patient 

group. Logistic regression analyses indicated that after adjusting 

for age, gender, cancer type and time since surgery, the number of 

body image concerns was significantly associated with scores on 

the BIS (p < 0.0001). One additional concern increased the odds of 

endorsing behavioral or emotional difficulties on the BIS by 112%. 

Time since surgery was also significantly associated with BIS scores. 

Despite considerable body image concerns prior to surgical treatment, 

elevated behavioral and emotional difficulties associated with body 

image concerns were found within one year of initial surgery (p = 0.03), 

with these scores remaining elevated greater than one year following 

surgery (p = 0.05). Up to 20% of patients expressed dissatisfaction 

with information provided to them about how to best cope with bodily 

changes or what to expect in terms of scaring/disfigurement following 

treatment. Nearly 1/3 of patients surveyed indicated they would have 

liked additional resources to help them cope with body image changes. 

Conclusions: These data provide useful information to document 

the nature and extent of body image concerns for this population 

and provide important targets for the development of psychosocial 

interventions. This work is directly linked to the development of a new 

psychosocial service targeting body image difficulties of this population, 

which will be briefly presented and discussed. The Body Image Therapy 

Service (BITS) is designed to provide evidence-based psychosocial 

interventions based on a cognitive-behavioral therapy model. 

S019 

SUBMENTAL FLAP VERSUS RADIAL FOREARM FLAP FOR ORAL 

CAVITY RECONSTRUCTION: COMPARISON OF OUTCOMES. Joseph 

A Paydarfar, MD, Urjeet A Patel, MD; Dartmouth Hitchcock Medical 

Center, Lebanon, NH, USA; Northwestern University Medical Center, 

Chicago, IL, USA. 

Background: Resection of oral cancer frequently requires flap 

reconstruction to preserve tongue mobility and function. While the 

radial forearm flap (RFFF) has been widely used for this purpose, 

the submental pedicled flap (SPF) is gaining popularity for intraoral 

reconstruction. The benefits of the SPF are thought to include ease of 

harvest, shorter surgery, and good functional outcome. Objective: The 

purpose of this study is to compare intra-operative, post-operative, and 

functional results of SPF versus RFFF reconstruction for tongue and 

floor of mouth reconstruction. Design: Multi-institutional retrospective 

review. Setting: Academic, tertiary referral center. Patients: All patients 

undergoing resection of oral tongue or floor of mouth cancer followed by 

reconstruction with either SPF or RFFF from 2003-2009 were included. 

Main Outcome Measure: Tumor stage, defect size, duration of surgery, 

duration of hospitalization, surgical complications, and speech and 

swallowing function. Results: The study included 60 patients, 27 with 

SPF reconstruction and 33 with RFFF. Gender, age and TNM stage were 

similar for both groups. Only 7 patients had received therapy prior to 

the study. Mean flap size was smaller for SPF (37 cm2) than RFFF (50 

cm2) (p

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cartilage invasion; however, close observation following medical 

therapy is required to identify recurrent disease. In comparison, patients 

undergoing TL with postoperative RT or CRT demonstrated markedly 

better local control. For patients with cartilage invasion, a prospective 

trial comparing response to medical therapy versus surgical therapy in 

patients with T4 laryngeal carcinoma is needed. 

S021 

DETERMINANTS OF LONG-TERM SPEECH AND SWALLOWING 

OUTCOMES FOLLOWING CHEMORADIOTHERAPY FOR 

LOCOREGIONALLY ADVANCED HEAD AND NECK CANCER. K W 

Mouw, PhD, D J Haraf, MD, K M Stenson, MD, E E Cohen, MD, E Blair, 

MD, M E Witt, RN MS, E E Vokes, MD, J K Salama, MD; The University 

of Chicago. 

Purpose: To identify factors that influence long-term speech and 

swallowing function in patients treated with induction chemotherapy 

(IndCT) followed by combined chemoradiotherapy (CRT) for 

locoregionally advanced head and neck cancer (HNC). Materials and 

Methods: A cohort of 221 patients was treated with IndCT followed by 

combined (CRT) for locoregionally advanced HNC between 1995 and 

2002 at the University of Chicago. Of the 184 patients not excluded for 

early death or locoregional failure, 163 (88.6%) were assigned a speaking 

score of 1-4 at an average of 34.9 months (range=1.5-68) following the 

completion of treatment, and 166 (90.2%) were assigned a swallowing 

score of 1-4 at an average of 34.5 months (range=1-76) following 

completion of treatment. Speaking and swallowing scores are based on 

the validated McMaster scale for head and neck radiotherapy outcomes, 

with a score of 1 indicating normal function and higher scores reflecting 

increasing speech and swallowing morbidity. Results: Patients received 

one of three radiation therapy (RT) dosing schemes during treatment, 

and there was a trend towards better speech and swallowing scores with 

decreasing overall RT doses. Swallowing scores did not vary significantly 

based on location of the primary site, whereas speaking scores were 

significantly worse in patients with a larynx or hypopharynx primary 

site compared to the oral cavity or oropharynx (P

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occurred at a median of 69 months after primary treatment. Multivariate 

analyses show that cT and cN status were significant predictors of OS 

and DSS, while cN was a significant predictor of LRRFS and DRFS. 

Discussion: This retrospective study of patients with minor salivary 

gland malignancies of the oropharynx is the largest series reported from 

a single institution. Patients have a more favorable outcome compared 

to patients with squamous cell cancer. Distant metastases were common 

and were the most common cause of treatment failure. 

S024 

THE INCIDENCE AND OUTCOME OF HEAD AND NECK SQUAMOUS 

CELL CARCINOMA PATIENTS WITH SUSPICIOUS PULMONARY 

FINDINGS ON PET/CT. Steven Shinn, Bradley A Schiff, MD, Janine 

Feng, MD, Keivan Shifteh, MD, Missak Haigentz, MD, Madhur Garg, MD, 

Richard Smith, MD; Albert Einstein College of Medicine. 

Purpose: Several studies in the past decade cite the utility of FDG- 

PET/CT for detection of pulmonary metastases and second primary 

malignancies in patients with head and neck cancers. However, there are 

few studies in the literature tracking the long-term outcomes of patients 

with pulmonary malignancies discovered with PET/CT. The aim of this 

study is to evaluate the long-term outcomes and survival of patients 

with head and neck squamous cell carcinomas who present with 

suspicious pulmonary findings on FDG-PET/CT. Methods: Between 

January 2005 and May 2009, 663 different head and neck cancer 

patients were presented at weekly Tumor Boards in the Department 

of Otolaryngology – Head and Neck Surgery, of which 433 patients 

received PET/CT scans. Results: FDG-PET/CT revealed pulmonary 

findings in 204 patients with head and neck squamous cell carcinoma 

(HNSCC). After excluding patients with dermal primary lesions, and 

those with primary lung tumors, 191 patients were analyzed. Of those191 

patients, 74 had positive findings suspicious for pulmonary metastases 

and/or second primary malignancies; 23 of these patients subsequently 

had histological confirmation of their malignancy. Additionally, PET/CT 

pulmonary findings were equivocal for 27 patients, of which 1 patient 

was confirmed pathologically positive via lung biopsy. Overall, the 

prevalence of biopsy-confirmed lung malignancy, metastases or second 

primary, was 24/433 (5.5%). Among the patients with (+) PET/CT scans 

treatment plans were altered in 18/74 patients (24%). Furthermore, of the 

23 biopsy confirmed patients with (+) PET scans, 12/23 (52%) patients 

had their therapeutic regimen changed to include curative resection of 

the lung malignancy, palliative radiation, or chemotherapy. The median 

interval of time between a (+) PET/CT and the positive lung biopsy was 

81.5 days. The median overall survival following a (+) PET/CT and (+) 

pulmonary diagnosis was 370 and 247 days, respectively. The median 

time interval between the definitive therapy for HNSCC and a (+) PET/ 

CT was 341 days. The survival percentages following their first (+) PET/ 

CT at 6 months, 1 year, and 2 years were 82% (19/23), 53% (9/17), and 

33% (2/6), respectively. Conclusion: PET/CT scans play an increasingly 

significant role in the management and surveillance of patients with 

HNSCC. Approximately 17% (74/433) of PET scans revealed pulmonary 

findings suspicious for malignancy. Of patients with findings suspicious 

for malignancy the median survival was less than one year. Patients 

with suspicious pulmonary findings on PET/CT have a poor prognosis. 

However, a subset of these patients are amenable to treatment and may 

still achieve long tern survival. 

S025 

INDUCTION CHEMOTHERAPY FOR ADVANCED SQUAMOUS CELL 

CARCINOMA OF THE PARANASAL SINUSES. Ehab Y Hanna, MD, 

M Kupferman, MD, R Weber, MD, M Kies, MD; MD Anderson Cancer 

Center. 

Purpose/Objective(s):To review the outcomes of patients with 

advanced (stage III-IV) squamous cell carcinoma (SCC) of the paranasal 

sinuses treated with induction chemotherapy prior to definitive local 

therapy. Materials/Methods: Forty six consecutive patients with 

previously untreated biopsy proven SCC of the paranasal sinuses who 

received induction chemotherapy during the course of their treatment 

were reviewed for demographics, tumor types and stage, treatment 

details and oncologic outcomes. Results: Of the 46 patients, the tumor 

epicenter was in the maxillary sinus in 31 (67%), ethmoid sinus in 9 

(20%), nasal cavity in 4 (9%), and sphenoid sinus in 2 (4%). All patients 

had T3 or T4 tumors, and 26% of patients had clinical evidence of 

nodal metastasis with an overall stage of III (20%) or IV (80%). Median 

age was 59 years. Induction chemotherapy regimens consisted of a 

combination of taxane and platinum in 80% of patients, either alone 

(14 patients), or in combination with a third agent such as ifosfamide 

(14 patients) or 5-FU (9 patients). The combination of taxane and 5-FU 

was used in the remaining 9 patients. Two thirds of patients (67%) 

achieved at least a partial response to induction chemotherapy, 24% 

had progressive disease, and 9% had stable disease. Subsequent 

treatment after induction chemotherapy consisted of either surgery 

usually followed by radiation or chemoradiation, or definitive radiation 

or chemoradiation with surgical salvage of any residual disease. Overall 

surgical resection was performed in only 50% of patients treated with 

induction chemotherapy. The 2-year survival for patients with at least 

a partial response or stable disease after induction chemotherapy was 

77%, in contrast to only 36 % for patients with progressive disease. 

Conclusions: Tumor response to induction chemotherapy in patients 

with advanced SCC of the paranasal sinuses may be predictive of 

treatment outcome and prognosis. Favorable response to induction 

chemotherapy is associated with better survival and a reasonable 

chance of organ preservation. 

S026 

CD40 IS REQUIRED FOR AN IMMUNE MEDIATED CLEARANCE OF 

HPV POSITIVE HEAD AND NECK CANCER. William C Spanos, MD, 

Denise Schwabauer, MS, Daniel W Vermeer, BA, Annie Herrig, BS, John 

H Lee, MD; Sanford Research/USD, Sioux Falls, SD, USA. 

Human papilloma virus (HPV) cancers have improved survival following 

therapy compared to their HPV negative counterparts. Our preliminary 

data suggests that treatment with cisplatin and radiation induce an 

immune response that aids in clearing HPV positive cancers. To better 

understand this immune related clearance we have examined cellular 

signaling present on head and neck epithelial cells that may aid in the 

immune response. Cellular signals, such as the presence or absence 

of receptors on immune cells or epithelial cells may be important to 

tumor clearance. CD40 receptor, a membrane glycoprotein, is found 

on dendritic cells as well as epithelial cells lining the oropharynx 

and nasopharynx. The interaction of CD40 receptor to CD40 ligand 

is important in driving the immune system to a T cell response. An 

activating CD40 antibody (CD40 ligand) has been used in the treatment 

of solid tumors (melanoma and colorectal). Using a mouse model of HPV 

positive head and neck cancer we have investigated the role of CD40 in 

head and neck cancer. Mouse tonsil epithelial cells (MTECs) transformed 

with HPV E6E7 and H-Ras (oncogenes) as well as human HPV positive 

and negative head and neck squamous cell cancer (HNSCC) cell lines 

showed no growth inhibition and no decreased clonogenic survival 

when treated with the activating antibody CD40 ligand compared to 

IgG control. This suggests that receptor activation on the epithelial cells 

does not induce cell death. To test whether CD40 receptor was essential 

for the induced immune response, HPV positive tumors were implanted 

into CD40 knockout, RAG-1 and wild-type mice. Interestingly CD40 

knockout mice grew with similar velocity to immunodeficient RAG-1 

mice (no B and T cells) with 0% survival despite treatment with cisplatin 

and radiation, while 80% of wild-type mice cleared their tumors. CD40 

receptor activation as an adjuvant to cisplatin/radiation treatment of HPV 

positive tumors in immune competent C57BL mice improved survival by 

20% compared to IgG cisplatin/radiation control. Complete clearance 

with tumor free survival occurred in 10% of mice treated with CD40 

ligand alone. CD40 receptor is a important component of the immune 

mediated clearance of HPV positive HNSCC in mice. Augmentation of 

the immune response using CD40 ligand may allow for dose reductions 

of chemotherapy and/or radiation in the treatment of head and neck 

cancer. 

S027 

VASCULAR ENDOTHELIAL GROWTH FACTOR C (VEGF-C) IS 

IMPORTANT IN THE DEVELOPMENT AND METASTASIS OF HEAD 

AND NECK SQUAMOUS CELL CARCINOMA. Rachel L Chard, BA, 

Hiroshi Yagi, MD PhD, Vyomesh Patel, PhD, Alfredo Molinolo, MD PhD, 

J. Silvio Gutkind, PhD; Oral and Pharyngeal Cancer Branch, National 

Institute of Dental and Craniofacial Research, National Institutes of 

Health, and Oregon Health & Science University School of Medicine. 

Head and neck squamous cell carcinomas (HNSCC) rank sixth among 


Oral Papers 

the most common cancers worldwide. Though advances in prevention 

and treatment have increased survival rates in other cancers, the 5-year 

survival rate for HNSCC patients, approximately 50%, has remained 

virtually unchanged for more than 30 years. In search of molecules with 

potential therapeutic benefit, we have conducted a comprehensive 

genomic and proteomic analysis of laser capture microdissected cancer 

and stromal cells from a large HNSCC frozen tumor collection from 

patients of distinct metastatic status. We observed that the expression 

of Vascular Endothelial Growth Factor C (VEGF-C) is a prominent feature 

in the most metastatic HNSCC lesions. VEGF-C is a member of VEGF 

family of growth factors and is most strongly identified with the process 

of lymphangiogenesis, or the growth and proliferation of the lymphatic 

vasculature. This observation prompted us to focus on the dysregulation 

of the lymphangiogenesis pathways in HNSCC. We have established 

rapid orthotopic models of HNSCC invasion in the tongue and intra-vital 

imaging approaches to monitor the process in live animals and, thus, are 

uniquely able to address the role of VEGF-C in the HNSCC metastasis. 

Using a lentiviral delivery system, we used two unique sequences of 

shRNA against VEGF-C to knockdown its release in OSCC3, a wellcharacterized 

cell line of high metastatic potential. We then injected 

these cells into SCID/Nod mice using our validated model of HNSCC 

metastasis, observing differences in tumor volume, metastasis and 

vasculature density. In parallel, we characterized the effects of VEGF-C 

secreted by OSCC3 control and VEGF-C knockdown cells on the ability 

of lymphatic endothelial cells to proliferate and migrate. We aim to 

demonstrate that the release of VEGF-C by tumor cells is important for 

the process of lymphatic metastasis and VEGF-C signaling should be 

further investigated as a therapeutic target in HNSCC. 

S028 

SIGNIFICANCE OF CIRCULATING TUMOR CELLS IN PATIENTS 

WITH SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK. 

Kris R Jatana, MD, Priya Balasubramanian, MS, Jas C Lang, PhD, Liying 

Yang, PhD, Courtney A Jatana, DDS, Elisabeth White, BA, David E 

Schuller, MD, Theodores N Teknos, MD, Amit Agrawal, MD, Enver Ozer, 

MD, Jeffrey J Chalmers, PhD; The Ohio State University, Arthur G. James 

Cancer Hospital and Solove Research Institute. 

Objective: 1) To present and discuss a high performance negative 

depletion methodology for the isolation of circulating tumor cells (CTCs) 

in the blood of patients with squamous cell carcinoma of the head and 

neck (SCCHN). 2) To begin to determine the correlation between the 

presence of CTCs and clinical outcome in SCCHN patients. Design: 

Prospective clinical follow-up study of SCCHN patients undergoing 

surgical intervention, who had peripheral blood tested for the presence 

CTCs using a negative depletion technique. Subjects: 30 patients 

diagnosed with SCCHN. Intervention: A negative depletion process to 

isolate and quantify CTCs from the blood of patients with SCCHN, using 

immunomagnetic separation was developed and validated. To date, 

this technique was performed on over 100 blood samples taken from 

patients at the time of surgery, and these patients have been followed 

in a prospective manner. Immunostaining for cytokeratin was performed 

on the enriched samples to determine the number of CTCs extracted 

from each patient’s blood sample. In addition, RNA was extracted from 

these enriched samples, and RT-PCR was used to determine if mRNA 

from EGFR was present. Correlation of CTCs, tumor stage, nodal 

status, EGFR status, and clinical outcome was made. Main Outcome 

Measure: Disease-free survival. Results: For the initial 30 patients, our 

data suggests that SCCHN patients with no detectable CTCs per mL 

of blood had a statistically significant higher probability of disease-free 

survival (p=0.03, mean follow-up=18 months). No CTCs were found in 

healthy human control blood samples. EGFR expression was present in 

62% of SCCHN patients with identifiable CTCs. In addition to cytokeratin 

markers, ongoing studies focus on using multicolor Confocal microscopy 

investigate the expression of other markers including “cancer stem 

cell” markers. Conclusions: An enrichment technology, based on 

the removal of normal cells, has been used on the peripheral blood of 

SCCHN patients for which outcome data is being collected. The data at 

this point indicates that this detection technology is potentially sensitive 

and specific enough to predict that if no CTCs were present, SCCHN 

patients had improved disease-free survival. A blood test with such 

a prognostic capability could have important implications in the 

management of SCCHN. 

www.ahns.info 

S029 

ENHANCED INVASIVE AND METASTATIC POTENTIAL OF CANCER 

STEM CELLS IN HEAD AND NECK SQUAMOUS CELL CARCINOMA. 

Samantha J Davis, BS, Vasu Divi, MD, John H Owen, BA, Silvana 

Papagerakis, MD PhD, Carol R Bradford, MD, Thomas E Carey, PhD, 

Mark E Prince, MD; Department of Otorhinolaryngology, University of 

Michigan, Ann Arbor, MI; Massachusetts Eye and Ear Infirmary/Harvard 

Medical School, Boston, MA. 

Objectives: Subpopulations of highly tumorigenic cells, or cancer stem 

cells (CSCs), have been identified within tumors of many types. These 

cells have the unique capacity to self-renew and produce differentiated 

progeny. In head and neck squamous cell carcinomas (HNSCC), the 

CSC population is contained within the cell fraction that expresses 

high levels of the surface molecule CD44. Although HNSCC CSCs are 

known to exhibit increased tumorigenicity compared to non-CSCs, 

it is unknown what role they may play in local invasion and distant 

metastasis. To explore this, we have designed both in vitro and in vivo 

models to study the behavior of this unique tumor cell subpopulation. 

Methods: In all experiments, cells were labeled with anti-CD44 

monoclonal antibody and sorted for CD44+ and CD44- fractions using 

flow cytometry. For in vitro studies, cells from three HNSCC cell lines 

(UMSCC-12, -14A, and -47) were serum-starved in media containing 1% 

FBS for 18 hours prior to sorting. The CD44+ and CD44- populations 

were plated in the upper chambers of Matrigel-coated and control 

inserts, with media containing 10% FBS and 30 ng/ml EGF in the lower 

chamber. Matrigel is a reconstituted basement membrane-like material 

and is well described as a tool for studying invasion. The chambers were 

incubated for 24 hours at 37°C. Cells remaining in the upper chamber 

were removed, and cells that had migrated to the lower chamber were 

fixed and stained. Cells were then counted using light microscopy. 

Results are expressed as percent invasion, calculated by dividing the 

number of cells that invaded through the Matrigel by the number of 

cells that migrated through the corresponding control insert. For in vivo 

study of CSC metastatic potential, CD44+ and CD44- cells from one 

primary tumor (HN-111) and one cell line (UMSCC-6) were injected into 

the tail veins of NOD/SCID mice. Lungs were harvested at six months 

to evaluate for the presence of metastasis. Results: In all three HNSCC 

cell lines, CD44+ cells were more invasive than CD44- cells. The increase 

in invasiveness ranged from 1.2 to 2.1-fold. UMSCC-12, a laryngeal SCC 

cell line, showed the greatest difference in invasion between the two 

populations. UMSCC-47, an HPV-positive tongue SCC cell line, showed 

an intermediate increase, while the floor-of-mouth SCC cell line UMSCC- 

14A showed the smallest increase in percent invasion (see Table 1). 

Three out of four mice injected with CD44+ cells and 0/4 mice injected 

with CD44- cells formed lung metastasis. Two of the metastasis arose 

from primary tumor CSCs injections and one from HNSCC cell line CSCs 

injections (see Table 2). Conclusions: An in vitro model of invasion 

and an in vivo model of metastasis to compare behavior of CD44+ and 

CD44- cells support the hypothesis that CSCs have the unique capacity 

for progression of disease outside the primary tumor bed. Interestingly, 

CD44+ cells not only have greater ability to invade through reconstituted 

basement membrane, but they also migrate more efficiently through the 

control inserts. This phenomenon could be due to enhanced general 

mobility of CSCs compared to the general tumor population. 

41

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S030 

RETROSPECTIVE ANALYSIS OF OUTCOME IN PATIENTS WITH 

ORAL PREMALIGNANT LESIONS: THE RISK FOR ORAL CANCER 

DEVELOPMENT. Vanda M Stepanek, MD PhD, Dianna B Roberts, 

PhD, Adel K El-Naggar, MD PhD, Martin W Jack, DDS MS, Vassiliki 

Papadimitrapoukoulou, MD, Ann M Gillenwater, MD; MD Anderson 


Background: Patients with clinically apparent oral lesions such as 

leukoplakia and erythroplakia, and those with pathologic findings of 

dysplasia are at increased risk to develop oral cancer. However, the 

reported rates of malignant transformation in different series varies 

greatly (from 1 to 37%) depending upon variables such as geographic 

location, length of follow up and prevalence of high risk behaviors such 

as tobacco use. This makes it difficult to predict an individual patient’s 

risk for oral cancer development rendering management of patients with 

oral premalignant lesions (OPLs) extremely challenging. 

Objective: To evaluate a large cohort of patients with OPLs in the 

United States in order to determine rate of oral cancer development and 

to identify correlations of clinical, pathologic, and demographic data 

with malignant transformation. Methods: Medical records of patients 

diagnosed with an OPL (oral leukoplakia or erythroplakia) between 

1970 and 2007 with a minimum follow up period of 12 months were 

retrospectively reviewed. Clinical and demographic data were recorded 

and histopathological assessments of biopsied tissues were reviewed. 

Correlations between parameters of interest were assessed by the 

Pearson chi-square test and, where appropriate, by the 2-tailed Fisher 

exact test. Results: A total of 305 patients with OPLs whose records 

met criteria for further evaluation were identified. 164 patients (53.8%) 

had multiple OPLs; anatomic subsites involved included tongue (45.6%), 

buccal (16.0%), gingival (13.0%) and the floor of mouth (10.3%). The 

median age of the patient cohort was 55 years, (range 23-90 years) with 

a male: female ratio of 154:151. 89.5% were Caucasian. 31.6 % were 

never smokers, 24.3% current smokers, and 34.3% former smokers. 

Interestingly, 65% of the OPLs in never smokers were dysplastic. 80% 

of patients underwent at least one surgical excision of an OPL and 

58% enrolled in a chemoprevention trial. A total of 81 patients (26.5%) 

developed oral squamous cell carcinoma, including 1 case of verrucous 

carcinoma; 39 cancers (49%) involved the oral tongue, 11 cases (14%) 

involved the floor of mouth. 32% of patients with dysplastic lesions 

compare to 18% of those with nondysplastic lesions progressed to 

cancer. 52% of patients with OPLs located on the tongue eventually 

developed a cancer. Conclusion: Patients with OPLs seen at a tertiary 

referral center in the United States have a high risk of developing oral 

carcinoma, similar to that of high risk patient cohorts in Asia. The 

presence of dysplasia and anatomic subsite are associated with risk 

of malignant transformation. Continued evaluate should focus on 

clinical, pathologic and molecular variables to be used to develop risk 

stratification systems for managing individual patients. 

S031 

FLUORESCENT SPECTROSCOPY FOR NON-INVASIVE EARLY 

DIAGNOSIS OF ORAL MUCOSAL MALIGNANT AND POTENTIAL 

MALIGNANT LESIONS. Pankaj Chaturvedi, FACS FAIS FICS MNAMS, 

Pradeep K Gupta, Shovan Majumdar; Tata Memorial Hospita, Mumbai 

and Center for Advanced Technology, Indore. 

Objectives: To validate the potential role of fluorescent spectroscopy 

in non-invasive early diagnosis of oral mucosal malignant and potential 

malignant lesions in a country with high prevalence of oral cancers. 

Methods: Patients visiting our hospital with oral mucosal malignant 

and potential malignant lesions underwent clinical examination, 

spectroscopic examination and biopsy. The spectroscopy was done 

using Laser induced fluorescence on abnormal mucosa in addition 

to other clinically normal looking sites like lip, vermilion, buccal 

mucosa, tongue, hard and soft palate. The resulting data was analyzed 

statistically. Results: There were 299 cases of biopsy proven oral cancer 

with 267 healthy volunteers as controls. In detecting oral cancer this 

device had a sensitivity of 78.6%, specificity of 83.9%. The positive and 

negative predictive values were 84.2% and 77.5% respectively. When 

lekoplakia (90 cases) and submucous fibrosis (88 cases) were compares 

with normal subjects (267 cases) the sensitivity, specificity, positive 

predictive value and negative predictive values were 83.2%, 87.3 %, 

92.1% and 74.4% respectively. This is far superior to the accuracy of 

visual examination by health workers as reported by a large cluster 

randomized trial in Kerala. Conclusion: The clinical study presented 

here demonstrates the ability to distinguish neoplastic / pre-neoplastic 

and normal oral mucosa in vivo objectively using low cost portable 

imaging system. The results of this pilot study suggest that this device 

can potentially improve oral screening efforts in low resource settings 

where clinical expertise and resources are limited. However, further work 

is ongoing to test the efficacy of this device in screening of oral mucosal 

malignant and potential malignant lesions in the community setting. 

S032 

ORAL SQUAMOUS CELL CARCINOMA: PREDICTING PROGNOSIS 

FOLLOWING RECURRENCE. Michael Kernohan, Dr, Jonathan Clark, 

Dr, Kan Gao, Mr, Ceri Hughes, Dr, Ardalan Ebrahimi, Dr; Sydney Head 

and Neck Cancer Institute. 

When patients present with local or regional recurrence the decision 

to treat further is based on the risk of morbidity balanced against 

benefit. When locoregional recurrences occur they do so within the 

first 2 years in 80% of cases. The aim of this study is to identify the 

clinical or pathological factors that predict the prognosis of patients 

with recurrent oral SCC. In particular, we sought to determine whether 

time to recurrence (TTR) was an important predictor when adjusted for 

other parameters. Prognostic information would be advantageous to 

counselling and treatment planning in this difficult scenario. Methods: 

Patients from the Sydney Head and Neck Cancer database were 

included in the study if they had a first recurrence of squamous cell 

carcinoma of the oral cavity, were treated with curative intent and had 

a minimum of 12 months of documented follow up. Patients were 

excluded if they had distant metastases at the time of recurrence. A 

total of 117 patients were included. Treatment at initial presentation 

was carried out by surgery alone (56/117), surgery with postoperative 

radiotherapy (51/117) or radiotherapy alone (6/117). Chemotherapy 

was added in 8/117 patients. A total of 10 clinical and pathological 

prognostic factors were examined. Statistical Analysis: Disease 

specific survival (DSS) was calculated from time of recurrence to death 

with disease using the Kaplan Meier method. Univariate comparisons 

were performed using the Log rank test. Variables with a p value < 0.1 

on univariate analysis were included in the initial multivariable model. 

Multivariable analysis was performed using a stepwise backwards Cox 

excluding variables with a p value > 0.05. Continuous variables were 

appropriately transformed to maintain linearity and potential interactions 

were examined. Results: The disease specific survival rate for the 

entire cohort at 5 years following salvage for recurrence was 28%. 

The most significant variables were; initial treatment modality (single 

or combined), site of recurrence (local or regional), TTR (12 months) and clinical T-stage. These variables proceeded to 

multivariate analysis. TTR was also examined as a continuous variable 

with a log transformation. There is strong evidence that decreasing TTR 

is associated with reduced survival (p = 0.007). Hazard ratios associated 

with TTR and site of recurrence are dynamic with a significant interaction 

between TTR and site of recurrence (p = 0.009) (Graph 1). Therefore 

in those patients who recur early (< 6 months) worse outcomes are 

associated with primary site recurrence compared to those who recur 

in the neck. In contrast for those patients who recur late (> 6 months) 

worse outcomes are associated with regional recurrence. 

Graph 1 


Oral Papers 

Conclusions: This retrospective study provides new information on 

survival prediction for these patients and demonstrates the interaction 

of clinically relevant prognostic factors that reflect variation in disease 

biology and behavior. 

This data and unique analysis has identified the following as independent 

prognostic variables: Time to recurrence; Initial treatment modality, single 

or combined; Site of failure, local or regional. The relationship of these 

variables is not fixed as they have a dynamic interaction. 

S033 

TARGETING A TREATMENT-RESISTANT, MESENCHYMAL-LIKE 

SUBPOPULATION WITHIN HEAD AND NECK SQUAMOUS CELL 

CARCINOMAS. Devraj Basu, MD PhD, Thierry-Thien K Nguyen, MS, 

Kathleen T Montone, MD, Anil K Rustgi, MD, Min Xiao, MS, Gregory 

S Weinstein, MD, Meenhard Herlyn, DVM DSc; The University Of 

Pennsylvania, Philadelphia VA Medical Center, The Wistar Institute. 

A barrier to effective therapy for head and neck squamous cell 

carcinoma (HNSCC) is intrinsic drug resistance within discrete 

subpopulations among heterogeneous phenotypes present in a given 

tumor. We have previously identified a subpopulation that arises from 

epithelial to mesenchymal transition in vitro and in vivo in HNSCCs. This 

mesenchymal-like subset is resistant both conventional and epidermal 

growth factor receptor-targeted chemotherapies in comparison to the 

majority of malignant cells with predominantly epithelial differentiation. 

Coexistence of these dual phenotypes in vivo underscores the need 

to target both malignant populations to achieve tumor eradication. 

High throughput drug screening has recently identified the potassium 

ionophore compound salinomycin as effective against breast carcinoma 

cells with mesenchymal-like features. Here we evaluate whether 

salinomycin possesses enhanced activity against mesenchymal-like 

subsets within HNSCCs, relative to the widely used conventional 

cytotoxic agent cisplatin. Low concentrations of salinomycin inhibited 

growth and induced apoptosis of the mesenchymal-like subpopulation 

expressing low E-cadherin (Ecad-lo) and high vimentin, while the same 

subset showed resistance to cisplatin. Cisplatin treatment enriched the 

Ecad-lo subset in vitro among surviving HNSCC cells, while salinomycin 

effectively depleted this subpopulation, decreasing percentage of 

residual cells with the mesenchymal-like phenotype. Mesenchymallike 

cells surviving salinomycin exposure showed diminished growth 

potential, contrasting with unaffected growth of Ecad-lo cells surviving 

cisplatin treatment. In vivo salinomycin treatment of a mouse xenograft 

derived from an HNSCC clinical sample arrested tumor growth 

without leading to the enrichment of mesenchymal-like cells seen with 

conventional agents. Overall these results suggest that salinomycin 

has activity against mesenchymal-like subpopulations across multiple 

types of carcinomas. They further provide proof of concept that minority 

subpopulations possessing intrinsic drug resistance within HNSCCs may 

be approached with distinct pharmacologic targeting strategies. 

S034 

INTRAVASCULAR HUMAN SALIVARY CELL DELIVERY TO TREAT 

SALIVARY CELL LOSS IN A RODENT MODEL. Millie Surati, MD, 

Seth Purcell, Shay Soker, PhD, Tamer AbouShwareb, MS MD PhD, 

James J Yoo, MD PhD, Christopher A Sullivan, MD; Department of 

Otolaryngology-Head and Neck Surgery, Wake Forest University School 

of Medicine; Wake Forest Institute for Regenerative Medicine, Winston- 

Salem, NC USA. 

Objective: Radiation therapy for head and neck cancer causes salivary 

gland cell loss and hypofunction. No cure exists for this condition. 

Replacement of lost salivary cells with a patient’s own cells could 

provide a physiologic solution to this problem. We aimed to determine 

the feasibility of therapeutic human salivary cell replacement using a 

novel intravascular cell delivery (IVCD) system in a rat model of salivary 

cell loss. Methods: Human submandibular gland (SMG) cells were 

explanted from tissue, expanded in culture, and evaluated for phenotypic 

and functional markers. Cultured cells were labeled with PKH-67 and 

suspended in complete medium. Three (3) male Sprague-Dawley rats 

underwent ligation of the right SMG. At 10 weeks, one (1) ligated rat 

SMG was harvested for histologic control. Normal rat SMG was used for 

comparison to ligated glands. The other two (2) rats underwent carotid 

artery catheterization and IVCD into the submandibular artery (1 million 

and 100,000 cells respectively). SMGs were harvested after 24 hours. 

www.ahns.info 

Histological assessment and cell characterization were performed. 

Radiated human SMG tissue was harvested during neck dissection, 

and histology was compared to ligated rat SMGs. Results: Cultured 

human SMG cells expressed functional markers at all passages. Ligated 

rat SMGs showed a decellularized tissue matrix comparable to human 

radiated salivary tissue. In IVCD specimens, PKH-67–labeled cells 

were widely dispersed in tissue; human phenotype and functional cell 

markers were identified in all IVCD cells. Conclusions: A rat SMG 

duct ligation model of cell loss achieves a picture that is histologically 

indistinguishable from irradiated human SMG glands. Directed IVCD 

to a damaged rat SMG delivers a full complement of functional human 

salivary cells that leave the intravascular space and are dispersed 

throughout a vascularized, decellularized target organ. Further study of 

salivary IVCD is warranted in an animal model of salivary hypofunction. 

S035 

SENSITIZATION OF HEAD AND NECK CANCER TO CISPLATIN 

THROUGH THE INHIBITION OF STAT3. Waleed M Abuzeid, MD, 

Samantha Davis, BS, Alice Tang, BS, Lindsay Saunders, BS, Jiayuh Lin, 

PhD, James R Fuchs, PhD, Carol R Bradford, MD, Thomas E Carey, 

PhD; University of Michigan and The Ohio State University. 

Objectives: Future advances in the treatment of cancer will involve 

disruption of the key molecules involved in tumor growth. Signal 

transducer and activator of transcription (STAT) proteins regulate 

key cellular fate decisions including differentiation, proliferation 

and apoptosis. STAT3, in particular, is a key mediator of oncogenic 

signaling. Over-expression of STAT3 induces tumor growth through 

up-regulation of downstream apoptosis inhibitors, facilitation of cell 

cycle progression and promotion of angiogenesis. STAT3 is activated 

in 82% of human head and neck squamous cell carcinomas (HNSCC). 

We hypothesized that targeted inhibition of STAT3 with a novel small 

molecule inhibitor (FLLL32) would induce marked cytotoxicity in 

HNSCC cells when used as a monotherapy and would also sensitize 

tumors to cisplatin chemotherapy. Methods: Western blot was used 

to determine STAT3 expression in two HNSCC cell lines, UM-SCC-29 

and -74B, and to confirm FLLL32-induced knock-down of STAT3. The 

LD50 for FLLL32 was determined for each cell line using cell proliferation 

assays. UM-SCC-29 cells were divided into 11 groups: no treatment 

controls, cisplatin monotherapy at doses of 25, 12.5, 6.25, 3.125 µM, 

monotherapy with FLLL32 (LD50 dose), combination therapy of FLLL32 

(LD50) with cisplatin at doses of 25, 12.5, 6.25, 3.125 and 1.562 µM. 

Cell proliferation was then assessed by 3 day MTT assay. Results: 

Both the UM-SCC-29 and -74B cell lines express STAT3 protein. 

Protein levels were significantly reduced in both cell lines following 

treatment with FLLL32. In UM-SCC-29, cisplatin monotherapy over 

72 hours suppressed tumor growth by 51%, 46%, 42% and 29% 

at 25, 12.5, 6.25 and 3.125 µM, respectively (p

Oral Papers 

The objective of this study was to identify additional pre-operative 

factors that could reliably be used to aid in determining the appropriate 

extent of thyroidectomy. Design: Retrospective chart review. Setting: 

Tertiary-care academic hospital. Patients: 200 consecutively treated 

patients who underwent thyroid surgery after having a FNAB at Mount 

Sinai Hospital that met the criteria for atypical cytology (corresponds 

to “follicular lesion / atypia of undetermined significance,” 2007 NCI 

guidelines). Main Outcome Measures: Malignant versus benign 

final histopathological diagnosis. Results: The final diagnosis was 

benign in 42.5% of patients and malignant in 57.5%. The presence of 

microcalcifications within the nodule on ultrasound (US) was significantly 

associated with a higher risk of malignancy (RR=1.31, p=0.04). When 

examined individually, age, sex, family history of thyroid malignancy, 

exposure to head and neck irradiation, nodule size, rim enhancement 

on US, and intranodular vascularity on US were not significantly 

associated with an increased risk of malignancy. Multivariate stepwise 

logistic regression was used to identify a model that could reliably 

predict a higher probability of malignancy. The final model determined 

that patients with microcalcifications on US and a nodule greater than 

or equal to 2.0cm in size had a 74.3% risk of malignancy versus a 

47.5% risk in patients with no microcalcifications and a nodule smaller 

than 2.0cm. This difference was statistically significant. Conclusions: 

Microcalcifications and nodule size can be used to risk stratify patients 

with an atypical FNAB result and aid in determining the appropriate 

extent of thyroidectomy. 

S037 

SURGICAL PRACTICE PATTERNS IN THE MANAGEMENT OF 

PAPILLARY THYROID MICROCARCINOMA. Arthur W Wu, MD, 

Marilene B Wang, MD, Chau Nguyen, MD UCLA Division of Head and 

Neck Surgery, Los Angeles, CA, USA; Anacapa Surgical Associates, 

Ventura, CA, USA. 

Background: The incidence of thyroid cancer has increased 6.2 fold 

from 1997 to 2004, partially stemming from increased detection of 

small papillary cancers. Recently, there has been debate in the literature 

regarding the proper treatment of papillary thyroid microcarcinoma 

(PTMC), with some advising completion total thyroidectomy and others 

suggesting hemithyroidectomy to be sufficient. Given conflicting 

opinions, we wished to analyze the prevailing trends for treatment of 

PTMC. We sought to determine whether a clinician’s experience, age, 

training background, and practice location affected his/her treatment 

decision. Methods: A 10 question survey was emailed to members 

of the American Academy of Otolaryngology-Head and Neck Surgery 

(AAOHNS) and the American Association of Endocrine Surgeons, posted 

in a general surgery forum on the Sermo website, and advertised in an 

AAOHNS bulletin. Four clinical scenario questions queried whether a 

physician would proceed with completion thyroidectomy for a PTMC. 

Two questions investigated the reasoning behind the surgeon’s decision. 

Lastly, there were four demographic questions querying training, surgical 

volume, location, and age. These variables were used to analyze 

responses to the four clinical scenarios using bivariate and multivariate 

statistics. Results: Of the total 438 responders who completed the 

survey, 335 identified themselves as otolaryngologists, 64 as general 

surgeons, and 32 as other. Given a single sub-centimeter PTMC, 70% of 

surgeons recommended no further surgery after a hemithyroidectomy, 

but a significant minority (30%) felt completion thyroidectomy was 

necessary. The decision to perform total thyroidectomy was significantly 

greater in the South (p=0.0052) and the West (p=0.0026). Additionally, 

otolaryngologists (p=0.039) were more willing to perform completion 

thyroidectomy compared to general surgeons. Given lymphatic invasion, 

89.5% recommended completion thyroidectomy. Otolaryngologists again 

were more inclined to proceed with total thyroidectomy compared to 

their general surgeon colleagues (p=0.019). In the scenario of multifocal 

PTMC, 85% chose completion thyroidectomy. The decision to perform 

completion thyroidectomy in this type of case was greater in the South 

(p=0.056) and the West (p=0.032) relative to the Northeast. Responding 

surgeons rated improved survival, surgeon preference, and the need for 

thyroid suppression as having little significance in their decision. The 

ease of patient follow-up and multifocality of disease were judged very 

significant. Of note, influence from literature, guidelines, and recognized 

authorities were rated as only somewhat or minimally significant. 

Conclusion: In this survey a majority of surgeons seem to follow national 

guidelines regarding surgical management of PTMC. However, significant 

differences in management and perception of PTMC exist. Location and 

surgical training appear to affect how a surgeon manages PTMC. In the 

case of PTMC, a consistent consensus for treatment has not emerged, 

but as more data on outcomes and prognosis come to light, there may 

be a stronger rationale for evidence-based treatment recommendations 

for PTMC. 

S038 

VOLUME-BASED TRENDS IN THYROID SURGERY. Christine G 

Gourin, MD, Robert E Bristow, MD, Ralph P Tufano, MD, Arlene A 

Forastiere, MD, Wayne M Koch, MD, Timothy M Pawlik, MD; Johns 

Hopkins Medical Institutions. 

Objective: Positive volume-outcome relationships exist for diseases 

treated with technically complex surgery, including thyroid surgery. 

However, contempory patterns of thyroid surgery are poorly defined. 

Methods: The Maryland Health Service Cost Review Commission 

database was queried for hospital and surgeon thyroid surgical case 

volumes from 1990-2009. Results: Overall, 21,351 thyroid surgeries 

were performed by 1,034 surgeons at 51 hospitals. Surgical cases 

increased from 9,459 in 1990-1999 to 11,892 in 2000-2009. The 

proportion of cases performed by high-volume surgeons increased from 

15.8% in 1990-1999 to 31.0% in 2000-2009 (OR=1.96, P

Oral Papers 

thyroglobulin level after 1st RAI treatment (2nd stimulated Tg) in the 

TT+CLND group was not different from that in the TT group (0.44 vs. 

0.69 ng/mL, P = 0.341). Also, the 3-year locoregional control rates of 

the TT+CLND group was not different from that of the TT group (98.3% 

vs. 96.5%, P = 0.368). Complication rates in the TT+CLND group were 

slightly higher than in the TT group, without statistical significance (P 

> 0.05). Conclusions: Prophylactic CLND could effectively clear the 

subclinical LNMs in central neck and reduce postoperative thyroglobulin 

level without significant increase of complications. However, prophylactic 

CLND had little prognostic benefit, particularly for patients with RAI 

treatment. 

S040 

ROUTINE PARATHYROID LOCALIZATION WITH 4-D 

COMPUTED TOMOGRAPHY/ULTRASOUND IN PATIENTS WITH 

HYPERPARATHYROIDISM. David I Kutler, MD, Rachel A Moquete, BA, 

William I Kuhel, MD, Eli Kazam, MD; Weill Cornell Medical Center. 

Background: Accurate preoperative localization of hyperplastic 

parathyroid glands increases surgical success and minimizes operative 

risk. 4D Computed Tomography (4D-CT) was recently shown to be highly 

sensitive and specific in identifying hyperplastic parathyroid glands in 

the reoperative setting. The purpose of this study is to document our 

decade long experience using 4D- Computed Tomography/Ultrasound 

(4D-CT/US) to localize abnormal parathyroid glands in patients with 

hyperparathyroidism. Study Design: This is a retrospective chart 

analysis of 185 patients who underwent a parathyroid localization series 

at Manhattan Diagnostic Radiology (MDR) and parathyroidectomy at 

Weill Cornell Medical Center between January 1998 and May 2009. 

Of the185 patients, 11 were in the reoperative setting. Results from 

preoperative localization studies were compared to operative findings, 

pathologic data and biochemical measurements to assess the sensitivity 

and specificity of the parathyroid localization series. Results: 4D-CT/ 

US demonstrated 96% sensitivity and 90% specificity when the imaging 

studies were used to lateralize the hyperfunctioning parathyroid gland 

to 1 side of the neck. Furthermore, the sensitivity and specificity of the 

parathyroid series to localize the hyperfunctioning parathyroid gland to 

a specific quadrant of the neck (ie right superior) was 82% and 92% 

respectively. Of the 185 patients, 4D-CT/US was felt to show a single 

adenoma in 146 patients. Of the 146 patients, 4D-CT/US accurately 

localized the adenoma to the correct side of the neck in 134 cases 

(92%). Multigland disease was found in 11 patients (8%) believed to 

have single gland disease. Of the 38 patient who were thought to have 

multigland disease based on the results of the 4D-CT/US, multigland 

disease was documented in 28 patients (74%). Only a single parathyroid 

localization study was non-localizing and that patient was found to have 

single adenoma. At follow up, 175 patients (95%) were cured, 8 (4%) 

had persistent primary hyperparathyroidism and 2 (1%) had permanent 

hypoparathyroidism. Conclusion: 4D-CT/US provides greater sensitivity 

and specificity when compared to the historical data for sestamibi 

imaging. When interpreted by a skilled radiologist, 4D-CT/US facilitates 

accurate preoperative planning in both the primary and reoperative 

settings. 

S041 

INTRAOPERATIVE PARATHYROID HORMONE MONITORING IN 

PARATHYROIDECTOMY; IS IT MANDATORY? Aviram Mizrachi, MD, 

Gideon Bachar, MD, Tuvia Hadar, MD, Raphael Feinmesser, MD, Thomas 

Shpitzer, MD; Department of Otorhinolaryngology and Head and Neck 

Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, and 

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 

Objective: To determine the value of intraoperative parathyroid 

hormone (IOPTH) monitoring in curative parathyroidectomy. Design: 

Retrospective series. Setting: University-affiliated tertiary medical 

center. Patients and Methods: Two hundred forty consecutive patients 

surgically treated for primary hyperparathyroidism were divided into 3 

groups by preoperative and intraoperative diagnostic modalities: group 1 

(n=109) - technetium 99m sestamibi (MIBI), ultrasonography, and IOPTH 

monitoring; group 2 (n=102) - ultrasonography and MIBI; group 3 (n=29) - 

ultrasonography and IOPTH monitoring. The sensitivity and specificity of 

each combination were compared. Results: Group 1: Ultrasonography 

and MIBI were concordant in 97% of cases, and additional IOPTH 

monitoring improved the success rate in the 3 discordant cases. Group 

www.ahns.info 

2: Ultrasonography and MIBI were concordant for the same site in 

95% of cases. Group 3: Ultrasonography had a sensitivity of 89% and 

a positive predictive value (PPV) of 96%. IOPTH monitoring increased 

the sensitivity to 96%, with no change in the PPV. Operative time was 

significantly longer (P

Oral Papers 

weeks). Pretreatment levels (% and absolute counts) of CD3, CD4, CD8, 

NK, and B cells and overall WBC were measured by flow cytometry. 

Correlations of subsets with HPV-16 status, tumor subsite, stage, T 

class, N class, smoking status, performance status, gender, response to 

chemoradiation, p53 mutation, EGFR expression and disease specific 

and overall survival were determined. Results: With median follow 

up of 6.6 years, 4-year disease specific survival was 76%. Improved 

survival was associated with elevated %CD8 levels, low CD4/CD8 ratio 

(p=.043, p=.11 respectively), low EGFR expression (p=.002), and HPV 

status (p=.017). Percent CD8 cell levels were significantly higher in 

HPV+ patients (p=0.038) and the CD4/CD8 ratio was lower (p=0.021). 

Total WBC tended to be lower in HPV+ patients (p=0.016). Mean WBC 

was higher and hemoglobin significantly lower in smokers compared 

to former or never smokers, but there were no significant differences in 

lymphocyte subsets among smokers and non-smokers. Higher %CD8 

cells were associated with response to induction chemotherapy (p=.022) 

and complete tumor response after chemoradiation (p=.045). Local 

failure was assocciated with low CD8 levels(p=.035). Conclusions: 

These findings confirm prior correlations of outcome with CD8 cell 

levels in patients with head and neck cancer in long term follow up 

of a prospective cohort of advanced oropharyngeal cancer patients. 

These are the first data demonstrating an association of higher levels of 

cytotoxic T lymphocytes with HPV+ cancer and support the conjecture 

that improved adaptive immunity may play a role in the favorable 

prognosis of these patients. 

S044 

FAS AND FAS LIGAND POLYMORPHISMS AND RISK OF SECOND 

PRIMARY MALIGNANCY IN PATIENTS WITH INDEX SQUAMOUS 

CELL CARCINOMA OF THE HEAD AND NECK. Mark E Zafereo, MD, 

Erich M Sturgis, MD, Dapeng Lei, Qingyi Wei, PhD, Guojun Li, PhD; MD 

Anderson Cancer Center. 

Objective: To examine the association between functional promoter 

single nucleotide polymorphisms of the FAS and FAS ligand (FASLG) 

genes and risk of second primary malignancy (SPM) after index 

squamous cell carcinoma of the head and neck (SCCHN). Methods: 

We genotyped the FAS-1377 G>A, FAS-670 A>G, FASLG-844 C>T, 

and FASLG IVS2nt-124 A>G polymorphisms in 1286 incident SCCHN 

patients who were prospectively recruited between 1995 and 2006 

and followed for SPM development. Results: One hundred twenty 

patients (9%) developed SPM: 85 (71%) tobacco-associated sites and 

35 (29%) non-tobacco-associated sites. Compared with the FAS-670 

AA and FASLG-844 CC genotypes, the FAS-670 (AG+GG) genotype 

and FASLG-844 (CT+TT) genotypes were associated with an increased 

SPM risk (P = 0.014 and 0.038, respectively) (HR, 1.57; 95% CI, 1.00- 

2.54 and HR 1.71; 95% CI, 1.15-2.54, respectively). No significantly 

increased SPM risk was associated with the FAS-1377 G>A and FASLG 

IVS2nt-124 A>G polymorphisms. After combining risk genotypes for all 

four polymorphisms, rates of SPM development with 0-1, 2, 3, and 4 risk 

genotypes were 6%, 9%, 11%, and 13%, respectively, and a stepwise 

increase in SPM risk was observed with increasing number of risk 

genotypes (P=0.004 for trend). Patients with 4 risk genotypes had a 2.5- 

fold increased risk for SPM compared to patients with 0-1 risk genotypes 

(HR, 2.53; 95% CI, 1.26-5.06). Conclusion: This large prospective 

cohort study supports a modestly increased risk of SPM after index 

SCCHN with FAS-670 A>G and FASLG-844 C>T polymorphisms and an 

even greater risk of SPM with multiple combined FAS and FASLG risk 

genotypes. 

S045 

TRANSORAL SURGERY USING ROBOTIC SURGICAL SYSTEM FOR 

HYPOPHARYNGEAL CARCINOMAS. Se-Heon Kim, MD, Young Min 

Park, MD, Won Shik Kim, MD, Jin Sei Jung, MD, Eun Chang Choi, MD; 

Yonse University College of Medicine. 

Objectives: Recent application of robotic technology in the fields 

of surgery has brought about improvement of minimally invasive 

techniques, which in turn, leads to decreased postoperative morbidity. 

In the treatment of hypopharyngeal carcinomas, performing transoral 

robotic surgery (TORS) may achieve a lower surgical morbidity rate 

as well as higher chance of organ preservation. Methods: TORS 

was performed using da Vinci Surgical Robot (Intuitive Surgical, Inc., 

Sunnyvale, CA) in nine patients with T1 or T2 pyriform sinus cancer. 

FK retractor (Gyrus Medical Inc., Maple Grove, MN) was used for 

transoral exposure of the lesion. A face-up 30-degree endoscope was 

inserted through the oral cavity and two instrument arms were located 

in both sides of the endoscope. Pyriform sinus was resected totally as 

cone-shape, and ipsilateral arytenoid cartilage was saved for function 

preservation. Inner perichondrium of thyroid cartilage was peeled off 

after perichondrium was incised horizontally to make sure safe margin 

of antero-lateral portion in pyriform sinus cancer cases. Results: TORS 

was performed successfully in all nine patients. The mean robotic 

operation time was 62.3 minutes, and an average of 15.6 minutes was 

required for the setting of the robotic system. There was no significant 

perioperative complication in all cases. Swallowing function completely 

returned in all patients within 7.8 days average. Decannulation could be 

carried out within an average of 6.2 days after surgery. Conclusions: 

Technical feasibility and efficacy of TORS for pyriform sinus resection 

was proven in this study. We propose TORS as a treatment option for 

organ preservation to increase the quality of life of the patients. 

S046 

TRANSORAL HIGHLY ARTICULATED ROBOTIC SURGERY (THARS) 

OF THE LARYNX: A NOVEL TECHNOLOGY AND APPLICATION. 

Carlos M Rivera-Serrano, MD, Brett Zubiate, MS, Rick Kuenzler, Howie 

Choset, Marco Zenati, MD, Steve Tully, Ummaheswar Duvvuri, MD PhD; 

University of Pittsburgh; Cardiorobotics, Inc; Carnegie Mellon University. 

Objectives: One of the major focuses in Head and Neck oncology is on 

organ preservation surgery. The current trend is to improve quality of life 

and decrease treatment-related morbidity using a variety of technology, 

which includes robotic surgery. Transoral robotic surgery (TORS) was 

developed to overcome limitations of traditional approaches, such as 

poor visualization and surgical precision. The most widely used system 

in robotic procedures is the da Vinci Surgical System (Intuitive Surgical, 

Sunnyvale, CA). Although the da Vinci Surgical System offers clear 

surgical advantages over traditional approaches, it still has restrictions. 

Despite ‘wristed’ tips, it has rigid operative arms that limit the degrees 

of movement in complex 3 dimensional spaces. In contrast, the ideal 

operative scenario in transoral robotic surgery of the upper aerodigestive 

tract is to have flexible robotic arms that configure to the anatomy 

of the patient. We present the foundations, novel modifications, and 

the first trials in cadaveric heads and necks (larynges), of the use of a 

highly articulated robotic probe, which is a teleoperated 102 degree 

of freedom device that can steer a self-supported, non-linear path. 

Study Design: Feasibility. Methods: Using human cadavers and 

anthropomorphic dummies, we investigated the feasibility of visualizing 

the endolarynx transorally with a highly articulated robotic probe, without 

performing suspension of the larynx. Two fresh and three preserved 

human specimens were used. Results: We were able to visualize the 

endolarynx in all specimens. The use of standard mouth retractors 

facilitated the initial delivery of the robot into the pharynx and endolarynx. 

A Needle for simulation of vocal fold injection was used through 

a channel of the robotic arm. Fiberoptic technology for visualization was 

employed, but failed to reveal fine anatomic detail. Conclusions: Highly 

articulated robotic technology is promising and holds great potential in 

transoral laryngeal surgery and preservation surgery of the head and 

neck. THARS technology avoids disadvantages of laryngeal suspension 

and current robotic surgery with rigid instruments, and can potentially 

improve clinical outcomes of endolaryngeal procedures. Further 

improvement in optical fibers and imaging will facilitate the clinical use of 

highly articulated robots in head and neck surgery. 

S047 

TRANSORAL ROBOTIC SURGERY FOR HEAD AND NECK 

SQUAMOUS CELL CARCINOMA: 1 AND 2-YEAR SURVIVAL 

ANALYSIS. Hilliary N White, MD, Eric J Moore, MD, Jeffrey S Magnuson, 

MD; University of Alabama at Birmingham and Mayo Clinic in Rochester, 

Minnesota. 

Objective: To report early 1 and 2-year survival outcomes for head 

and neck squamous cell carcinoma using transoral robotic assisted 

resection. Study Design: Prospective case study. Methods: Outcomes 

from a cohort of 85 patients from two tertiary care centers (University of 

Alabama at Birmingham and the Mayo Clinic in Rochester, Minnesota) 

with head and neck squamous cell carcinoma of all stages and subsites 

that underwent transoral robotic assisted resection between March 2007 


Oral Papers 

and December 2008 were studied. The mean follow-up time was 26 

months (range 12 to 33 months). Results: Using a Kaplan-Meier survival 

analysis, the 1 and 2-year recurrence free survival for the cohort was 

90.5 and 87.7 respectively. There were 7 stage 3 tumors and 10 stage 4 

tumors. There had been a total of 11 recurrences: 3 local recurrences, 

6 regional recurrences, and 2 distant recurrences. At the time of the 

study 1 patient had died of their disease, 1 patient had died of other 

disease, and 2 patients were alive with disease. None of the patients 

were PEG dependent at last follow-up. Conclusion: The early functional 

and oncologic results justify the continued treatment of select head and 

neck squamous cell carcinoma patients with robotic assisted surgical 

resection. 

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47

Poster Papers 

P001 (COSM Poster #23) 

STAT3 ACTIVATION IN MYELOID DERIVED SUPPRESSOR CELLS 

OF HEAD AND NECK CANCER PATIENTS MAY REGULATE IMMUNE 

SUPPRESSIVE FUNCTION. David M Vasquez-Dunddel, MD PhD, Tullia 

C Bruno, MS, Emilia Albesiano, PhD, Juan Fu, PhD, Drew Pardoll, MD 

PhD, Young Kim, MD; PhD Sidney Kimmel Comprehensive Cancer 

Center, Johns Hopkins University School of Medicine, Baltimore, 

Maryland 21231, USA. 

Myeloid-derived suppressor cells (MDSC) have been demonstrated 

to play a key immune suppressive role in different types of cancer. 

Several mechanisms have been proposed to be associated with the 

suppressive activity of this group of cells. We focused our study in the 

relevance of STAT3 activation of peripheral circulating MDSC and intratumoral 

MDSC, characterized as CD33+ CD11b+ CD14+ HLA-DR-/low 

cells in patients with head and neck cancer. MDSC were isolated and 

multicolor cell analysis was performed. Our study demonstrated that 

head and neck cancer patients had elevated levels of circulating and 

intra-tumoral CD33+ CD11b+ CD14+ HLA-DR-/low MDSC cells that 

suppress autologous T-cell proliferation. These cells show a high level of 

phosphorylated STAT3 when compared with CD11b+ CD14+ HLA-DR+ 

cells. Understanding the association of these mechanisms is important 

for the design of future immunotherapeutic approaches for advanced 

head and neck malignancies. 


ROLE OF IMMUNOSUPPRESSIVE T CELLS IN PAPILLARY THYROID 

CARCINOMAS. Sofia Lyford-Pike, MD, Shiwen Peng, MD, Ralph P 

Tufano, MD, Sara I Pai, MD PhD; Johns Hopkins University School of 

Medicine. 

Background: Tumors can modulate their local microenvironment in 

order to evade immune surveillance mechanisms. Normally, effector 

T cells play an important role in eradicating abnormal cellular growth, 

whereas suppressor T cells dampen active immune responses to prevent 

processes such as autoimmunity. However, in the cancer setting, the 

presence of these suppressor T cells can facilitate tumor growth by 

counteracting effector T cell anti-tumor immune responses. Objective: 

To evaluate the role of suppressor T cells (specifically, regulatory T 

cells (CD25+CD4+FoxP3+) and the PD-1:PD-1 L1/L2 pathway) in the 

development of papillary thyroid cancer. Design: Patients diagnosed 

with papillary thyroid carcinoma who were undergoing surgical resection 

were eligible for the study. Mononuclear cells were isolated from the 

peripheral blood, primary thyroid tumor and contralateral normal thyroid 

tissue (CN). From these mononuclear cells, T cell populations were 

evaluated for the expression of CD4, CD8, CD25, CD45, CD3, PD-1, 

and FoxP3 using multi-color flow cytometry. Outcomes Measures: 

Cell population frequency and density were compared among 

peripheral blood, primary tumor and CN. Results: The frequency of 

CD25+CD4+FoxP3+ T cells was increased in tumors (mean 32.57%) 

when compared to CN (9.09%) or blood (4.57%), p=0.03. CD4+/PD- 

1+ T cells were increased in tumors when compared to CN or blood 

(means: 56.24%, 30.01%, 3.33%, respectively, p= 0.008). CD8+/ 

PD-1+ T cells were also increased in tumors compared to CN or blood 

(means: 57.80%, 29.31%, 4.82% respectively, p=0.006). Conclusion: 

Suppressor T cells are detected at high frequency in papillary thyroid 

cancers. This increased frequency may correlate with clinical outcomes. 

Although the presence of high numbers of these suppressor cells has 

been previously reported in the peripheral blood of cancer patients, this 

is the first report of their detection at high frequency within the primary 

tumor. Locally targeting these tumor-infiltrating immunosuppressive cell 

populations may enhance anti-tumor immune responses and thereby 

improve clinical outcomes. 


INDUCIBLE NITRIC OXIDE SYNTHASE (INOS)-DIRECTED 

TARGETED THERAPY REVERSES INFILTRATION OF 

IMMUNOSUPPRESSIVE MYELOID CELLS IN A MOUSE MODEL OF 

CUTANEOUS MELANOMA. Padmini Jayaraman, PhD, Falguni Parikh, 

MS, Foaz Kayali, MD PhD, Ian Sambur, MD, Vijay Mukhija, MD MPH, 

Nina Chinosornvatana, MD, Esther Lopez-Rivera, PhD, Johnny Kao, MD, 

Andrew G Sikora, MD PhD; Mount Sinai School of Medicine. 

Tumor-mediated immunosuppression is increasingly recognized to play 

an important role in cancer maintenance, progression, and resistance 


to immunotherapy. Myeloid-derived suppressor cells (MDSC) are 

immature myeloid cells which infiltrate solid tumors, including cutaneous 

melanoma, squamous cell carcinoma, breast, prostate, and other 

cancers. MDSC potently inhibit anti-tumor T lymphocyte responses 

through a variety of mechanisms including expression of the enzyme 

arginase, reactive oxygen species, and the production of nitric oxide 

(NO) by iNOS. While inhibitors of iNOS can antagonize suppression of T 

cell responses by MDSC, iNOS and NO have not previously been shown 

to play a role in the accumulation of MDSC into solid tumors. We tested 

the effect of the small molecule iNOS inhibitor N6-(1-Iminoethyl)-Llysine-dihydrochloride 

(L-NIL) on infiltration of MDSC into syngeneic B16 

murine melanoma in C57BL/6 mice. Flow cytometry analysis of singlecell 

suspensions from subcutaneous B16 tumors revealed progressive 

infiltration of GR1+CD11b+ MDSC. MDSC infiltration was correlated with 

elevated serum levels of vascular endothelial growth factor (VEGF), a 

soluble mediator associated with MDSC recruitment. Oral treatment of 

tumor-bearing mice with L-NIL reduced the intratumoral accumulation of 

MDSC by 2-5-fold, which was associated with a significant reduction of 

serum VEGF levels. The proportion of CD4+ and CD8+ T was diminished 

in the spleens of tumor-bearing mice; L-NIL treatment partly reversed 

the decline in CD4+ and CD8+ splenocytes, and was associated with a 

modest (20-30%) increase in tumor-infiltrating CD4+ and CD8+ T cells, 

and enhanced infiltration of natural killer (NK) cells. In summary, targeted 

inhibition of iNOS reduces intratumoral MDSC infiltration and enhances 

trafficking of immunocytes into melanoma, suggesting a potential 

strategy for reversing tumor-mediated immunosuppression. 


SOLUBLE FACTORS PRODUCED BY ORAL SQUAMOUS CELL 

CARCINOMA STIMULATE OSTEOCLASTOGENESIS. Mohammed 

AlKindi, DDS ScOMS, Osama Hussien, MD DS, Svetlana Komarova, 

PhD; McGill University. 

Objective: Bone invasion by oral squamous cell carcinoma (OSCC) 

affects the patient’s quality of life as well as the disease prognosis. 

However, the precise mechanisms of interactions between OSCC cells 

and bone cells are poorly understood. Since osteoclasts are critical 

for bone destruction, we hypothesized that tumor cells can directly 

stimulate osteoclasts formation. Methods: BHY human OSCC cellline 

demonstrating bone invasive phenotype was cultured for 48 h and 

conditioned medium (CM) was collected. The effect of BHY CM on 

osteoclast formation from RAW 264.7 mouse monocytic cell line was 

assessed. Osteoclasts were identified as multinucleated TRAP-positive 

cells and expression of osteoclast markers Calcitonin receptor, RANK, 

Cathepsin K and TRAP was assessed by real-time PCR. Results: 

Addition of BHY CM (50%) to untreated RAW 264.7 did not induce 

osteoclast formation. However, when RAW 264.7 were primed with 

RANKL for 2 days and then treated with BHY CM, marked (2-6 fold) 

induction of osteoclastogenesis was observed. We have found that BHY 

CM induced ERK1/2 phosphorylation in osteoclast precursors. Treatment 

with MEK1/2 inhibitor PD98059 resulted with significant inhibition 

of BHY CM-induced osteoclastogenesis. In addition, p38 inhibitor 

SB203580, but not an inactive control SB202474, also significantly 

inhibited osteoclastogenic effect of BHY CM. Conclusion: Squamous 

cell carcinoma cells produce soluble factors that stimulate osteoclast 

formation from RANKL-primed precursors in the absence of supporting 

cell types. Tumor-derived factors act by stimulating ERK1/2 and p38 

MAPK pathway in osteoclast precursors. 


PRIMARY HEAD AND NECK SQUAMOUS CELL CARCINOMAS AND 

HNSCC-DERIVED XENOGRAFTS HAVE DISTINCTLY DIFFERENT 

METYHLATION AND EXPRESSION SIGNATURES THAN HNSCC- 

DERIVED CELL LINES. Patrick T Hennessey, MD, Michael F Ochs, 

PhD, Wojciech K Mydlarz, MD, Joseph A Calfiano, MD; Department 

of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical 

Institutions, Baltimore, MD. 

Objective: Alterations in promoter methylation and the resulting 

changes in gene expression have been shown to play a critical role in 

the pathogenesis of a wide variety of human cancers. Although primary 

tumors are preferred sources of DNA and RNA for studying methylation 

and gene expression changes in cancer, many studies rely on cell 

lines to investigate these relationships due to either a lack of access to

Poster Papers 

primary tumors or a lack of sufficient primary tumor for the experiments. 

To address the issue of having insufficient primary tumor available for 

research purposes, our lab grew xenografts from fresh primary tumors 

in nude mice. The methylation and expression patterns of tumor-derived 

xenografts, tumor-derived cell lines, and cell lines derived from normal 

oral mucosa were then compared to primary tumors. Design: Genomic 

DNA and total RNA were extracted from primary tumors, xenografts, 

and cell lines. Genomic DNA samples were analyzed by methylation 

microarrays. The RNA samples were analyzed using expression 

microarrays. Data from the microarrays were normalized and then 

analyzed independently using unsupervised hierarchical clustering. The 

data from both microarray platforms were subsequently analyzed using 

Significance Analysis of Microarrays (SAM) to generate lists differentially 

methylated and differentially expressed genes. Subjects: Genomic DNA 

and total RNA were extracted from five HNSCC cell lines (JHU-O11, 

JHU-O22, FADU, UM-22A and UM-22B), two cell lines derived from 

normal oral mucosa (OKF6 and NOK-SI), four primary HNSCC tumors 

and four matched tumor-derived xenografts grown in nude mice. 

Results: Unsupervised hierarchical clustering analysis of the normalized 

methylation array data demonstrated similar overall methylation in the 

primary tumors, xenografts and OKF6 cell line compared to the HNSCC 

cell lines and NOK-SI cell line, which was evident at the first branch point 

in the dendrogram. Globally, all of the cell lines except the OKF6 cell line 

were hypermethylated compared to the primary tumors and xenografts. 

Expression analysis demonstrated a clustering of primary tumors and 

xenografts into one group and all cell lines into a second group after 

the first branch point on the dendrogram. SAM analysis identified 239 

genes up-regulated and 941 genes down-regulated in both tumors 

and xenografts when compared to the cell lines. Conclusions: Tumorderived 

xenografts appear to better represent the methylation and gene 

expression signatures seen in primary tumors than HNSCC cell lines. 


THE ROLE OF MAGEA2 IN THE TUMORIGENIC PATHWAY OF 

HNSCC. Chad A Glazer, MD, Ian M Smith, MD, Sheetal Bhan, PhD, 

Wenyue Sun, PhD, Steven S Chang, MD, Kavita M Pattani, MD, William 

Westra, MD, Zubair Khan, MD, Joseph A Califano, MD; Johns Hopkins 

Medical Institutions. 

Objective: The disruption of p53 function via missense somatic 

mutations is known to be a central factor in the oncogenic pathway 

leading to HNSCC; however, many primary HNSCC tumors lack 

mutations in the TP53 tumor suppressor gene. It is currently unknown 

how the p53 pathway is silenced in this subset of HNSCC. Recent 

evidence has shown that the MAGEA family may be involved in the 

downstream silencing of p53 gene targets via the MAGEA2-p53 complex 

shown to be active in melanoma. In this study, we examine the role of 

MAGEA2 in the tumorigenesis of HNSCC. Methods: Primary tissue 

microarray data and quantitative RT-PCR (qRT-PCR) in a separate cohort 

of primary tissue showed that MAGEA2 is differentially overexpressed in 

HNSCC. Anchorage dependent growth studies and cell cycle analysis 

using flow cytometry were performed in normal upper aerodigestive cell 

lines after transfection with a MAGE2 construct. Small interfering RNAs 

(siRNA) were then used to knockdown MAGEA2 in HNSCC cells, and 

growth characteristics were examined. qRT-PCR was used to evaluate 

expression changes of p53 downstream targets following transfection 

of MAGEA2 into normal upper aerodigestive cell lines. Results: Cancer 

Outlier Profile Analysis (COPA) was used to analyze 49 HNSCC tumors 

and 19 normal upper aerodigestive tissue mRNA expression arrays. 

This analysis showed that MAGEA2 was significantly overexpressed 

in 15/49 tumors (30%) (p

Poster Papers 

PDH activity thereby increasing aerobic glycolytic metabolites, resulting 

in normoxic HIF1α stabilization. This study suggests a role for chronic 

tobacco exposure in the development of aerobic glycolysis and 

normoxic HIFα activation as a part of HNSCC initiation. These data may 

provide insights into development of chemopreventive strategies for 

smoking related cancers. 


SNAIL CONTROLS THE MESENCHYMAL PHENOTYPE AND DRIVES 

ERLOTINIB RESISTANCE IN HNSCC CELLS. Guanyu Wang, MD PhD, 

David Hu, MD, Jie Luo, MS, Mariam Dohadwala, PhD, Qahera Munaim, 

Ontario Lau, MD, Chi Lai, MD, David Elashoff, PhD, Steven Dubinett, 

MD, Maie St. John, MD PhD; University of California, Los Angeles, 

Jonsson Comprehensive Cancer Center. 

Purpose: The presence of regional metastases in HNSCC patients 

is a common and adverse event associated with poor prognosis. 

Understanding the molecular mechanisms that mediate HNSCC 

metastasis may enable identification of novel therapeutic targets. 

Our recent work on human HNSCC tissues underlies Snail’s role as a 

molecular prognostic marker for HNSCC. Snail positivity is significantly 

predictive of poorly differentiated, lymphovascular invasive, as well as 

regionally metastatic tumors. We recently reported the role of Snail in 

the inflammation-induced promotion of EMT in HNSCC. However, other 

important Snail-dependent malignant phenotypes have not been fully 

explored. Here, we investigate the capacity of Snail to drive EMT in 

human oral epithelial cell lines, and its ability to confer drug resistance. 

Experimental Design: Snail was overexpressed in HOK and OKF 

oral epithelial cell lines. AIG assays, wound healing assays, invasion & 

migration assays, spheroid modeling, and drug resistance assays were 

performed. Differential gene expression between Snail-overexpressing 

and control epithelial and tumor cell lines was evaluated using gene 

expression microarray analysis. Results: The overexpression of Snail 

in human oral epithelial cell lines ( HOK, OKF) drives EMT. OKF-Snail 

and HOK-Snail lines demonstrate growth in Anchorage-independent 

growth assays; a decreased capacity to form tight spheroids; increased 

resistance to erlotinib; and they were highly invasive and migratory. Gene 

expression analysis also revealed Snail-associated differential gene 

expression with the potential to affect inflammatory cytokine regulation, 

migration, invasion and diverse aspects of HNSCC progression. 

Conclusion: Snail controls the mesenchymal phenotype and drives 

erlotinib resistance in HNSCC cells. Snail may prove to be a useful 

marker in predicting EGFR inhibitor responsiveness. 


NEW MECHANISMS THAT REGULATE C-MYC ONCOGENIC 

ACTIVITY IN HEAD AND NECK SQUAMOUS CELL CARCINOMA. 

Vivian F Wu, MD MPH, Amy Farrell, PhD, Xiao-Jing Wang, MD PhD, 

Rosalie C Sears, PhD Departments of Otolaryngology-Head and Neck 

Surgery and Molecular and Medical Genetics, Oregon Health and 

Science University, Portland OR; Department of Pathology, University of 

Colorado Denver Health Sciences Center, Aurora, CO. 

Background: c-Myc protein is highly expressed in approximately 70% 

of human tumors, including head and neck squamous cell carcinoma 

(HNSCC). Recent research by our laboratory and others has revealed 

a novel signaling pathway that controls c-Myc protein stability through 

two conserved phosphorylation sites, threonine 58 (T58) and serine 

62 (S62), providing another mechanism for the accumulation of c-Myc 

in human tumors. Since many of the proteins involved in controlling 

c-Myc expression through a phosphorylation dependent degradation 

pathway can be misregulated in human cancer, we predict that 

aberrant phosphorylation of c-Myc is a major mechanism for c-Myc 

overexpression in cancer. Our research using a novel c-Myc knock-in 

mouse model shows that c-Myc mutation at Threonine 58 to Alanine, 

which leads to constitutive Serine 62 phosphorylation and increased 

c-Myc stability, increases epithelial cell proliferation and can lead to 

hyperplasia in the upper aerodigestive tract, including the tongue 

and esophagus. Altered c-Myc stabilization thus may be needed to 

initiate head and neck tumor formation. Objective: To examine c-Myc 

phosphorylation and stabilization in HNSCC development. Methods: 

Human HNSCC and normal tissue samples were obtained through 

Institutional Review Board approved protocols. Protein, RNA, DNA 

and tissue sections were prepared from these samples. We then 

evaluated phosphorylation patterns of c-Myc at T58 and S62 in human 

HNSCC samples and compared them to normal tissue. We correlated 

phosphorylation status to recurrence patterns and disease stage. 

Setting: Tertiary care academic medical center. Results: 

Immunofluorescence indicates overexpression of c-Myc oncoprotein 

in 7/7 tumor samples compared to adjacent tissue. Furthermore, total 

Myc and pS62 were increased and pT58 was decreased in tumor 

compared to adjacent tissue. This was confirmed by immunoblot. In 

addition, analysis of mRNA indicated a subset with elevation: 5/26 

(19.2%) in human HNSCC samples. Interestingly, of the 5 samples with 

elevated mRNA, 3 samples (60%) were recurrences of oral cavity or 

oropharyngeal SCC (including one patient with dermal metastasis) and 

the other 2 were advanced stage larynx SCC. Of the 21 samples without 

elevated myc expression, 7/21 (33%) were recurrent cancer with 19/21 

samples being advanced stage SCC. Conclusions: Total c-Myc and 

S62 phosphorylation appears to be elevated in human HNSCC while 

T58 phosphorylation is decreased. This is consistent with the c-Myc 

phosphorylation pattern seen in other cancers such as breast and 

Burkitts lymphoma. Understanding the role of c-Myc phosphorylation 

patterns will provide better strategies for creating targeted therapies for 

application in clinical trials for HNSCC. 


GENOMIC SCREENING IN DIFFERENT HISTOLOGICAL STAGES IN 

ORAL SQUAMOUS CELL CARCINOMAS. Sabrina Daniela da Silva, 

PhD, Fabio Aubuquerque Marchi, MSc, Fernando Augusto Soares, PhD, 

Silvia Regina Rogatto, PhD, Luiz Paulo Kowalski, PhD; AC Camargo 

Hospital. 

Background: Despite of progress in therapy, the prognosis of patients 

with oral squamous cell carcinoma (OSCC) has still not improved 

significantly over the last decades. These tumors are associated with 

several genetic/epigenetic changes and substantial efforts have been 

prompted to identify molecular biomarkers to predict cancer risk and 

prognosis. Objectives: Array comparative genomic hybridization (aCGH) 

analysis was performed in order to identify chromosomal imbalances 

and genome-wide screening in different histological graduation groups of 

OSCC. Methods: Were included 30 fresh frozen samples (3 groups with 

10 primary OSCC samples in histological grade I, II, and III) and normal 

reference genomic DNA from commercial source. Clinical and treatment 

data were obtained from the medical records and all histological 

diagnosis was reviewed. OSCC was microdissected using laser capture 

microdissection (LCM) and DNA hybridization was performed in Agilent’s 

44K arrays. The expression differences for 5 selected genes were 

confirmed by immunohistochemical reaction in a TMA with 75 OSCC. 

Results: Copy number changes were detected in 90% of the cases. It 

was observed that there is a pattern for genomic instability with gain and 

losses in the chromosome of these samples. The most recurrent copy 

number changes were gains at 1, 2, 8, 11, 12, and 17. These regions 

showed similarity in their pattern of imbalance to the chromosomal 

alterations described in all three groups. The protein expression of 

topoisomerase-II alpha was associated with invasive tumors (P=0.042) 

and vascular embolization (P=0.044). Transforming growth factorbeta3 

(TGFB3) was correlated with smoking patients (P=0.026) and 

cellular proliferation (Ki_67 - P=0.023). N-myc downstream-regulated 

gene (NDRG1) showed significance association with signal transducer 

and activator of transcription (STAT1 P

Poster Papers 

varying concentrations of MK-2206. Cell counts were performed using 

flow cytometry, and gel electrophoresis on cell lystaes were run to 

probe markers of Akt activity by Western Blot. Nude mice with human 

SCC1-flank tumor xenografts were treated with oral dosing of 120 mg/ 

kg of MK-2206 thrice weekly. Tumor size was assessed after each 

treatment using digital calipers. Results: Treatment with MK-2206 

was sufficient to kill over 50% of all 3 cells lines at 1.5 uM and over 

95% of cells at 2.5 uM in 48 hours. Western blots of cell lysates at 48 

hours showed decreased phosphorylization of Akt at the T308 residue 

as well as lowered expression of the downstream markers GSKb and 

pRAS40. MK-2206 treatment of nude mice bearing xenografted SCC1 

flank tumor were significantly smaller compared to untreated controls 

(p=0.05). Conclusions: This data supports the further exploration of the 

AKT pathway inhibitor, MK-2206, as a novel inhibitor in head and neck 

cancer. 


MOLECULAR MARKERS OF MRN IN CISPLATIN-BASED 

CHEMORESISTANCE WITH HUMAN HEAD AND NECK CANCER. 

Taku Yamashita, MD PhD, Shunsuke Miyamoto, MD, Wei-Ting Hwang, 

PhD, Bert W OαMalley, MD PhD, Daqing Li, MD PhD; University of 

Pennsylvania School of Medicine, Philadelphia, PA. 

Background: Chemoresistance to cisplatin significantly contributes 

to treatment failure in clinical practice for head and neck cancer. The 

MRE11/RAD50/NBS1 (MRN) complex is well known a major DNA 

repair system. Our previous in vitro study shows that enhanced DNA 

repairing by MRN is a critical molecular mechanism for cisplatinbased 

chemoresistance. The present study further investigates if the 

finding of enhanced DNA repairing is responsible for cisplatin-based 

chemoresistance with human head and neck squamous cell carcinoma 

(HNSCC) in an animal model and if this finding correlates to the clinical 

study with patients who suffer from HNSCC. Methods: An animal model 

with human HNSCC was used for this study. Tumor volume changes 

were measured in two dimensions and the net intensities of fluorescence 

from the tumor with tdTomato were also measured before and after 

cisplatin treatment. Immunohistochemistry studies were carried out 

for detecting the MRN expression and apoptosis. The chemoresistant 

profile of the tumor model was established depending on these studies. 

The patients with HNSCC who initially received cisplatin monotherapy 

were investigated. Immunohistochemistry studies were conducted 

for detecting the MRN expression and apoptosis. These results were 

analyzed by using a linear regression model with random effects to 

compare with established animal tumor model and in vitro findings. 

Results: Our animal model demonstrated that chemoresistance 

to cisplatin is associated with increased expression levels of MRN 

after cisplatin treatment (p

Poster Papers 

immunohistochemistry. Cytoplasmic and nuclear levels of the protein 

were scored. Adjacent noncancerous tissue was taken from each sample 

for a control. RNA was extracted from the respective tissues and RT- 

PCR analysis of COX-2, VEGF and TNF-α was carried out. Subjects: 

Adult patients who underwent treatment for squamous cell carcinoma 

of the oral tongue. Results: Preliminary data demonstrate that HuR 

is increasingly localized in the cytoplasm rather than the nucleus 

with increasing stage. Accordingly, VEGF, TNF-α, and COX-2 mRNA 

levels were found to increase exponentially by RT-PCR. Scoring of the 

immunohistochemical staining and quantification of HuR by Western 

blotting is currently underway. Conclusions: Collectively, our data 

demonstrate that dominant role of HuR in oral cancer progression and 

correlated with increased COX-2, VEGF, and TNF-α mRNAs. 


DNA COPY NUMBER-ASSOCIATED DIFFERENTIAL GENE 

EXPRESSION BETWEEN TUMOR CELLS FROM METASTATIC 

LYMPH NODES VS. THOSE FROM NODE-NEGATIVE PRIMARY 

TUMORS IN ORAL CANCER. Eduardo Mendez, Chang Xu, Yan 

Liu, Wenhong Fan, Melissa P Upton, John R Houck, Pawadee 

Lohavanichbutr, David R Doody, Neal D Futran, Lue P Zhao, Stephen 

M Schwartz, Pei Wang, Chu Chen; University of Washington/Fred 

Hutchinson Cancer Research Center. 

To identify DNA copy number–associated gene expression changes that 

may play an important role in oral squamous cell carcinoma (OSCC) 

metastasis, we interrogated DNA and RNA isolated from tumor cells 

from metastatic lymph nodes (n=20) and those from non-metastatic 

primary tumors (n=17) using Affymetrix 250K Nsp single nucleotide 

polymorphism arrays and U133 Plus 2.0 expression arrays, respectively. 

After data normalization and filtering, 19,791 expression transcripts 

remained for analysis. Overall, copy number aberration (CNA) accounted 

for expression changes in about 48% of the transcripts studied. With a 

false positive rate < 5%, 1,985 transcripts were found to be differentially 

expressed between tumor cells from metastatic lymph nodes and 

those from node-negative primary tumors. Out of these, 114 were 

found to have a significant correlation between DNA copy number and 

gene expression (False Discovery Rate (FDR)

Poster Papers 


MOLECULAR DISRUPTION OF RAD50 SENSITIZES HEAD AND 

NECK CANCER TO RADIATION THERAPY. Shunsuke Miyamoto, MD, 

Hui Wang, PhD, Taku Yamashita, MD PhD, Bert W O’Malley Jr., MD, 

Daqing Li, MD; The University of Pennsylvania, School of Medicine, 

Department of Otorhinolaryngology-Head & Neck Surgery, Philadelphia, 

PA. 

Purpose: Current combined external beam radiation therapy (XRT) and 

chemotherapy have demonstrated as a definitive or adjuvant therapy 

against advanced head and neck cancers. However, combined modality 

treatments often result in intolerable levels of toxicity to the patients. It 

has been well-known that enhanced DNA double strand break (DSB) 

repairing is one of the most important mechanisms for developing 

radioresistance in the tumor cells and a protein complex consisting of 

Mre11, Rad50, Nbs1 (MRN) acts as a critical component in the repair of 

DNA DSB. The present study investigates if the use of targeted Rad50 

disruption could sensitize the tumor cells to XRT for the treatment of 

human head and neck squamous cell carcinoma (HNSCC). Our goal 

is to establish a most effective treatment strategy while minimizing 

XRT morbidity for the HNSCC. Method: Two human HNSCC tumor 

cell lines, JHU012 and JHU022, and nude mice as animal model were 

used in this study. A dominant-negative recombinant adenoviral vector 

containing mutant Rad50 (Ad-Rad50) was constructed. The tumors 

were treated with Ad-Rad50, replication-defective virus (DL312), or 

untreated as mock control and XRT at a dose of 2 Gy. Cell viability and 

tumor volume were evaluated to analyze anti-tumor activity of different 

treatment groups. Neutral comet assay was performed for quantification 

of DNA DSB damage. Apoptosis in tumor cells was evaluated by 

using immunohistochemistry. Result: Our study demonstrates that 

targeted Rad50 disruption by Ad-Rad50 significantly interrupts the 

DNA DSB repairing and increases DNA damage associated with 

apoptosis in the tumor cells. Increased levels of tumor cell apoptosis 

were found associated with combined Ad-Rad50 and XRT treatment 

group. The combined Ad-Rad50 and XRT treatment demonstrated 

the best anti-tumor result relative to other groups both in vitro and in 

vivo. Conclusion: The present study suggests that Ad-Rad50 gene 

transfer effectively interrupts DNA DSB repairing and results in inducing 

significant radiosensitization in the HNSCC tumor cells to XRT. This 

strategy is potentially applicable to advanced head and neck cancer in 

the human. 


EXPRESSION OF VEGF-C IN ORAL SQUAMOUS CELL 

CARCINOMA CORRELATES WITH SENTINEL LYMPH NODE 

LYMPHANGIOGENESIS. HIROKI ISHII, KAZUAKI CHIKAMATSU, 

KOICHI SAKAKURA, MASANORI MIYATA, NOBUHIKO FURUYA, 

KEISUKE MASUYAMA; Department of Otolaryngology-Head and Neck 

Surgery, University of Yamanashi, Gunma University. 

Objective: The most important prognostic factor in patients with oral 

squamous cell carcinoma (OSCC) is regional lymph node metastases, 

which usually spreads first to the sentinel lymph nodes (SLNs). However, 

little is known about molecular mechanisms by which tumors spread to 

the lymphatic vessels, to the SLNs and distal lymph nodes. In this study, 

we investigated whether primary tumors induce lymphangiogenesis 

within SLNs in patients with OSCC. Methods: Twenty-three metastasisnegative 

SLNs obtained from 10 patients with OSCC were evaluated 

for the mRNA expression of VEGFR-3 and LYVE-1 using a real-time 

quantitative RT-PCR assay, and compared with control lymph nodes 

from 10 patients with non-cancerous diseases. We also investigated 

VEGF-C expression of the primary tumor by immunohistochemistry. 

Results: In SLNs, there was highly significant correlation between 

the expression of two lymphatic markers examined. Notably, the level 

of LYVE-1 expression in SLNs, despite the absence of metastasis, 

was significantly higher compared with that in control lymph nodes. 

Moreover, SLNs from patients with VEGF-C-positive tumor showed 

significantly higher expression of VEGFR-3 than those from patients 

with VEGF-C-negative tumor. Conclusions: Our results suggest that the 

primary tumor induces lymphangiogenesis in SLNs before metastasizing, 

and that VEGF-C may play an important role in the metastatic process of 

OSCC. 


INACTIVE MUTATIONS OF THE C-KIT SIGNALING PATHWAY IN 

ADENOID CYSTIC CARCINOMA OF THE SALIVARY GLANDS: 

IMPLICATIONS FOR C-KIT TARGETED THERAPY. Osamu Tetsu, MD 

PhD, Janyaporn Phuchareon, PhD, Annie Chou, DDS, Darren P Cox, 

DDS MBA, David W Eisele, MD, Richard C Jordan, DDS PhD; Head and 

Neck Cancer Research Laboratory, Department of Otolaryngology-Head 

and Neck Surgery, School of Medicine, University of California, San 

Francisco, San Francisco, California. 

Adenoid cystic carcinoma (ACC) is a malignant salivary gland neoplasm 

well-known for its potential to invade structures of the head and neck, 

spread along nerves, and to metastasize systemically, particularly to the 

lungs. Unfortunately, conventional therapies for this malignancy often 

result in significant morbidity but have not improved the low long-term 

survival rate. Improved systemic therapies are clearly needed for this 

disease. ACC consistently shows overexpression of the receptor tyrosine 

kinase c-Kit, which has been considered to be a therapeutic target. 

However, the role of c-Kit in the pathogenesis of ACC is not currently 

understood. We performed mutational analysis of the c-Kit gene (KIT) 

and its downstream effectors including HRAS, KRAS, NRAS, BRAF, 

PIK3CA and PTEN in 17 ACC. We identified that two ACC had distinct 

missense mutations in the c-Kit gene, resulting in G664R and R796G 

amino acid substitutions in the kinase domain. Furthermore, two ACC 

tumors without KIT mutations had missense mutations in either KRAS 

or BRAF, resulting in S17N K-Ras and V590I B-Raf mutants. We then 

explored the functional consequences of these amino acid substitutions 

in cultured cells and found that these c-Kit, K-Ras and B-Raf mutations 

were inactive. These observations suggest that the c-Kit signaling 

pathway must be dispensable for maintaining an established ACC 

phenotype. As a result, our findings suggest that selective c-Kit inhibition 

is not a suitable treatment strategy for ACC. 


STEM CELL MEDIATED TARGETED THERAPY ON THE HEAD AND 

NECK SQUAMOUS CELL CARCINOMA. Seong Keun Kwon, MD PhD, 

Seung U. Kim, MD PhD; Dongguk University Ilsan Hospital. 

Introduction: 5-fluorouracil (5-FU), is the effective chemotherapeutic 

agent in advanced head and neck cancer patients. However, it has 

serious side effect and high dose levels are required for the response. 

Recently stem cells have been explored as potential vehicles for delivery 

of anti-cancer agents due to tropism for tumor locations. Cytosine 

deaminase (CD) can convert far less toxic substrate 5-fluorocytosine 

(5-FC) to 5-FU. In this study, we aim to elucidate the role of stem cell 

transfected with CD in head and neck cancer animal model. Method: 

1) Cell proliferation assays. F3.CD(neural stem cell transfected with 

CD gene), F3(neural stem cell) were incubated by themselves or with 

and SNU-1041 (head and neck cancer cell line) . Culture medium was 

replaced with medium containing 0 to 1500 ng/mL 5-FC. Five days 

later, plates were subjected to the MTT assays. 2) In vivo stem cell 

migration assays: In nude mouse, SNU-1041 cells were subcutaneously 

injected. One week later, F3.CD cells tagged with Feridex were injected 

via tail vein. One week later stem cell injection, mouse were sacrificed 

and Prussian blue staining was done. 3) In vivo anti-cancer effectof 

systemically administered F3.CD: In nude mouse, SNU-1041 cells were 

subcutaneously injected. On week after, F3.CD cells were injected via tail 

vein. Animals were treated with 500 mg/kg/d 5-FC i.p. in two rounds of 5 

consecutive days with 2-day break. Tumor volume was measured every 

day. Results: 1) 5-FC did not affect SNU-1041 or F3 cell proliferation, 

however, it inhibited F3.CD cell and SNU-1041 cocultured with F3.CD in 

dose dependent manner. 2) On Prussian blue staining, stem cells were 

identified only around the tumor. 3) Significant inhibition of tumor growth 

was observed in all animals injected with F3.CD by day 14. None of the 

animals exhibited any signs of toxic side effects. Conclusion: Stem cells 

transfected with suicide gene showed anticancer effect without the side 

effect. Stem cell based treatment can be a powerful strategy of targeted 

therapy. 

www.ahns.info 

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Poster Papers 


THERAPUTIC TARGETING OF TRK SUPRESSES TUMOR 

PROLIFERATION AND ENHANCES CISPLATIN ACTIVITY IN HNSCC. 

Turker Yilmaz, MD, Tilahun W Jiffar, PhD, Gabriel de la Garza, Heather 

Lin, Jeffrey N Myers, MD PhD, Michael E Kupferman, MD; MD Anderson 

Cancer Center, University of Texas. 

Head and neck squamous cell carcinoma (HNSCC) is a biologically 

aggressive disease that has been modestly impacted by improvements 

in therapeutic strategies. Several lines of evidence support the role of 

TrkB for invasion and metastasis in various solid tumor models, and 

we have shown an important function of this receptor in HNSCC tumor 

biology. Therapeutic modulation of TrkB function has been supported 

in the literature by the development of small molecule inhibitors 

(SMI) with minimal success. To assess the validity of targeting TrkB 

in HNSCC, we tested a novel SMI, AZ64, and show significant dose 

and time-dependant inhibition of cellular proliferation in cell lines. 

Genetic studies revealed the specificity of this compound for the TrkB 

receptor, as exposure of cells that had genetic suppression of TrkB did 

not demonstrate abrogated oncogenic signaling. We next assessed 

the impact of AZ64 as a chemotherapy-sensitizer, and identified an 

enhancement of cisplatin-mediated anti-proliferation across all cell 

lines. We then demonstrated that AZ64 can overcome chemotherapy 

resistance in a novel model of cisplatin resistance in HNSCC. Modulation 

of the pro-oncogenic STAT3 and Src pathways was identified, 

suggesting molecular mechanisms of action for AZ64. In this study, 

we demonstrate the feasibility of targeting TrkB, and suggest a novel 

approach for the treatment of some chemotherapy-resistant HNSCC. 


MASTER REGULATOR OR FIBROSIS EFFECTOR: OPTIMIZING 

THE TARGET IN RADIATION SKIN INJURY PREVENTION. Benjamin 

R Roman, MD, Sara B Immerman, MD, Judy W Lee, MD, Richard A 

Zoumalan, MD, Mark D DeLacure, MD FACS, Pierre B Saadeh, MD; New 

York University Langone Medical Center. 

Background: Radiated skin undergoes fibrotic changes due to activation 

of the transforming growth factor-B (TGFB) cascade. A downstream 

effector is SMAD3, a nuclear transcription factor that directly activates 

genes involved in extracellular matrix production and the upstream 

master regulator, TGFB1. In order to define the relative roles of TGFB1 

and SMAD3 in radiation injury, we inhibited both with transcutaneouslydelivered 

small interfering RNA (siRNA). Methods: The dorsal skin of 

FVB wild-type mice was isolated and radiated (45Gy). TGFB1, SMAD3, 

or nonsense siRNA was delivered using an agarose-based delivery 

matrix to two separate dorsal skin areas immediately after radiation 

and every five days thereafter. Skin was harvested after 4 or 8 weeks. 

TGFB1 and SMAD3 expression was assessed by hematoxylin and eosin 

(H&E) staining, immunohistochemistry (IHC), Western blot, and RT-PCR. 

Radiation-induced fibrosis was measured quantitatively via tensiometry 

to calculate Young’s modulus, a measure of rigidity. Results: Murine 

skin treated with topical SMAD3 or TGFB1 siRNA demonstrated effective 

inhibition of these genes at week 4 and persistent suppression at week 

8. Grossly, when compared to the TGFB1 and nonsense siRNA groups, 

the SMAD3 group exhibited substantially slower progression of radiation 

injury (i.e. erythema to dry desquamation to wet desquamation). On H&E, 

fibrotic changes including collagen deposition and epidermal thickening 

were significantly decreased in SMAD3 groups compared to controls. 

Interestingly, TGFB1 siRNA did not change the tissue architecture 

compared to control. TGFB1 silencing resulted in blunted SMAD3 

levels (Western blot/ RT-PCR) whereas SMAD3 silencing revealed near 

complete knockdown of itself. Tensiometry showed decreased tension 

in SMAD3 siRNA-treated skin as compared to nonsense siRNA (Young’s 

modulus of 9.29 MPa vs. 14.68 MPa; normal non-radiated skin was 7.78 

MPa). TGFB1 siRNA similar to nonsense. Conclusions: Only SMAD3 

silencing has a positive phenotypic and histologic effect on skin fibrosis. 

While the entire TGFB cascade is activated by radiation, SMAD3 may be 

the critical mediator of radiation-induced skin damage. 


LOCALIZED GENE SILENCING IN THE SKIN USING INTRA AND 

TRANSCUTANEOUS DELIVERY OF SIRNA. Benjamin R Roman, 

MD, Sara Immerman, MD, Richard A Zoumalan, MD, Judy W Lee, MD, 

Stephen M Warren, MD, Mark D Delacure, MD, Pierre B Saadeh, MD; 

NYU Medical Center. 

Background: Intra and transcutaneous drug delivery has evolved 

rapidly, with routine applications in dermatologic and systemic diseases. 

Concomitantly, siRNA has been used in the laboratory setting for 

molecular pathway research, but has only recently been brought to bear 

directly on diseases in vivo. Our research pairs these efforts to deliver 

siRNA to the skin, an organ readily amenable to topical therapy and 

beset by a vast array of targetable genetic derangements, including head 

and neck cancer, skin cancer, and radiation fibrosis. We demonstrate 

a novel method in a murine model of removing the stratum corneum 

to improve penetration, followed by a novel method of siRNA delivery 

to the skin. Methods: The dorsal skin of wild-type FVB mice was 

shaved/depilated. Experiments involving tape, ethanol, glycolic acid, 

phenol, and various doses of Triton-X identified the ideal pretreatment 

reagent. The stratum corneum was removed using this reagent, and 

naked siRNA (500 pmol) was delivered in an agarose matrix delimited 

in a hydrocolloid cutout and covered with a hydration-enhancing semiocclusive 

dressing. Knockdown of a housekeeping gene (MAPK1) was 

evaluated (immunohistochemistry [IHC], western blot, and RT-PCR). 

These techniques were then applied to a murine model of radiationinduced 

skin fibrosis to inhibit SMAD3, a key mediator of fibrosis. 

Results: H+E staining demonstrated that the stratum corneum was most 

effectively removed by 1% Triton X-100 after 4 hours. IHC demonstrated 

near complete full-thickness MAPK1 inhibition by 24 hours, with return 

to normal by 14 days. A similar time course of MAPK1 inhibition was 

confirmed by western blot and RT-PCR. SMAD3 siRNA pretreatment 

largely abrogated the dramatic increase in SMAD3 normally associated 

with 20gy irradiation of murine skin (IHC/RT-PCR). Downstream effectors 

of extracellular matrix deposition and fibrosis were similarly reduced. 

Conclusions: We demonstrate a novel method of temporary, local gene 

silencing in the skin by knocking down a housekeeping gene, as well as 

reversing molecular and histologic changes associated with radiationinduced 

skin injury. Cutaneous siRNA delivery has the potential to impact 

the treatment of a variety of diseases in the head and neck. 


ONCOGENIC RAS ACTIVATION ENHANCES CELL PERMISSIVENESS 

TO INFECTION AND ONCOLYSIS BY VACCINIA VIRUS. Babak Givi, 

MD, Chun-Hao Chen, MD, Pingdong Li, MD, Sen Li, Daniel L Price, 

MD, Nanhai Chen, PhD, Yong A Yu, PhD, Qian Zhang, MD PhD, Aladar 

A Szalay, PhD, Yuman Fong, MD, Richard J Wong, MD; Department 

of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; 

Genelux Corporation, San Diego Science Center, San Diego, CA. 

Background: Mutations of Ras may activate signaling pathways 

that affect cell proliferation, migration, cytoskeletal structure, and 

result in oncogenic transformation. Oncogenic Ras mutations are 

found in approximately 20% of all human cancers, including head 

& neck and thyroid cancers. Oncolytic vaccinia virus possesses a 

remarkable ability to selectively infect, replicate within, and lyse cancer 

cells in animal models. However, the cancer cell characteristics that 

promote their increased susceptibility to viral infection over normal 

cells have not been elucidated. Our goal was to assess if oncogenic 

Ras activity is a determinant of cell permissiveness to vaccinia viral 

oncolysis. Methods: A replication-competent, engineered vaccinia 

virus (GLV-1h68) expressing green fluorescent protein (GFP) and betagalactosidase 

(B-gal) was used to infect Madin-Darby canine kidney 

(MDCK) cells or RasV12-transformed MDCK cells (MDCK-Ras) at a 

multiplicity of infection (MOI) of 5, 10 or 20. Early gene expression was 

compared by assessing GFP, B-gal, and E3L viral protein production. 

Viral proliferation was assessed by plaque assays. Cell viability assays 

were performed to compare cytotoxicity susceptibility. Small molecule 

inhibitors of MEK (PD98059), PI3K (LY 294002), and mTOR (rapamycin) 

were used to assess the contributions of these signaling pathways 

to viral gene expression. Results: MDCK-Ras cells consistently 

exhibited significantly greater permissiveness to vaccinia infection and 

gene expression than MDCK cells. MDCK-Ras exhibited robust GFP 


Poster Papers 

expression at 8 hours post-infection, in comparison to 16 hours for 

MDCK cells. B-gal expression was more than five-fold higher in MDCK- 

Ras cells than MDCK cells at 8 hours post-infection, and three-fold 

higher at 16 hours. The vaccina protein E3L was expressed at 2 hours 

post-infection in MDCK-Ras cells, in comparison to 6 hours postinfection 

in MDCK cells. Vaccinia replication was two-fold higher in 

MDCK-Ras cells than in MDCK cells at all MOIs tested. MDCK-Ras cells 

were also consistently more susceptible to vaccinia oncolysis. MDCK- 

Ras cells were completely non-viable by 5 days post-infection at MOI 

5, and by 3 days at MOIs 10 and 20. In contrast, MDCK cells remained 

40% viable by 5 days post-infection at MOI 5, and 25% and 10% viable 

by 3 days at MOIs 10 and 20, respectively. The PI3K inhibitor, LY294002, 

reduced B-gal expression by GLV-1h68 in a dose dependent manner for 

both MDCK-Ras (60%) and MDCK (90%) cells. PD98059 and rapamycin 

reduced B-gal expression by

Poster Papers 

profession. 


NON-SURGICAL MANAGEMENT OF OROPHARYNGEAL, 

LARYNGEAL AND HYPOPHARYNGEAL CANCER: THE FOX CHASE 

CANCER CENTER EXPERIENCE. Genevieve Andrews, MD, Miriam 

Lango, MD, Roger Cohen, MD, Steven Feigenberg, MD, Ranne Mehra, 

MD, Barbara Burtness, Sidrah Ahmed, BS, Nicos Nicolaou, MD, John 

Gaughan, PhD, John A Ridge, MD PhD; Fox Chase Cancer Center. 

Objective: To characterize contemporary trends in clinical outcomes 

of patients with oropharynx, larynx and hypopharynx cancer treated 

at one tertiary care cancer center. Methods: Retrospective single 

institution cohort study. Results: Review of 180 patient records from 

1993-2004 revealed that the number of patients with oropharyngeal 

cancer treated nearly doubled while the number of patients with 

laryngeal and hypopharyngeal cancers declined (p=0.006). Since 

2000, concurrent chemotherapeutic regimens rather than radiation 

alone became the dominant treatment approach for advanced stage 

disease, with associated improvements in recurrence-free and overall 

survival (p=0.009, and p=0.006, respectively). Stratification by tumor 

site, however, revealed survival benefits were limited to oropharyngeal 

and hypopharyngeal cancer patients, while no significant improvement 

was observed in laryngeal cancer patients. In the multivariate analysis, 

T stage (p=0.0001) and chemotherapy use (p=0.0001) were associated 

with improved survival. The recurrence-free survival of non-smokers was 

better than for former or current smokers (p=0.01) but was accounted for 

by the earlier T-stage of non-smokers on presentation in the multivariate 

analysis (p=0.0001). Local relapse has remained the predominant initial 

site of failure for oropharyngeal cancer (14 of 17 relapses or 82%) but 

not laryngeal cancer (3 of 7 relapses or 42%). Compared to laryngeal 

cancer patients, those with oropharyngeal recurrences were less likely 

to undergo surgery with curative intent (p=0.02) and were less likely to 

achieve locoregional control after disease recurrence. Conclusion: The 

survival of oropharyngeal cancer patients treated at our institution has 

improved over the last 15 years, which is likely related to changes in 

treatment and tumor biology. Patients with locally advanced vs. earlier 

T-stage oropharyngeal cancer are more likely to have a tobacco-related 

malignancy and are at relatively higher risk of local failure. 


THE CHANGING TRENDS OF TONSIL CANCER EPIDEMIOLOGY 

IN SOUTH EAST ENGLAND: 1987 – 2006. Oladejo Olaleye, MRCS 

DOHNS MPH, Ram Moorthy, FRCS ORLHNS, Owen Lyne, PhD, Myles 

Black, FRCS ORLHNS, David Mitchell, FRCS, Jill Wiseberg, PhD; William 

Harvey Hospital, Ashford Kent, United Kingdom. 

Introduction: The incidence of palatine tonsil cancer (TC), unlike some 

other head and neck tumours, has been increasing worldwide, as 

demonstrated in current literature. The population of the South East of 

England (comprising London, Kent, Surrey and Sussex) is approximately 

12 million people. It provides a unique opportunity to study the changing 

epidemiology of TC in the most ethnically and socially diverse region of 

the United Kingdom. Studying these changes is of immense value to 

understanding the nature of the disease, develop prevention strategies, 

improve early diagnosis and guide resource allocation. Aim: To analyse 

the changing epidemiology of TC in SE England over a 20 year period, 

1987 – 2006. Methodology: A retrospective, quantitative study using 

secondary anonymised data obtained from the Thames Cancer Registry 

of all patients registered with TC (ICD-10 code C09) between 1987 

– 2006. Ethical approval was granted by the Kent Research Ethics 

Committee and data analysed using SPSS v.17. Results: 1987 - 2006: 

1,794 cases of TC were registered: 1987 - 1996: 645 cases; 1997 - 

2006: 1,149 cases (a 78% increase); The population of SE England 

increased in the 20 year period from 10.7 million to 11.8 million (a 10% 

increase). Gender: 1987 - 2006: Males 1,292 (72%), females 502 (28%); 

Ratio 2.6:1; 1987 - 1996: Males 437 (67.8%), females 208 (32.2%); 

Ratio 2.1:1; 1997 - 2006: Males 855 (74.4%), females 294 (25.6%); 

Ratio 2.9:1 (significant difference). Age at Diagnosis: 1987 - 2006: 

Mean 60.4 years, Std Dev. 12.15; Range: 18.8 - 94.4 years; 1987 - 

1996: 61.55 years, Std Dev. 12.57; 1997 - 2006: 59.64 years, Std Dev. 

11.80. Incidence: TC incidence increased over 20 years and peaked 

in 2006; Range: 5.09 - 14.45 cases per 100,000; Mean 8.0, Std Dev 

2.64; Incidence was highest in the age group 40 – 60 years, particularly 

males. Synchronous Tumours: 122 (6.8%) with TC had synchronous 

tumours. Survival Analysis: 78 TC registrations were excluded as they 

were death certificate only registrations; 997 registrations had died; 471 

(1987 – 1996) and 526 (1997 – 2006); 719 of cases were still alive as of 

July 2008. 125 (1987 - 1996) and 594 (1997 - 2006). Median Survival 

Times: 1987 - 2006: 4.36years (95% C.I 3.64 - 5.08); 1987 - 1996: 

2.74years (95% C.I 2.19 - 3.28); 1997 - 2006: 5.72years (95% C.I 4.38 

- 7.06). Survival Prognosis: Worse in older ages, p12 week ND group (p=0.05 and p=0.04). There were 

no significant differences in overall survival (p=0.85), progression free 

survival (p=0.90) and regional relapse (p=0.53) between the 12 week ND groups. Conclusions: Patients undergoing ND 

>12 weeks after CRT had less surgical complications compared with 

patients undergoing ND 12 

weeks after CRT did not negatively influence survival parameters. These 

findings indicate that neck imaging can be delayed until 12 weeks after 

CRT and ND can be safely performed thereafter without adverse impact 

on surgical complications or survival parameters. 


FUNCTIONAL MRI OF TONGUE MOTOR TASKS IN PATIENTS WITH 

TONGUE CANCER: OBSERVATIONS BEFORE AND AFTER PARTIAL 

GLOSSECTOMY. Samantha Haupage, Kyung K Peck, PhD, Ryan C 

Branski, PhD, Meier Hsu, MS, Andrei Holodny, MD, Dennis Kraus, MD; 

Memorial Sloan-Kettering Cancer Center. 

Objectives: In order to maintain oral nutrition, patients treated with 

partial glossectomy must adapt to altered anatomy which likely 

involves substantive contributions from the central nervous system. 


Poster Papers 

The current study seeks to provide preliminary data regarding this 

central, adaptive response during tongue motor tasks utilizing functional 

magnetic resonance imaging (fMRI) before and after glossectomy. We 

also sought to compare three different tongue-associated fMRI tasks 

to determine which is most beneficial to implement for future studies 

of the precentral gyrus. Methods: Six patients with tongue cancer 

underwent fMRI before and six months after partial glossectomy. Data 

obtained were compared to nine healthy controls. Functional studies 

were performed in a 1.5T Scanner GE Signa LX Scanner (GE Medical 

System, Milwaukee, WI) with a standard birdcage head coil. Image 

processing and analysis were performed with AFNI software. Functional 

block-design paradigms included: 1) Tongue tapping, 2) Dry swallowing, 

and 3) Bolus swallowing. For whole brain analysis, activation across 

different brain regions between pre- and post-surgical scans was 

qualitatively compared by a board-certified neuroradiologist who visually 

detected areas in which activation varied between tasks. In addition, 

ten voxels with the greatest activation within the tongue movementassociated 

region were selected from each task, averaged, and used to 

generate corresponding BOLD signal percent change maps. Results & 

Conclusion: Following surgery, increased activation was observed in the 

superior parietal lobule, superior frontal gyrus, inferior frontal gyrus, and 

anterior cingulate. These areas of increased cortical activation following 

surgery are involved with planning, movement, and sensation of the 

tongue during swallowing. The premotor cortex and the parietal cortex 

may function synergistically in planning and execution, and integrating 

sensory and motor input to control and manipulate objects. Similarly, the 

supplementary motor area (SMA), located in the superior frontal gyrus, 

is involved in motor planning of complex sequential movements. Given 

the complexity of swallowing, increased SMA activation is expected. 

The inferior frontal gyrus is believed to be activated prior to swallowing 

and may control nonspeech orofacial sensorimotor behaviors. Following 

surgery, increased activation in the inferior frontal gyrus may contribute 

to the cognitive processes involved in swallowing. The anterior cingulate 

cortex (ACC) has been suggested to mediate emotional response to pain 

and be involved in initiating voluntary swallowing. New ACC activation 

following surgery may be attributed to pain during the different fMRI 

tasks, and/or subjects requiring increased attention to swallowing due to 

the altered anatomy. Region of Interest (ROI) analysis of the precentral 

gyrus confirmed increased cortical activity following surgery. This finding 

may suggest that these patients may experience some normalization 

of tongue function following resection. Furthermore, comparisons 

between pre-surgical scans and controls suggested the dry swallow 

task was sensitive to elicit tongue-related activation in the precentral 

gyrus (p≤0.05). However, we also acknowledge that the relatively small 

sample size may also impact these findings. The implications of these 

findings may contribute to our increased insight into the role of the CNS 

and ultimately direct rehabilitation strategies for patients with swallowing 

disorders. 


MANAGEMENT OF COMPLETE ESOPHAGEAL STRICTURE AFTER 

TREATMENT OF HEAD AND NECK CANCER USING DILATION BY 

RENDEZVOUS. Jonathan Fowlkes, BA, Philip Zald, MD, Peter Andersen, 

MD FACS; Oregon Health and Science University. 

Objective: Evaluate the efficacy and complications of dilation by 

rendezvous, for treatment of complete esophageal stricture. Design: 

Retrospective chart review of patients who underwent dilation by 

rendezvous between 2002 and 2009. Setting: Tertiary care academic 

training hospital. Patients: Fifteen patient charts were identified. All 

patients had received either radiation or chemoradiation for head and 

neck cancer. Average age was 67 [21-89]. Interventions: 17 dilations 

by rendezvous were performed on 15 patients. Average followup was 

16 months [1-41]. Main Outcome Measures: Pre- and post-treatment 

diet, gastrostomy tube status, swallowing scores, and operative 

complications. Results: 6 of 15 patients were gastrostomy tube free 

at last follow-up, 11 of 15 had improvement in their swallowing score. 

Average swallowing score improved from 4 to 2.2 (Wilcoxon signedrank 

test, p=0.0036). There were four complications. One patient died 

of cardiac arrest due to air embolus. One patient had a dehiscence 

of the gastrostomy tube site with entry of the flexible endoscope into 

the peritoneal cavity requiring an exploratory laparotomy. One patient 

had a displaced gastrostomy tube following the operation requiring a 

www.ahns.info 

subsequent exploratory laparotomy. One patient lost an incisor during 

the procedure. Conclusions: Complete esophageal stricture following 

radiation is a difficult problem to manage. Dilation by rendezvous does 

offer benefit to most patients and is a reasonable starting point for 

managing this problem. However, significant risks are associated with 

the procedure that should be carefully considered by the clinician and 

patient. 


INTER-OBSERVER VARIABILITY FOR INDIVIDUAL FEATURES OF 

TWO ORAL DYSPLASIA GRADING SYSTEMS. Paul C Nankivell, 

Mr, Hazel Williams, Dr, Paul Matthews, Dr, David Snead, Dr, Hisham 

Mehanna, Associate Professor; Institute of Head and Neck Studies and 

Education (InHANSE). 

Introduction: Oral dysplasia is a pre-malignant condition. The ability 

to identify which lesions will progress to cancer is therefore important. 

Histological grading is currently the gold standard, but is known to 

suffer from inter-observer variability. The variability of grading the 

architectural and cytological features used in these systems has not 

been well characterised. If certain features do show poor agreement, this 

may explain the overall variability of the systems. Attempts to improve 

agreement for these features may improve the reliability and accuracy of 

these systems. Purpose: To investigate the inter-rater variability for each 

architectural and cytological feature used in the WHO and binary grading 

systems for oral dysplasia. Material: 68 archived oral dysplasia slides of 

varying grades. Methods: 3 pathologists (2 head and neck specialists) 

blinded to the initial grade and clinical outcome independently assessed 

each slide. Architectural and cytological features, as specified in the 

WHO classification, were marked as present or absent. Variability was 

assessed using pairwise percentage agreements and kappa correlations. 

Multi-rater kappas were calculated to give overall agreement for each 

feature. Results: Kappa scores ranged from -0.03 to 0.61 for the 

individual features. Multi-rater kappas showed agreements ranging from 

-0.07 to 0.45. The features with the highest variability were increased 

nuclear size and increased number/size of nucleoli. Cytological features 

showed higher variability than architectural ones. Agreement between 

raters for each individual feature was lower than their overall agreement 

for grade. There was a better agreement between the head and neck 

pathologists than between them and the general pathologist. 

Conclusions: Certain histological features show more inter-rater 

variability than others. The features exhibiting poor correlation here 

are different to those found in other studies. These features may be 

the reason for the overall variability in dysplasia grading. A focus on 

improving these features may increase the reliability and accuracy of 

these grading systems. 


DEFINITIVE SURGICAL MANAGEMENT OF MANDIBULAR 

OSTEORADIONECROSIS WITH MICROVASCULAR FREE FLAP 

RECONSTRUCTION: COMPLICATIONS, FUNCTIONAL OUTCOMES, 

AND COST. Mark E Zafereo, MD, Brandon L Christianson, BA, Diana 

B Roberts, PhD, Beth M Beadle, MD, Mark S Chambers, DDS, Jan S 

Lewin, PhD, Randal S Weber, MD; University of Texas MD Anderson 


Objective: To describe complications, functional outcomes, and cost 

associated with mandibulectomy and free flap reconstruction for 

mandibular osteoradionecrosis (ORN). Methods: Medical records of 

60 consecutive patients who underwent mandibulectomy and free flap 

reconstruction for mandibular ORN at a single tertiary care institution 

between 2000 and 2006 were retrospectively reviewed. Results: 

Forty-two males and 16 females underwent mandibulectomy and 

free flap reconstruction a mean of 69 months following completion 

of radiation therapy (mean radiation dose, 63 Gy). Fifty-four patients 

(90%) were reconstructed with one free flap, while 6 patients (10%) 

required two simultaneous free flaps. Five patients (8%) required a 

pectoralis major pedicled flap in addition to a free flap. Microvascular 

free flap reconstruction included fibula (45 patients), anterolateral thigh 

(11), rectus abdominis (5), radial forearm (3), and lateral arm (2). There 

were 2 (3%) perioperative deaths, and 39 patients (65%) experienced 

postoperative complications including 8 fistulas, 3 plate exposures, 2 

carotid artery blowouts, 3 partial flap losses, and 6 total flap losses. 

Twenty-five patients (42%) required at least one subsequent surgery to 

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manage postoperative complications, and 16 patients (27%) required 

at least two subsequent surgeries. Nine of these patients underwent a 

subsequent free flap (7 patients) or pectoralis flap (2 patients). Patients 

with larger defects (> 7 cm) and longer time interval since radiation (> 

2 years) were more likely to experience complications (p = 0.03 and 

p=0.03, respectively). Patients with longer time interval since radiation, 

as well as current smokers, were also more likely to require subsequent 

operations to manage complications (p = 0.03 and 0.04, respectively). 

Forty-seven patients (78%) were able to attain at least 80% speech 

intelligibility, and 41 patients (68%) achieved an oral diet without a 

gastrostomy tube. With a mean follow-up time of 25 months, 44 patients 

(73%) were alive and 16 patients (27%) had died. Conclusions: Patients 

with mandibular ORN suffer higher morbidity than other head and 

neck cancer patients undergoing similar major resections and free flap 

reconstructions. Smoking, larger defects, and longer time interval since 

radiation may increase risk of significant postoperative complications. 

Our findings suggest that mandibulectomy and free tissue transfer can 

be successful in the treatment of ORN, but there may be significant 

challenges in the postoperative management. Early surgical treatment 

should be considered as expectant managment may be associated with 

increased complications. 


STROBOSCOPY IN STAGING OF LARYNGEAL CARCINOMAS. 

Matthew H Rigby, MD, Jason Orlic, MD, Paul Hong, FRCSC MD, 

Timothy Brown, FRCSC MD, Jonathan Trites, FRCSC MD, Robert Hart, 

FRCSC, S.Mark Taylor, FRCSC FACS MD; Dalhousie University Division 

of Otolaryngology. 

Introduction: Squamous cell carcinoma of the glottis is the second 

most common head and neck cancer. Clinical staging of laryngeal 

cancers is of important in determining a patient’s prognosis and the 

course of treatment. This is usually done with a flexible laryngoscope 

and requires visualization of vocal cord involvement, extension to the 

subglottis or supraglottis, and presence or absence of vocal cord 

fixation. Stroboscopy allows better assessment of the mucosal wave, 

and it may be more sensitive to detecting deeper invasion of tumour, and 

decreased vocal cord mobility. As stroboscopy was felt to provide more 

information, its correlation of stroboscopic staging to operative staging 

was compared to the correlation of conventional staging with operative 

staging. The interrater reliability of stroboscopy to stage glottic cancer 

was also assessed. Methods: 55 patients with glottic cancer underwent 

recorded pre-operative laryngeal stroboscopy in addition to conventional 

staging in the clinic. The patients were then staged at time of tumour 

resection with CO2 laser. The stroboscopy videos were independently 

viewed and staged by two fellowship trained head and neck surgeons 

who were blinded to the pre- and post-operative staging. Kendall’s tau-b 

test was used to evaluate the agreement amongst staging techniques 

(operating room staging, clinical staging, and stroboscopic staging. 

Interobserver agreement in the stroboscopy staging was evaluated using 

the intraclass correlation coefficient. Results: 49 patients completed 

clinical, stroboscopic and operative staging. Using operative staging the 

cases were staged as follows: 14 T1A, 3 T1B, 28 T2, 4 T3. There was 

excellent interrater agreement between two surgeons using stroboscopy 

to stage glottic lesions with an intra-class correlation coefficient of 0.90. 

Clinical staging was adequately correlated with OR staging (r=0.746). 

Clinical staging had a higher agreement with OR staging than both of 

the surgeon’s using stroboscope staging (r=0.532 and r=0.519) which 

only had a weak correlation with OR staging. Conclusion: The use 

of stroboscopy allowed two experienced observers to stage glottic 

carcinomas similarly. However, staging with stroboscopy did not 

correlate well with conventional clinic staging, nor with operative staging, 

which remains the gold standard. 


EFFICACY OF POST-CHEMORADIATION SELECTIVE NECK 

DISSECTION AS A SALVAGE INTERVENTION FOR CLINICALLY 

PERSISTENT NODAL DISEASE. Muthuswamy Dhiwakar, MD, Thomas 

Robbins, MD, Francisco Vieira, MD, James Malone, MD, Krishna Rao, 

MD PhD; Southern Illinois University School of Medicine, Springfield, IL 

and The University of Tennessee Health Science Center, Memphis, TN. 

Background: Selective neck dissection (SND) is becoming more 

commonly used in the multimodal treatment for squamous cell 

carcinoma of the head and neck (SCCHN). However, there is a paucity 

of data to support its application specifically as an effective salvage 

intervention following chemoradiation. Objective: To determine the 

rate of regional recurrence among patients with SCCHN who had a 

post-chemoradiation SND for early salvage of clinically persistent nodal 

disease. Methods: Retrospective analysis of patients with SCCHN 

treated with definitive chemoradiation at 2 academic centers. A total of 

62 patients subsequently underwent 69 SNDs as salvage for clinically 

persistent nodal disease and were selected for analysis. The median time 

interval between completion of chemoradiation and neck dissection was 

10 weeks. The rates of regional recurrence and recurrence-free survival 

were determined. Results: Among the neck dissection specimens, there 

was pathological evidence of residual tumor in 34 (49%). Over a median 

follow-up of 31 months, 40 (65%) patients remained free of disease, 

while the rest developed recurrence. Failures were due to recurrence at 

the primary site in 7 (11%) patients, in the neck in 4 (6%) patients, and at 

distant sites in 11 (18%) patients. All 4 regional recurrences were isolated 

to the neck without associated disease at the primary site. Of these, 

only 1 occurred in the ipsilateral targeted neck. Conclusion: Salvage 

SND appears to be an effective intervention to control persistent nodal 

metastases in patients treated with chemoradiation for SCCHN. 


CLINICOPATHOLOGIC FEATURES ARE STRONGER PROGNOSTIC 

FACTORS THAN HISTOLOGY OR GRADE IN RISK STRATIFICATION 

OF PRIMARY PAROTID MALIGNANCIES. Rohan R Walvekar, MD, 

Pedro A Andrade Filho, MD, Raja R Seethala, MD, William E Gooding, 

MS, Dwight E Heron, MD, Jonas T Johnson, MD, Robert L Ferris, 

MD PhD; LSU Health Sciences Center, New Orleans, LA 70112 and 

University of Pittsburgh School of Medicine and Cancer Institute, 

Pittsburgh, PA 15213. 

Objective: To determine the relative contribution of clinicopathologic 

risk factors versus low- and high-risk grade histologic groups to assist 

management of primary parotid cancers. Study Design: Retrospective 

chart review. Methods: 168 primary parotid malignancies were treated 

surgically at a tertiary care center from 1982 to 2005. Of these, 115 

patients with complete follow up information were further analyzed. 

Pathologic updating and re-classification in 28% of cases enabled 

comparison of tumor histology or grade with current consensus criteria. 

Clinical outcomes of high- and low-risk histology and grade were 

compared with the influence of traditional clinicopathologic risk factors. 

Results: Of 115 cases, the male: female ratio was equal and the median 

age was 63 years (range, 15 to 89 years). Mucoepidermoid carcinoma 

(n=28) was the most common histology. The median follow-up was 44 

months (range, 0 to 278 months). 40% of low-risk histology patients 

who underwent neck dissection had pN+ disease. The median time 

to recurrence was not reached for low-risk tumors as compared to 29 

months for high-risk tumors (p = .0001). Interestingly, extracapsular 

spread (ECS) and margin status were independent prognostic factors 

and conferred significantly greater prognostic value than histologic 

grade risk group. Disease free survival (DFS) and overall survival (OS) at 

5-years for the entire cohort was 51% and 57%, respectively. Risk group 

was a strong independent predictor of OS but not DFS. Conclusions: 

Risk group defined by histology and grade was associated with diseasefree 

survival. ECS and margin status were independent predictors of 

disease-free survival. Inclusion of ECS and margin status substantially 

improved the prediction of disease recurrence, supporting elective neck 

dissection and post-operative radiotherapy for high-grade tumors or low 

risk histologies with positive margins or ECS. 


PREDICTORS IN OUTCOME OF MUCOEPIDERMOID CARCINOMA 

OF THE SALIVARY GLAND. Catherine H McHugh, MD, Dianna B 

Roberts, PhD, Adel K El-Naggar, MD, Kupferman E Michael, MD; 

The University of Texas MD Anderson Cancer Center Department of 

Head and Neck Surgery, Baylor College of Medicine Department of 

Otolaryngology Head and Neck Surgery. 

Title: Predictors of Outcome in Mucoepidermoid Carcinoma of the 

Salivary Gland. Background: Mucoepidermoid carcinoma (MEC) is 

the most common malignancy of the major and minor salivary glands. 

The behavior of MEC has been historically difficult to predict, but prior 

reports demonstrate histologic grade and tumor stage as important 


Poster Papers 

prognostic factors. To assess the impact of clinical and pathological 

findings on disease outcomes, we analyzed patients treated for MEC 

at a high volume cancer center to evaluate for additional prognostic 

indicators to help clarify the disease process further. Methods: A 

retrospective clinical review of all patients with MEC of the salivary 

glands treated at a tertiary cancer center from 1990 to 2007 was 

performed. Patients with less than 2 years of follow-up were excluded. 

Statistical analysis was used to investigate relationships between clinical 

and pathologic characteristics and survival. Results: One hundred 

twenty five patients with a diagnosis of MEC were analyzed. There was 

a slight female predominance with 68 (54.4%) females and 57 (45.6%) 

males. The majority of cases of MEC were found in the parotid gland 

(86.4%) followed by the submandibular gland (12%). Histologically, there 

were 24% low-grade (LG), 44% intermediate-grade (IMG), and 32% 

high-grade (HG) tumors. The 5 year overall survival (OS) and disease 

free survival (DFS) of all patients were 79.3% and 76.5% respectively. 

Facial nerve palsy, skin involvement, fixed tumor, rapid growth, and a 

submandibular gland location were found to be poor prognostic factors. 

No difference in OS or DFS was found between LG and IMG tumors. 

T1 and T2 tumors together had an OS and DFS of 93.5% and 88.3% 

whereas T3 and T4 tumors had significantly worse survival of 41.9% 

and 43.1%, respectively (p1 received 

XRT. 1/2 patients with positive margins received XRT (1 refused XRT). 

All 8 patients with ECS received XRT. 23/25 (92%) of patients received 

XRT within 1 year (2 refused). 2/2 patients with positive margins received 

chemotherapy. 8/8 patients with ECS received chemotherapy. 27/30 

(90%) of patients recommended for XRT underwent dental evaluation. 

Post-treatment measures: All patients underwent regular 3 month follow 

up. 13/25 (52%) of patients who underwent XRT had documentation of a 

TSH post radiation. Conclusion: The two areas that require attention in 

our institution are documentation and performance of smoking cessation 

and TSH monitoring for hypothyroidism. We will discuss the importance 

of quality standards and how we have modified our clinical program to 

improved care. 


EXTRACAPSULAR DISSECTION: MINIMALLY INVASIVE SURGERY 

APPLIED TO PAROTOID PLEOMORPHIC ADENOMA. Munehisa 

Fukushima, MD PhD, Mamoru Miyaguchi, MD; Higashiosaka City 

General Hospital. 

There are two main problems after the parotoid tumor operation. One is 

facial paralysis and another is tumor recurrence. Recently, to get over 

these problems we mainly performed extracapsular-dissection(ECD) for 

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parotoid tumor cases in these several years.This study is designed in 

an attempt to assess the immediate and long term results of ECD in a 

consecutive series of 30 patients presenting with parotid pleomorphic 

adenoma. 


MUCOEPIDERMOID CARCINOMA IN CHILDREN: A REVIEW OF 49 

CASES. Jesse T Ryan, MD, Randal S Weber, MD, Michael E Kupferman, 

MD; Department of Otolaryngology, National Naval Medical Center, 

Bethesda, MD and Department of Head and Neck Surgery, Division 

of Surgery, The University of Texas M. D. Anderson Cancer Center, 

Houston, TX 

Objectives: Epithelial salivary gland neoplasms are rare in children. 

Malignant tumors account for 30-50% of cases in the pediatric age 

group, with mucoepidermoid carcinoma being the most common 

histology. We reviewed our experience to determine the presentation, 

treatment, pathologic features, and outcomes for this rare disorder. 

Methods: A retrospective chart review was conducted from 1953 to 

2007. 49 patients were identified with a diagnosis of mucoepidermoid 

carcinoma and their charts were examined for presentation, treatment, 

pathologic features, and outcomes. Results: 49 patients with 

mucoepidermoid carcinoma were treated at our institution from 1953 

to 2007. Average age at presentation was 14.6 years. 88% of patients 

were 10 years or older at the time of initial visit. Tumors were located 

in major salivary glands in 57% of cases. The parotid gland was 

the most common subsite (49%), followed by the oral cavity (35%), 

submandibular gland (8%), and oropharynx (6%). 24% of patients 

presented with nodal disease. All patients underwent surgery, and 11 

patients (22%) were treated with radiation therapy. Pathologic grade 

was available in 44 patients. Tumors were classified as low grade in 13 

patients (30%), intermediate grade in 25 patients (57%), and high grade 

in 6 patients (14%). The 5-year survival was 98%, and 10% of patients 

developed recurrence. Conclusion: Mucoepidermoid carcinoma in 

children carries a favorable prognosis and can be successfully treated 

with surgery alone in most cases. Radiation therapy should be used in 

selective cases. 


SURGICAL MANAGEMENT OF SQUAMOUS CELL CARCINOMA OF 

THE SOFT PALATE AND FACTORS PREDICTIVE OF OUTCOME. N 

Gopalakrishna Iyer, MD PhD, Iain J Nixon, MD, Leslie Kim, BA, Frank 

Palmer, BA, Monica Whitcher, BA, Jatin P Shah, MD PhD, Snehal G 

Patel, MD, Ian Ganly, MD PhD; Memorial Sloan-Kettering Cancer Center. 

Background: Squamous cell carcinoma of the soft palate is uncommon 

and there is limited data reporting outcomes. Despite the general trend 

to treat patients with oropharyngeal cancers with radiation or chemoradiation 

therapy, a significant number of patients with soft palate 

cancer are managed with primary surgery. The aim of this study was 

to report our experience in the surgical management of patients with 

squamous cell carcinoma of the soft palate. Methods: Retrospective 

review of institutional databases identified 228 patients treated with 

curative intent between 1976 and 2005. Of the 228 patients, 194 were 

treated with surgery +/- postoperative radiation and 34 treated with 

primary radiation therapy +/- chemotherapy. Median follow-up time for 

the entire cohort was 53 months (range 2-260). The 194 patients treated 

with surgery represent the cohort of patients in our study. Median age 

was 59 years (range 33-85), 112 (58%) were male and 82 (42%) female. 

Overall survival (OS), disease specific survival (DSS), local recurrence 

free survival (LRFS), regional recurrence free survival (RRFS), locoregional 

recurrence free survival (LRRFS) and distant recurrence free 

survival (DRFS) were calculated using the Kaplan Meier method. The 

following variables: overall stage, clinical T-status (cT), clinical N-status 

(cN), tumor morphology (exophytic versus endophytic), depth of invasion 

(2mm) and margin status were analysed by univariate and 

multivariate analysis for predictors of outcome. Results: The majority 

of patients had early stage disease: 148 (77%) had T1 or T2 tumors 

and 143 (74%) had a clinically negative neck. The 5-year OS, DSS and 

RFS rates were 48%, 68%, and 55% respectively. Eighty-eight (45%) 

patients developed a second primary tumor. Overall, 45% patients 

developed recurrence: 25% local, 23% regional and 11% distant. 

Univariate analysis showed that overall stage, cT status, cN status, 

tumor morphology and tumor thickness were significant predictors of OS 

and DSS, but only T-status remained significant on multivariate analysis. 

Patients with T2, T3 and T4 tumors were 2.2, 2.3 and 3.1 times more 

likely to die from disease compared to patients with T1 tumors. For local 

and locoregional recurrence free survival, univariate analysis showed that 

cT status, morphology and tumor thickness were significant predictors, 

while multivariate analysis showed that only cT status and tumor 

morphology remained significant. Patients with endophytic morphology 

were 2.6 times more likely to have local recurrence compared to 

exophytic tumors. Conclusion: This study examines one of the largest 

cohort of patients with carcinoma of the soft palate treated with primary 

surgery. Clinical T status and tumor morphology are important predictors 

of outcome in patients with this disease. 


THE IMPACT OF AGE ON SURVIVAL AND DEMOGRAPHIC TRENDS 

IN OROPHARYNGEAL SQUAMOUS CELL CARCINOMA. Kevin S 

Emerick, MD, Vasu Divi, MD, Raymond Jean, BS, Sebastian Jara, BS, 

Jim Michaelson, PhD, Derrick T Lin, MD, James W Rocco, MD PhD, 

Daniel G Deschler, MD; Harvard Medical School. 

Objective: To assess the impact of age on survival from oropharynx 

cancer over the past 30 years. To assess demographic trends in 

oropharynx cancer as well as any correlations between age, stage and 

survival. Methods: Oropharyngeal specific data was obtained from 

the SEER database from 1973 to 2003. Patients were divided into an 

age over 60 cohort and age under 60 cohort. Demographic, survival 

and staging were assessed by decade and compared between age 

groups as well as to a control group of oral cavity tumors. Statistical 

analysis was performed on all parameters. Results: Overall disease 

specific survival increased from 69% to 83% during this time period for 

oropharyngeal cancer. 5 year survival improved in the under 60 group 

from 71.5% to 87.5%, and it improved in over 60 group from 68% to 

77.5%. When comparing the groups within each decade of analysis, 

patients under 60 did significantly better in all 3 decades. This survival 

difference between age groups increased significantly over three 

decades from 2.98% to 9.93% (p

Poster Papers 

Materials and Methods: we evaluated 23 cases of neck dissection in 13 

patients affected by laryngeal cancer. They were all clinically N0. Group 

1 (6 cases) were treated with a superselective neck dissection (IIA-III- 

IV); group 2 (17 cases) were treated with a selective neck dissection 

(levels IIA-IIB-III-IV). Motor unit action potential (CMAP) and the electrical 

activity of the superior part of the trapezius muscle were evaluated by 

electromyography in each case at different time points: preoperatively 

(T0) and after surgery at week 1,3 (T1 and T3) and after one year (T3). 

We also asked our patients to perform the “Neck Dissection Quality Of 

Life Questionnaire” and the “arm Abduction Test”. These tests were 

performed about 1 month after surgery. Results: In all the cases at 

the end of surgery it was possible to assess the integrity of the spinal 

accessory nerve. There was no anatomical evidence of nerve damage. 

At T0 CMAP evaluation and electromyography were normal in all the 

cases. Amplitude was 10,9 mV on average in group 1 and 11,8 mV in 

group 2. No spontaneous activity was present in all the cases. At T1 

CMAP amplitude was 6,5 mV in group 1 and 2,7 mV in group 2. No 

spontaneous activity was observable in the trapezius muscle of group 

1 cases, while it was present in 8 cases of the group 2. Inference was 

reached in 3 cases of group 1, transition in 1 case and poor oscillation 

was observable in two cases. We found reduction of the voluntary 

contraction in group 2: complete absence in 9 cases, single oscillation 

in 3 cases, poor transition in 1 case and normal in 4 cases. At T2 

CMAP amplitude was 6,43 mV in group 1 and 3,12 mV in group 2. 

Spontaneous activity was relievable in 2 cases of group 1 and in all the 

cases of group 2. No voluntary contraction was present in group 2. At 

T3 CMAP amplitude was 9.6 mV in group 1 and 9.12 mV in group 2. 

We found the reduction of the spontaneous activity and an increased 

voluntary activity in both the 2 groups. The arm abduction test showed 

greater impairment in abduction in group 2; no differences between the 

two groups were present at the clinical evaluation with questionnaire. 

CONCLUSIONS: Our data confirm that surgical manipulation of the 

nerve may determine a severe impairment of nerve conduction when 

sublevel IIB is involved in the dissection. With negative frozen section 

in the sublevel IIA, the Authors suggest to avoid, whenever possible, the 

dissection of the sublevel IIB. 


NO MAN’S LAND IN HEAD & NECK SURGERY: THE STROMAL 

TISSUE BETWEEN THE PRIMARY TUMOR AND THE CERVICAL 

LYMPH NODES (THE T-N TRACT) IN ADVANCED TONGUE TUMORS. 

ANATOMICAL AND ONCOLOGICAL CONSIDERATIONS ON A 

TERRITORY AT RISK FOR METASTATIC DISEASE. Luca Calabrese, 

MD, Roberto Bruschini, MD, Angelo Ostuni, MD DDS, Valeria Navach, 

MD, Enrica Grosso, MD, Fausto Maffini, MD, Maria Angela Massaro, MD, 

Luigi Santoro, MD, Fausto Chiesa, MD; European Institute of Oncology. 

Approximately one third of patients with squamous cell carcinoma 

(SSC) of the tongue have clinically evident neck metastases at the 

time of diagnosis, [2] while micrometastases are found in up to 50% 

of patients who undergo neck dissection with no overt lymph node 

involvement [3]. Patients with pathological lymph nodes have a fiveyear 

survival that is about half that of pN0 cases [4]. Conventional neck 

dissection removes lymph node levels I-V, or in selective procedures 

levels I to III or IV. Level I consist of the submandibular area between 

the mylohyoid muscle, the digastric muscle and the mandibular bone 

anteriorly. It does not include the two or three small nodes (maximum 

size 1cm) often present in the deep submandibular area, in proximity of 

the sublingual gland on the internal surface of the mylohyoid muscle, 

termed sublingual lymph nodes by Rouviere [6]. These nodes are not 

routinely detected by clinical evaluation or conventional radiological 

imaging and if metastatically involved they are rarely increased in size. 

Recent reports in literature have begun to draw attention to the lingual, 

sublingual and deep submandibular lymph nodes and the relevance 

of their involvement as important prognostic factors [1, 7]. We recently 

reported on compartmental tongue surgery (CTS) as a novel surgical 

ablative technique to address primary untreated advanced tumours of 

the tongue. This technique is based on anatomical considerations that 

have demonstrated a longitudinal progression of tongue tumours as well 

as a potential continuity of the primary disease with a distinct but so far 

undefined territory of potential, and at times initial, metastatic spread. We 

have defined the “T-N” tract as the fibro-fatty glandulo-stromal bridge 

that includes the glandular, neuro-vascular and lymphatic tissues uniting 

www.ahns.info 

the primary lesion to the cervical lymphatic chain. Clinical evidence and 

the anatomical considerations made in the development of CTS pushed 

us to study the T-N tract and its involvement in advanced stage disease 

treated with major ablative surgery (CTS) and neck dissection. We 

conducted a pilot study on a sample of 150 consecutive patients with 

previously untreated primary advanced tongue tumours. After demolition 

with in-continuity lateral neck dissection the specimen is removed enblock 

and the surgeon prepares it for the pathologist on the back table. 

It is dissected in its three component portions: the primary, the T-N tract 

and the contents of the neck. As with the rest of the specimen, the T-N 

tract is methodically analyzed microscopically for presence or absence 

of metastatic disease. In 11 patients we found evidence of disease in the 

T-N tract and its involvement correlated negatively with local and locoregional 

relapse and overall survival. We present a discussion on the 

challenges surgical oncologists face in the management of the neck and 

the impact of the T-N tract and an anatomical approach to the potential 

pathways of disease progression. 


FACTORS ASSOCIATED WITH PHARYNGOESOPHAGEAL 

STRICTURE IN PATIENTS TREATED WITH A UNIFORM 

CHEMORADIATION PROTOCOL FOR OROPHARYNGEAL 

SQUAMOUS CELL CARCINOMA. Simon R Best, MD, Patrick K 

Ha, MD, Eva Zinreich, MD, Marshall Levine, MD, Melissa Walker, MS 

CCCSLP, Jaclyn Trachta, MS CCCSLP, Karen Ulmer, RN, John Saunders, 

MD, Peter Murakami, Richard Thompson, Joseph A Califano, MD, 

Barbara P Messing, MS CCCSLP; Department of Otolaryngology, Johns 

Hopkins Hospital, Baltimore, MD, USA; Milton J. Dance Head and Neck 

Center, Greater Baltimore Medical Center, Baltimore, MD, USA; Johns 

Hopkins University, Biostatistics Consulting Center, Baltimore, MD, USA. 

Purpose: Pharyngoesophageal stricture is a known complication of 

organ-sparing treatment protocols for head and neck cancer. However, 

its risk factors are incompletely understood and the pathophysiology of 

stricture formation not clearly delineated. Study Design: Retrospective 

analysis of all patients undergoing a uniform cisplatin-based 

chemotherapy protocol and concurrent radiation for oropharyngeal 

squamous cell carcinoma was performed. After excluding patients with 

less than one year follow-up, 67 patients were available for analysis. 

Stricture formation was assessed on serial barium swallow studies 

and by the need for dilation. Results: A stricture was present in 13 

(19%) patients. The presence of stricture was associated with tumor 

location (tonsil vs. base of tongue, p = 0.03), neck dissection following 

chemoradiation (p = 0.03), and the duration of severe radiation-induced 

mucositis (weeks with mucositis >= 2, National Cancer Institute 

Common Toxicity Criteria; p =

Poster Papers 

often confused with high grade mucoepidermoid carcinoma and only 

recently have histologic criteria for delineation been formalized. In this 

report, we describe the experience at the University of Pittsburgh. Study 

Design: Retrospective cohort study. Methods: After obtaining approval 

from the institutional review board, clinical and demographic data were 

retrieved from the University of Pittsburgh Tumor Registry (1973-2004) 

on 20 previously unreported cases of adenosquamous carcinoma. These 

were re-examined using current histologic criteria to confirm diagnosis. 

Breakapart FISH using probes targeting the MAML2 gene region to 

detect the t(11;19)(q21;p13) or MECT1-MAML2 translocation was also 

performed to confirm delineation from from high grade mucoepidermoid 

carcinoma. Results: This is the largest series of this rare tumor to date. 

There was a 3:1 male to female preponderance with a peak incidence 

in the sixth decade of life. Larynx was the most common site of disease 

accounting for almost 50% of the cases with oral cavity and oropharynx 

accounting for another 30%. Nine of the tumors were T1 or T2. Nodal 

metastases were found in 25% of cases. There were 3 deaths and 5 

recurrences with a mean followup of 5 years. Five year disease specific 

survival was 83%. All cases were negative for the MECT1-MAML2 

translocation. Conclusion: Although previous studies have reported a 

dismal prognosis for adenosquamous carcinoma, our cohort suggests 

that in lower stage disease without nodal metastasis, prognosis is 

not uniformly poor. The absence of the MECT1-MAML2 translocation 

confirms biologic distinction from mucoepidermoid carcinomas. 


MINIMALLY INVASIVE TRANSORAL SURGERY. Ian M Smith, MD, 

Jeremy D Richmon, MD, Ray Blanco, MD, Joseph A Califano, MD; Johns 

Hopkins Medical Institutes. 

Transoral Laser Microsurgery (TLM), Endoscopic Laser Assisted 

Laryngeal Surgery and Transoral Robotic Surgery (TORS) have come 

into favor for the treatment of upper aerodigestive head and neck 

squamous cancers. These approaches have been employed in an effort 

to mitigate or eliminate morbidity associated with traditional, open 

surgical approaches used alone or in combination with chemotherapy 

and radiation therapy. We hypothesized that these diverse techniques 

employ highly similar basic surgical principles, and that the success of 

these techniques depends primarily on two factors: 1) an axial approach 

to resection of tissue that avoids proximal interruption of sensory 

nerves and maintains a more physiologic sensory innervation, and 2) 

an anatomic reconstruction that recapitulates the physiologic, activated 

state of phonation or deglutition. We hypothesize that the relative 

success and failure of a variety of transoral surgical techniques in diverse 

anatomic sites can be predicted on the basis of these principles, and 

provide supporting data from anatomic studies and functional studies 

on these seemingly diverse surgical approaches that validate these 

concepts. Based on these data, we suggest that the rapid proliferation of 

novel technology defined approaches may more precisely be understood 

in functional anatomic terms, and should be grouped together as a 

unified entity, e.g. Minimally Invasive Transoral Surgery (MITS). 


REFLUX IN HEAD AND NECK CANCER PATIENTS AFTER 

RADIATION THERAPY. Allis H Cho, MD, Ellen A Lewis, NP, Cherie-Ann 

O Nathan, MD; LSUHSC-Shreveport. 

Objectives: To determine if reflux is increased in laryngohypopharyngeal 

cancer patients who have had radiation (XRT) ± 

chemotherapy compared to non-radiated patients. Design: Prospective 

study. Setting: State University Hospital. Patients: Twelve patients 

with advanced head and neck cancer were evaluated for reflux events 

using a nasopharyngeal 24 hour pH probe in the last year. Three patients 

had XRT ± chemotherapy as primary treatment and nine patients were 

newly diagnosed and treatment was not yet initiated before the pH 

probe reflux study was performed. There were no patients on reflux 

medications at the time of the pH probe study except one patient who 

still had considerable reflux despite the medication. Main Outcome 

Measures: Ryan scores measuring positive reflux events. Results: The 

majority of patients had laryngeal cancer (83%). All patients who were 

treated with XRT ± chemotherapy primarily had significant reflux as 

indicated by considerably higher Ryan scores (mean of 547.42 ± 303.59 

upright) compared to those who did not have XRT ± chemotherapy 

(mean of 37.42 ± 63.70 upright) (p=0.0004). Two of the three patients 

treated primarily with XRT ± chemotherapy had reflux in upright and 

supine positions, while one patient had reflux only in the upright 

position. Four of the nine non-radiated patients had reflux only in the 

upright position, and no one had reflux in the supine position. The 

mean supine Ryan scores of patients treated with XRT ± chemotherapy 

was 27.88 ± 35.41 compared to 2.88 ± 1.23 in nonradiated patients 

(p=0.0398). Conclusions: This preliminary study demonstrated that 

XRT ± chemotherapy caused significant increase in Ryan reflux score 

compared to non-radiated patients. Given that XRT causes xerostomia 

and the absence of the neutralizing affect of bicarbonate in the saliva, we 

believe that XRT causes a significant increase in LPR. Although this is 

a pilot study and the numbers are still small, the results are striking and 

there is no objective data in literature linking XRT to reflux at this time. 


HEAD AND NECK SQUAMOUS CELL CARCINOMA IN THE SETTING 

OF ORGAN TRANSPLANTATION. Rahul Seth, MD, Eric D Lamarre, MD, 

Paul Kwak, MD, Joseph Scharpf, MD, Robert R Lorenz, MD, Brian B 

Burkey, MD; Cleveland Clinic. 

Background: Solid organ transplantation has become a frequently 

performed procedure. The immunosuppression required for transplanted 

organ survival increases rates of malignancy in this population, 

particularly of cutaneous malignancies. Recently, the commonly used 

immunosuppressant sirolimus, an mTOR kinase receptor inhibitor, 

has demonstrated potential anti-neoplastic efficacy. We examine 

our experience with head and neck squamous cell carcinoma (SCC) 

among solid organ transplant recipients and a preliminary review of the 

effectiveness of sirolimus in this population. Methods: Retrospective 

study of patients diagnosed with squamous cell carcinoma of the head 

and neck with a history of previous solid organ transplantation at the 

Cleveland Clinic between 1999 and 2009. Patients with both cutaneous 

and upper aerodigestive tract malignancies were included. Cutaneous 

malignancies were included if they had loco-regional metastasis to the 

neck or parotid gland. We reviewed the medical records of 20 patients. 

Results: Squamous cell carcinomas of cutaneous origin occurred 

in 9 of the 20 patients, while upper aerodigestive tract malignancies 

comprised the remainder. Nineteen of the 20 patients (95%) were 

diagnosed with advanced stage 3 or 4 malignancies. Kidney transplants 

were the most commonly transplanted organ (48%). Five patients 

(25%) had dual organ transplantation. The overall survival of this patient 

population was 40% at mean follow-up time of 30.1 months. Two year 

disease specific survival was 58.8%. However, overall disease-specific 

mortality was 50.0%, and mean time until death was 16.3 months. 

Multi-modality therapy was used in most patients. Fourteen patients 

(70%) underwent surgical resection, and 19 (95%) were treated with 

either definitive or adjuvant radiation therapy. Forty percent of patients 

had loco-regional recurrence. Immunosuppressant medications and 

dosages were able to be reduced in 11 patients. Nine patients were 

switched to sirolimus therapy after SCC diagnosis. Loco-regional 

recurrence among patients treated with sirolimus was 33.3%, and 

50.0% among those not treated with sirolimus (p=0.65). Conclusions: 

Immunosuppressed patients represent a difficult population of patients 

to treat given their comorbidities, multi-disciplinary care required, and 

aggressive malignancies. In our examined group of patients, mortality 

rates were high despite aggressive treatment. To enhance tumor control, 

immunosuppressive medications were reduced when possible. Due to 

its dual immunosuppressive and potential anti-neoplastic properties, 

sirolimus may play a role in the management of transplant recipient 

advanced head and neck malignancy. 


SENTINEL LYMPH NODE MAPPING FOR T1/T2 ORAL SQUAMOUS 

CELL CARCINOMA: DOES IT HAVE THE SAME EFFICACY AS FOR 

CUTANEOUS MELANOMA? Jose H Steck, MD, Erlon M Balielo, MD, 

Marina Linek, MD, Erivelto M Volpi, MD, Antonio L Souza, MD; Mario 

Gatti Hospital - Campinas - Brazil, Onccape Clinic, Cirucape. 

Background: Neck metastases are one of the most valuable prognostic 

factors both for patients with Oral Squamous Cell Carcinoma and Head 

and Neck Cutaneous Melanoma. The Sentinel Lymph Node Mapping 

(SLNM) is a useful technique to stage lymphatic bases in solid tumors 

and had become standard of care for staging Cutaneous Melanoma. 

Some controversies exists for the use of SLNM for oral cancer and it is 


Poster Papers 

not considered standard of care for this pathology. 

Objective: To study the SLNM in oral cancer as a Diagnostic Staging 

procedure and compare its accuracy with SLNM for Head and Neck 

Cutaneous Melanoma. Patients and Methods: We analyzed 104 

consecutive SLNM from the Head and Neck region, 32 with initial Oral 

Cancer staged T1 or T2 N0 (Group A), and 72 Cutaneous Melanoma 

from the Head and Neck Region staged T1b or more N0 (Group B), 

all performed by the same Surgical Team. All patients underwent 

preoperative Lymphoscintigraphy, intraoperative use of blue dye and 

gamma probe, and postoperative pathological serial sections with 

immunohistochemical study for the Sentinel Lymph Node (SLN). For Oral 

Cancer the first 18 patients were also submitted to Supraomohyoid Neck 

Dissection to validate the SLNM technique. The minimal follow-up was 

14 months. To compare the 2 Staging tests we analyzed the Sensitivity, 

Specificity, Positive Predictive Value (PPV), Negative Predictive Value 

(NPV) and overall Accuracy from both Groups. Results: The mean age 

of the Group A was 62 (range 28 to 80), with 25 men (77%). For Group 

B it was 58 (range 13 to 81), with 37 men (51%). At least 1 SLN was 

located in 31/32 patients in the Group A (96.8%), and 70/72 in Group B 

(97.2%). We had 1 False Negative in the Group A, with 83% Sensitivity, 

100% Specificity, a PPV of 100% and NPV of 96.1%. The overall 

Accuracy was 96.7%. For the Group B there were 2 False Negatives, 

88% Sensitivity, 100% Specificity, PPV of 100% and NPV of 96.4%. The 

Overall Accuracy for Group B was 97.1%. The Mortality rate of Group 

A was 6% (2 patients with positive SLN). Conclusion: The Accuracy 

of SLNM to adequately stage T1/T2 Oral Squamous Cell Carcinoma is 

comparable to SLNM for Head and Neck Cutaneous Melanoma. 


INDUCTION CHEMOTHERAPY FOR ORAL CAVITY CANCERS. T 

Loree, M Chadha, V Jayaprakash, K Thankappan, S McCloskey, M 

Sullivan, E Hatton, N Rigual; Roswell Park Cancer institute. 

Objective: There is a paucity of reports on the role of induction 

chemotherapy (IC) in the treatment of advanced oral squamous cell 

carcinoma (OSCC). We present our experience utilizing IC in the 

management of stage III/ IV OSCC. Patients & Methods: Twenty 

patients (10 floor of the mouth, 6 oral tongue, 3 buccal mucosa, 1 hard 

palate) with stage III/IV OSCCs were included in the study. The median 

age of the cohort was 61 years, 50% were females and 50% current 

smokers. Six patients had stage III disease and 14 had stage IV. Patients 

were treated with 2 to 4 cycles of 1 week or 3 week induction regimens 

[9 patients with cisplatin+taxotere (CT), 5 with CT+5-fluorouracil (5FU), 

3 with CT+Erbitux(E), 3 patients with CT+xeloda and 1 with CE+5FU]. 

IC response was evaluated utilizing clinical exam as well as imaging. 

Patients with >80% response were classified as near complete response 

(NCR), whereas patients with

Poster Papers 


INTENSITY-MODULATED RADIATION THERAPY (IMRT) IN THE 

TREATMENT OF OROPHARYNGEAL CARCINOMA: CLINICAL 

OUTCOMES AND RELATION OF PAROTID GLAND VOLUME WITH 

XEROSTOMIA. Benjamin Weinberg, MA, Aruna Turaka, MD, Tianyu Li, 

MS, Joshua Silverman, MD PhD, Nicos Nicolaou, MD, Miriam N Lango, 

MD, Barbara Burtness, MD, John A Ridge, MD PhD FACS, Steven J 

Feigenberg, MD; Fox Chase Cancer Center, University of Maryland, The 

Brody School of Medicine at East Carolina University. 

Objective: To determine the pattern of failures and relation of the 

parotid gland (PG) volume with xerostomia in patients treated with 

IMRT for squamous cell cancers of the oropharynx. Methods: Between 

January 2001 and December 2006, 49 patients with oropharyngeal 

cancer received IMRT with curative intent at Fox Chase Cancer Center. 

Among these, 48 (98%) were squamous cell carcinoma and 1 (2%) 

adenocarcinoma. The median age was 58 years (range: 41-85), 82% 

were smokers, and 90% were stage III or IV. 86% received definitive RT 

(63% concurrent chemoradiotherapy and majority received cisplatin, 

22% RT alone), and 8% were re-irradiation cases. Volume (Vmean) of 

the PG (mean, ipsilateral and contralateral with respect to the primary 

tumor) was analyzed for relationship to Xerostomia by using Wilcoxon 

test in 28 patients. Pearson’s correlation coefficient was used to see 

relation between the percentage weight loss with parotid gland volume. 

The mean dose constraint to parotid gland was 26 Gy. RTOG acute 

toxicity scoring was used to grade Xerostomia. Patient tumor and 

treatment related factors, including age, T stage, N stage, location of 

primary tumor, addition of chemotherapy, and RT doses were analyzed 

for patterns of failure and incidence of xerostomia. Results: The median 

follow up was 16 months (range: 1 – 84). The 2-year local, locoregional, 

distant metastases free survival and overall survival rates were 90%, 

90%, 91% and 71% respectively with a median time to failure of 15 

months. V mean of PG’s were 19 cc, 29 cc and mean RT doses were 

50 Gy, 25 Gy respectively on the ipsilateral and contralateral sides. 

Median percent weight loss was 10% at 7th week of treatment. Grade 

1-2 acute xerostomia was seen in 94% and Grade 3 in 4%. There was 

no statistically significant correlation between percent weight loss or 

xerostomia and either ipsilateral (p= 0.2) or contralateral PG volumes 

(p= 0.3). There was no difference in incidence of xerostomia in relation 

to age, gender, addition of chemotherapy, location of tumor, RT dose, 

RT duration by Wilcoxon test. Conclusions: Our results show very 

good locoregional control rates and use of IMRT resulted in acceptable 

xerostomia rates. 


DEVELOPMENT OF A HYBRID SIMULATOR FOR ENDOLARYNGEAL 

SURGERY. Iain J Nixon, Mr, Frank L Palmer, Mr, Ian Ganly, Dr, Snehal 

Patel, Dr; Memorial Sloan Kettering Cancer Center. 

Background: New techniques and applications of minimally invasive 

surgery require appropriate training. Unlike laparoscopic surgery, 

endolaryngeal techniques are single operator dependant, which 

prevents effective mentoring in the operating room. There is therefore 

great need for a realistic laryngeal simulator, both to allow endoscopic 

skills acquisition for trainees, and for continued education of practicing 

surgeons. Our aim was to produce a surgical simulator which recreated 

the challenge of endolaryngeal microsurgery using inexpensive, readily 

available animal tissue that has anatomy closely resembling the human. 

Methods and Materials: We developed a hybrid simulator by integrating 

a porcine larynx into an existing airway training manikin. The porcine 

larynx provides a structurally similar organ to the human equivalent 

and is readily available. More importantly, animal tissue ensures 

realistic tissue characteristics and provides excellent tactile feedback 

to the surgeon. To create the hybrid model, the tracheal and laryngeal 

structures of the manikin were opened and the porcine larynx inserted 

with the epiglottis abutting the model’s tongue base. By incorporating 

an airway manikin we added the ability to teach the technique of 

suspension laryngoscopy to the trainee. The degree of difficulty could be 

adjusted by changing the mobility of the jaw and flexibility of the neck 

to simulate actual endoscopic surgery in the operating room. Results: 

We found the manikin was realistic and provided a challenge similar to 

human laryngoscopy. The porcine larynx approximated the human larynx 

in size and had both false and true cord structures, making it an ideal 

tool for the practice of oncological laser resections. The structure of the 

true cords allowed the raising of a microflap, which in turn allowed for 

training in the techniques of phonosurgery. The simulator can be used for 

cold steel as well as CO2 laser techniques. Conclusion: We present a 

hybrid surgical simulator using a modified airway manikin and a porcine 

larynx. Our model can be used to realistically recreate the challenge of 

endolaryngeal micro-surgery within a laboratory environment and to 

allow acquisition and practice of endoscopic surgical skills outside the 

operating room. 


ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY LARYNGO- 

PHARYNGEAL CANCER - A NEW TREATMENT STRATEGY FOR THE 

HEAD & NECK CANCER. Ichiro Tateya, MD, Manabu Muto, MD, Shuko 

Morita, MD, Ryo Asato, MD, Tomoko Kanda, MD, Seiji Ishikawa, MD, 

Shinpei Kada, MD, Morimasa Kitamura, MD, Shigeru Hirano, MD, Juichi 

Ito, MD; Kyoto University, Japan. 

Background and Purpose: Laryngo-pharyngeal cancer is often 

advanced when detected and has relatively poor prognosis. Surgical 

operation for advanced cases impairs swallowing and/or vocal 

function and chemoradiotherapy sometimes causes severe adverse 

effects involving severe swallowing disorders. Early detection of the 

tumor is important because it not only improves survival rate but also 

minimizes functional loss of swallowing and voice. We have previously 

reported that narrow band imaging (NBI) combined with magnifying 

endoscopy is useful in detecting early superficial laryngo-pharyngeal 

cancers, which are difficult to detect with a standard endoscopy. For 

such cases, we are applying endoscopic submucosal dissection 

technique which is increasingly used for early esophageal cancer. In 

this study, we investigated the usefulness of endoscopic submucosal 

dissection for early laryngo-pharyngeal cancer. Operation Procedure: 

Under general anesthesia, specially designed curved laryngoscope 

was inserted to allow a working space in the pharyngeal lumen and 

magnifying endoscopy (GIF TYPE H260Z; Olympus, Tokyo) was inserted 

transorally to visualize the field. The extent of the lesion was determined 

by NBI and iodine staining and the margins of the lesion are marked 

with coagulation. Mixed solution of glycerol, epinephrine, and saline 

was injected into the submucosal space under the lesion, creating a 

safety space. The space lifts the lesion to facilitate its removal and 

minimizes damage to the deep layers of the laryngo-pharyngeal wall. 

A circumferential incision into the submucosa was performed around 

the lesion and the lesion was dissected from the laryngo-pharyngeal 

wall. Cutting and dissection procedure was performed either with 

specialized endoscopic electric knife or with orally inserted curved 

electric knife. Fasting period was usually 1-2 days after operation. 

Results: Since September 2007, 47 cancer lesions were removed from 

28 patients (twenty seven men and one woman, median age 67 y.o.). 

Of the 28 patients, 8 patients (29%) had synchronous multiple cancers 

at laryngo-pharyngeal sites. Eight patients (29%) had a history of head 

and neck cancer, and twenty patients (71%) had a history of esophageal 

cancer. Tumor origin was thirty eight lesions in the hypopharynx, 8 

lesions in the oropharynx, and one lesion in the larynx, respectively. 

In the hypopharynx, 74% of the lesions were located in the piriform 

sinus. Tracheostomy was performed in one case which had four 

synchronous multiple lesions in the hypopharynx. Regarding adverse 

effects, post operative bleeding occurred in one case which needed 

emergency tracheostomy. With a median follow-up period of 15 months, 

metachronous multiple laryngo-pharyngeal cancer occurred in 4 cases 

(14%) and recurrence occurred in one case (4%). All the metachronous 

cancer cases and the recurrent case were controlled with additional 

endoscopic submucosal dissection. The cause-specific survival rates 

at two years were 100%. All the patients could retain their pharynx 

and their speaking, breathing, and swallowing functions. Conclusions: 

Endoscopic submucosal dissection for early laryngo-pharyngeal cancer 

allows excellent survival and the preservation of swallowing and voice 

functions. Early detection of superficial laryngo-pharyngeal cancer with 

narrow band imaging technology and the treatment with endoscopic 

submucosal dissection can be a new treatment strategy for the head and 

neck cancer. 


Poster Papers 


ULTRASOUND-GUIDED PHOTODYNAMIC THERAPY FOR DEEP 

SEATED PATHOLOGIES: A PROSPECTIVE STUDY. Waseem Jerjes, 

MSc PhD MBBS BDS, Colin Liew, FDS FRCS, Tahwinder Upile, MS 

FRCS, Hamdoon Zaid, MSc BDS, Mosse Charles, PhD, Morley Simon, 

MRCP FRCR, Konstantinos Karavidas, MD DMD, Hopper Colin, MD 

MBBS BDS; University College London Hospitals. 

Background: Interstitial photodynamic therapy (iPDT) remains an 

attractive remedial option in minimally invasive surgery. Our aim in this 

prospective study was to evaluate the outcome following ultrasoundguided 

iPDT (US-iPDT) of deep seated pathologies. Patients’ reports 

on quality of life with clinical and radiological evaluation were the 

main end point parameters used to assess the outcome. Methods: 

Sixty-eight patients were referred to the UCLH Head and Neck Centre, 

London for treatment of various deep pathologies involving the head 

and neck region, upper and lower limbs. All patients were discussed at 

the UCLH Head and Neck MDT. It was decided that the only available 

option was to offer interstitial photodynamic therapy under general 

anaesthesia, using 0.15mg/kg mTHPC (Foscan) as the photosensitising 

agent. Following treatment, patients were followed-up for a mean time 

of 7 months. Results: All patients who presented with visual problems 

reported improvement after treatment. Also, 14/17 reported improvement 

of breathing. Improvement of swallowing was reported by 25/30 patients; 

while speech improvement was evident in 16/22 patients. 33/44 reported 

reduction in the disfigurement caused by their pathology. All patients 

reported improved limb function. Clinical assessment showed that 

half of the patients had “good response” to the treatment and a third 

reported “moderate response” with two patients being fully cured. 

Radiological assessment comparing imaging 6-week post-PDT to the 

baseline showed stable pathology with no change in size in 13 patients, 

minimal response in 18 patients, moderate response in 23 patients and 

significant response in 11 patients. Conclusion: The growing body 

of evidence regarding the efficacy of interstitial photodynamic therapy 

suggests that it will have a leading role in minimally invasive surgery 

and interventional oncology, especially with the development of imageguided 

iPDT. 


REFINEMENT OF THE RADIAL FOREARM DONOR SITE USING 

ACELLULAR DERMAL MATRIX. Carlos R Medina, MD, Sameer Patel, 

MD, John Ridge, MD PhD, Neal S Topham, MD FACS, Neal S Topham, 

MD FACS; Fox Chase Cancer Center, Temple University Hospital. 

Introduction: Squamous cell carcinoma of the tongue is the most 

common intraoral malignancy. The majority of the cancers are located 

on the anterior two-thirds of the tongue. Therefore this cancer can 

often be treated with a hemiglossectomy. Free-tissue transfer is often 

required to reconstruct the defect on the floor of the mouth. The radial 

forearm free flap has been the most commonly used flap to drape the 

floor of the mouth. The simplest way to close the donor site is to use 

a split thickness skin graft. Skin grafting requires the creation of an 

additional wound as the donor site for the skin. Problems with graft 

take can hamper the postoperative progress or delay discharge from 

the hospital. Moreover, skin graft closure of the donor site leaves a 

visible contour defect in the forearm of the patient that underwent this 

procedure. We present a novel technique for tongue reconstruction 

that uses acellular cadaveric dermis to pre-laminate the radial forearm 

free flap. We believe that our method can help reduce the donor site 

morbidity by achieving direct closure of the soft tissue defect. Methods: 

Nineteen consecutive patients requiring subtotal glossectomies for 

tongue malignancy underwent a two stage procedure to reconstruct 

the tongue using a pre-laminated radial forearm free flap between April 

2006 and September 2009. A functional assessment of swallowing 

and speech of this group of patients was performed. The results were 

compared to those of eleven other patients with the same diagnosis who 

underwent similar resections but had their reconstruction performed with 

a standard radial forearm free flap. Results: All patients that underwent 

tongue reconstruction using the acellular cadaveric dermis achieved 

comparable results to the control group in terms of range of motion, pain 

strength, speech, swallowing, and appearance of the donor site. All 19 

patients in the experimental group did not require split thickness skin 

grafting for closure of the forearm donor site. Conclusions: The use of 

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acellular cadaveric dermis to pre-laminate the radial forearm free flap 

for tongue reconstruction demonstrated to be a safe, reliable, versatile 

and convenient method for intraoral reconstruction. All of the patients 

experienced an improved the appearance of the forearm donor site by 

eliminating the need for skin grafting. The possibility of permanently 

disturbing hand function is reduced while it also eliminates the potential 

transfer of hair to the mouth of the patient. Our technique achieved 

excellent functional outcomes while reducing the morbidity associated 

with procedure. 


PRIMARY RADIATION, SECONDARY SURGERY IN PATIENTS WITH 

FACIAL NERVES AT RISK FROM CARCINOMAS OF THE PAROTID 

GLAND. Nathan Hales, MD, Jesus E Medina, MD, Chance Matthiesen, 

MD, Carl Bogardus Jr., MD, J. Spencer Thompson, MD, Greg A Krempl, 

MD; The Universitiy of Oklahoma Health Science Center. 

Introduction: Carcinoma of the parotid gland can appear clinically and 

radiographically in close proximity to the facial nerve placing it at risk 

if primary surgery is undertaken. Post-operative radiation is utilized in 

most of these cases. Treatment with radiation first, “a reversed order 

of treatment approach,” has not been widely utilized but has potential 

to decrease the size of tumors and thereby decrease the risk of facial 

nerve injury or sacrifice with surgery. Methods: At the University of 

Oklahoma this reversed approach has been utilized when patients 

presented with documented malignancies and initial evaluation revealed 

tumors that were either rapidly growing, fixed to the skull base or 

otherwise locally advanced and carried a high risk of sacrifice of a 

functioning facial nerve. An analysis of this practice was performed to 

evaluate outcomes. Results: Eighteen patients with nineteen tumors 

were reviewed, with ages ranging from 20 – 89 (mean 69). The mass 

was poorly mobile or fixed in 83% of patients. Cytopathology included 

SCCA in 39%, mucoepidermoid carcinoma in 17%, poorly differentiated 

neuroendocrine tumors in 11%, adenocarcinoma in 6%, squamoid in 

6%, and other in 22%. All patients were treated with primary radiation: 

18 tumors were treated definitively with a mean dose of 6925 cGy while 

1 tumor progressed during radiation and therapy was discontinued 

after 5425 cGy. Complete clinical response was seen in 8 tumors (42%) 

and none of these underwent parotidectomy however one patient 

developed mild facial weakness following radiation. A partial response 

occurred in 9 tumors (47%) 3 of which underwent subsequent surgical 

resection. A poor response occurred in 2 tumors (11%) one that had 

skull base erosion and developed facial paralysis and one that had 

minimal response locally and developed regional and distant metastasis 

during radiation. Of the three patients who underwent surgical resection 

one patient underwent a radical parotidectomy, one a superficial 

parotidectomy/temporal bone resection with sacrifice of the upper 

division of the facial nerve while the third patient was successfully 

excised with complete facial nerve preservation. Initial facial nerve 

function was House Brackman 1 in 88% and House Brackman 2 in 

12%. Ninety percent of patients remain alive, with 61% free of disease. 

From an intent to treat perspective, of 19 facial nerves deemed at risk 

1 developed complete facial paralysis during treatment, 1 developed 

partial facial paralysis during treatment, 1 required sacrifice of the main 

trunk of the facial nerve and 1 required sacrifice of the upper division. 

Fifteen nerves (79%) were intact with no change in function at the 

end of treatment utilizing this reversed order of treatment approach. 

Conclusion: Primary radiation therapy followed by surgery, if needed, 

can be a successful treatment strategy for treating carcinomas of 

the parotid that place the facial nerve at high risk of sacrifice at initial 

presentation. This series demonstrates excellent response rates, overall 

survival, and post therapy preservation of facial nerve function with 

avoidance of surgical risk to the facial nerve in the majority of cases. 


GLAND PRESERVING THERAPIES FOR CHRONIC SIALADENITIS: A 

GERMAN AND U.S. COMPARISON. M. Boyd Gillespie, MD, Johannes 

Zenk, MD, Michael Koch, MD, Heinrich Iro, MD; Medical University of 

South Carolina; University of Erlangen. 

Objective: Compare similarities and differences in techniques and 

outcomes in gland preserving salivary surgery for chronic sialadenitis 

at a German and U.S. tertiary-referral head and neck surgery program. 

Methods: A retrospective review was performed on two prospectively 

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created department databases to identify patients with chronic 

sialadenitis treated with gland preservation strategies. Results: A total 

of 1181 patients were treated at the German center over a 16 year period 

compared to 44 patients over 2 years at the U.S. center. There was a 

slight male predominance in Germany (53%) compared to a majority of 

female (54%) in the U.S. Salivary stones were a much more common 

cause of gland obstruction in Germany compared to the U.S. (97% 

v. 52%), whereas ductal strictures were a more commonly diagnosed 

caused in the U.S. (25% v. 3%). All patients were initially treated with 

one or more gland preserving therapies including salivary endoscopy, 

sialodochoplasty, steroid infusion, Botox injection, ductal stenting, and 

extracorporeal shock wave lithotripsy. The most common treatmentrelated 

complication was ductal perforation which was observed in 2% 

of German cases and 4.5% of U.S. cases. A greater percentage of U.S. 

patients required gland excision compared to German patients (20% v. 

2%). The majority of patients with intact glands were asymptomatic in 

both Germany and the U.S. (92% v. 85%) after mean follow-up times 

of 6 months (Germany) and 8 months (U.S.). Identified reasons for the 

higher rate of gland extirpation in the U.S. included less familiarity with 

endoscopic salivary techniques; a higher rate of ductal strictures likely 

related to previous dilation attempts; mean stone sizes on the upper 

limits (7 mm) of what can easily be removed via endoscopy; lack of 

access to lithotripsy; and performance of the procedures under general 

anesthesia making open conversion easier to perform. Conclusion: 

Gland preservation can be achieved using a variety of techniques 

in the majority of patients who present with chronic sialadenitis. It is 

anticipated that U.S. outcomes will start to mirror the superior rates 

of gland preservation observed in Germany as these techniques are 

mastered and applied to a wider population of potential patients. 


ONCOLOGICAL OUTCOMES AFTER SUPRACRICOID PARTIAL 

LARYNGECTOMY. Isabel Sanchez-Cuadrado, MD, Alejandro Castro, 

MD, Ricardo Bernaldez, MD, Antonio Del Palacio, MD, Javier Gavilan, 

MD; La Paz University Hospital. 

Objective: To review the oncological outcomes of supracricoid partial 

laryngectomy at our Deparment. Methods: Retrospective review 

of clinical records of patients that underwent supracricoid partial 

laryngectomy at our institution. Forty-one patients with glottic or 

supraglottic squamous cell carcinoma were identified. Data concerning 

patient and tumor characteristics, surgery, postoperative period, and 

follow-up were collected. Results: All patients were male, with a mean 

age of 56 years (range 38-71 years old). Thirty-seven percent of tumors 

were classified as locally advanced carcinomas (T3-T4). Thirty-three 

patients (80%) underwent supracricoid laryngectomy with crico-hyoidoepiglotto-pexy 

(CHEP). Epiglottis was resected in the other 8 patients. 

One patient died in the immediate postoperative period because of 

cardiac tamponade, six developed pneumonia, two had a postoperative 

bleeding that required reintervention and other two developed pharyngocutaneous 

fistula. The median follow-up period was 38 months. More 

than 85% of the patients completed more than 2 years of follow up. 

Five-year actuarial local control rate was 80%, being 91% for T1-T2 

tumors and 61% for locally advanced tumors. Thirty-five patients (85%) 

preserved their larynx. The 6 patients that underwent total laryngectomy 

had a local recurrence or a regional recurrence that infiltrated the larynx. 

No laryngectomy was performed for functional reasons. Conclusions: 

Supracricoid partial laryngectomy is an oncologically safe procedure 

to preserve laryngeal functions in selected patients with glottic and 

suproglottic carcinomas. Our results are comparable to those reported in 

the literature. 


LARYNGEAL FUNCTION PRESERVATION FOLLOWING 

SUPRACRICOID PARTIAL LARYNGECTOMY. Alejandro Castro, MD, 

Isabel Sanchez-Cuadrado, MD, Ricardo Bernaldez, MD, Antonio Del 

Palacio, MD, Javier Gavilan, MD; La Paz University Hospital. 

Objective: To analize the functional outcomes of supracricoid partial 

laryngectomy at our Deparment. Methods: Forty-one patients with 

glottic and supraglottic carcinomas underwent supracricoid partial 

laryngectomy at our institution since it was introduced in 1998. Data 

concerning time to decanulation and oral intake were collected from the 

clinical records. 

Twenty-seven patients were alive, preserved their larynx and had a 

minimum follow-up of 3 months at the time of this survey. All but one 

accepted participation in a functional evaluation that includes a voice 

questionnaire (Voice Handicap Index), a swallowing questionnaire (M.D. 

Anderson Dysphagia Inventory) and objective measurements of voice 

quality (maximum phonation time and maximum intensity). Results: 

Ninety-eight percent of the patients were decannulated, with a median 

time to decannulation of 14 days. Every patient achieved oral intake, at a 

median time of 18 days after surgery. Median Voice Handicap Index (VHI) 

score was 26, with 75% of patients scoring less than 40 (the VHI score 

ranges from 0 to 120: lower scores represent less subjective handicap). 

Median M.D. Anderson Dysphagia Inventory (MDADI) score was 92, 

with 75% of patients scoring 80 or over (the MDADI score ranges from 

20 to 100: higher scores correspond to better swallowing function). 

Median maximum phonation time was 12 seconds (Q1 = 8 sec; Q3 = 14 

sec). Median maximum intensity was 99 dB (Q1 = 95 dB; Q3 = 100 dB). 

Conclusions: Laryngeal function can be preserved with supracricoid 

partial laryngectomy in selected patients with glottic and supraglottic 

carcinomas. Quality of life measurements demonstrate excellent voice 

and swallowing following this procedure. 


3D ANALYSIS OF NEOGLOTTIS AFTER SUPRACRICOID 

LARYNGECTOMY WITH CHEP. Yutomo Seino, Meijin Nakayama, 

Makito Okamoto, Masahiko Takeda, Syunsuke Miyamoto; Seiichi 

Hayashi Department of Otorhinolaryngology, Kitasato University School 

of Medicine. 

Objective: To morphologically analyze the three-dimensional (3D) 

configuration of the neoglottis after supracricoid laryngectomy with 

cricohyoidoepiglottopexy (SCL-CHEP). Patients and Methods: 

Multidetector helical CT scanning was performed for 21 patients 

who received SCL-CHEP. Fine cut CT image was evaluated at a 

slice thickness of 1.25 mm. Then 3-D models of the neolarynx were 

reconstructed using INTAGE Realia (KGT Inc) on a Windows computer. 

In this study, ossification of the cricoid and arytenoid cartilages and 

virtual endoscopic images of the airway were visualized on 3-D images. 

Results: 1) Mobility of arytenoid cartilages; In patients with bilateral 

arytenoids remaining, mobility of arytenoids was well preserved. The 

mobility was even better in patients with only one arytenoid. There were 

no findings suggesting arytenoid dislocation. 2) Morphology of the 

airway; Two types of airway configurations, one with a single stream and 

the other with a combination of several streams, were observed during 

phonation. There were significant differences between these two groups 

in terms of MPT and VHI analyses. Discussion: Because neolarynx 

morphology is directly related to postoperative phonetic function, 3D 

images of arytenoid mobility and airway configuration demonstrated 

useful information related to the post SCL-CHEP neolarynx. The 

preserved arytenoid tended to be rotated excessively inward, phonation 

may have also occurred in various airways outside of the arytenoid 

region followed by mucosal vibration, which may be a sound source. 

This information may be useful for improving the surgical technique so 

that better laryngeal function can be attained. 


RESTAGING PRIMARY SITE BIOPSY CAN OPTIMIZE SELECTION OF 

PRIMARY THERAPY IN HIGH STAGE (III/IV) SQUAMOUS CANCER. 

H J Wanebo, MD, R Rathore, MD, K Radie-Keane, MD, N Ready, MD, 

A Nadeem, MD, J Belliveau, PhD, P Nigri, MD, P Chougule; Landmark 

Medical Center Woonsocket, RI USA, Roger Williams Medical Center 

Providence, RI USA, Rhode Island Hospital Providence, RI USA, Brown 

University Providence, RI USA. 

Objective: Neoadjuvant therapy for stage III/IV head and neck cancer 

(H&N Ca) provides an opportunity for primary site organ preservation 

and improved progression free survival. Although clinical observation 

of response is commonly used to select final primary site therapy 

(continued chemo radiation (CRT) vs. surgical savage), restaging biopsy 

appears to be a more precise method of selecting optimum primary site 

therapy. Materials & Methods: A consecutive series of neoadjuvant 

protocols by the Brown Oncology Group (BrUOG) has focused on 

restaging primary site biopsy to select therapy of Stage III/IV squamous 

cancer since 1995. Initially concurrent preoperative Paclitaxel (P) (60mg/ 

M2) + Carboplatin (C) ( 2AUC) (H & N53) or P 40m/M2 + C (1 AUC) + RT 


Poster Papers 

(45G) H&N 67 was given to 63 evaluable pts. Subsequent studies utilized 

induction chemo (H&N79) P 135mg/M2, C (2AUC), weekly x 6 followed 

by chemoradiation therapy or (H&N86) P60-100mg/M2, C(2AUC), 

Ifosfamide 1gm/M2/wk x6 weeks followed by same CRT. P 40 C (1AUC) 

+ 45 Gy in 30 pts (13 operable). Patients with positive restaging biopsy 

had subsequent resection whereas those with negative re-biopsy had 

completion chemo radiation therapy (68-72Gy) of primary site. Results: 

Concurrent protocols (53 & 67) chemoradiation showed a complete 

pathologic response in 70% of pts vs. a 52% clinically determined 

CR permitting completion radiation with primary site preservation in 

70% of patients. Neck dissection revealed persistent nodal disease in 

34% confirming continued need for neck surgery in patients with N1-3 

disease. Protocols 79 & 86 (induction followed by chemo radiation) 

resulted in an 86% complete path response. Survival OS & DFS were 

equivalent in patients having completion chemo Radiation (44%/54%) or 

Surgery, (55%/54%). A major factor associated with persistent cancer at 

the primary site was high T stage (T 3 & 4) in 94% of patients requiring 

resection vs. 58% in patients having a pathologic CR after Chemo RT. 

Overall site related factors for persistent cancer were (high T stage, base 

of tongue, Larynx and mandible). Conclude: Restaging biopsy after 

neoadjuvant chemo radiation (C RT) is superior to clinical assessment 

alone in demonstrating a complete response to therapy and permitted 

completion radiation therapy and primary site organ preservation in over 

70% of patients with concurrent C RT and 86% after induction therapy. 

Surgical resection (RO) limited to those with persistent tumor permits 

tumor eradication at primary site and long term survival and disease 

control that is equivalent to the more biologically favorable radiation 

treated group. 


RETROPHARYNGEAL NODE METASTASIS AFTER ORGAN- 

PRESERVATION SURGERY FOR HYPOPHARYNGEAL SQUAMOUS 

CELL CARCINOMA. Kazunari Nakao, MD PhD, Kenya Kobayashi, 

MD, Naoko Hasegawa, MD, Aiko Shiraishi, MD, *Takahiro Asakage, MD 

PhD, *Tatsuya Yamasoba, MD PhD; Department of Otolaryngology- 

Head and Neck Surgery, Kanto Medical Center, Tokyo *Department of 

Otolaryngology- Head and Neck Surgery, Faculty of Medicine, University 

of Tokyo. 

Objective: Lateral retropharyngeal node, also known as Rouviere’s 

lymph node, is anatomically located between median and profound lobe 

of deep cervical fascia in the level of nasopharynx and oropharynx. It is 

known to receive the lymphatic drainage from pharyngeal wall. Although 

the metastasis to the retropharyngeal node is one of the typical failure 

patterns in the treatment of hypopharyngeal cancer, the analyses for 

its risk factors and the therapeutic strategy are both still inconsistent. 

The factors related to the retropharyngeal node metastasis are highly 

likely not the same as the general risk factors of head and neck cancer 

such as positive surgical margins, extracapsular spread (ECS) of nodal 

metastasis and multiple nodal metastasis. We analyze the cases of 

retropharyngeal node metastasis after organ-preservation surgery for 

hypopharyngeal squamous cell carcinoma and discuss about the risk 

factors and the appropriate attitude for this vicious entity. Methods: Out 

of 168 patients who were seen at our institute in last nine years with a 

diagnosis of hypopharygeal cancer, 27 patients (25 men and 2 women) 

underwent the larynx-preservation surgery. These surgeries contents 

6 trans-oral resection and 21 partial pharyngectomy with free jejunal 

reconstruction. Age of these patients ranged from 48 to 78 years old 

(average 62.5 years old). Follow-up period was 4 to 91 months. Results: 

Cause-specific 2-year and 5-year survival rates were 85.6% and 56.7% 

respectively. Of 27 patients in this series, 5 (18.5%) had an emergence of 

retropharyngeal lymph node metastases in the course of postoperative 

follow-up. All the cases were given chemoradiation or radiation as 

salvage therapy. Two died of retropharyngeal metastasis, 1 are alive with 

disease, 1 died of lung metastasis and 1 died of comorbid esophageal 

cancer. Three of these 5 cases were pathologically nodal metastasis 

free with the neck dissection which was performed simultaneously with 

the organ-preservation surgery. None of these cases had ECS of nodal 

metastasis. The subsite of their original disease was posterior wall in all 

of five cases. The surgical margin was negative in 4 cases and positive 

for carcinoma in situ in 1 case. Conclusions: Our data suggests that 

retropharyngeal node metastasis be deeply associated with cancer 

invasion to the posterior wall and that the posterior wall of hypopharynx 

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might have an independent direct lymphatic route to retropharyngeal 

node. Although the post-operative radiation may have a negative impact 

in terms with the functional outcome after organ-preservation surgery, 

it must be considered for the cancer invaded to the posterior wall of 

pharynx. 


ONCOLOGIC AND FUNCTIONAL OUTCOMES OF LASER SUGERY 

FOR GLOTTIC RECURRENCES AFTER RADIOTHERAPY. Giorgio 

Peretti, MD, Cesare Piazza, MD, Francesca Del Bon, MD, Stefano 

Mangili, MD, Daniela Cocco, MD, Piero Nicolai, MD; Department of 

Otorhinolaryngology - Head and Neck Surgery, University of Brescia, 

Italy. 

Introduction: Transoral laser surgery (TLS) for early and intermediate 

glottic cancer is considered a valuable option, with good oncologic 

and functional outcomes. Despite this, radiotherapy (RT) is still 

considered the gold standard therapeutic strategy in many centers. 

However, TLS surely represents the treatment of choice in selected 

local recurrences after RT. Material and Methods: Between February 

1995 and September 2007, 30 patients (29 males, 1 female; mean age, 

67 years; range, 49-86) affected by rT1-rT2 glottic cancer, previously 

submitted to RT, were treated by TLS at our Institution for recurrence 

of local disease. Oncologic outcomes for the entire cohort of patients 

were evaluated by the SPSS statistical package. Functional outcomes 

in terms of speech and swallowing were analyzed in a subset of 9 

patients by Voice Handicap Index (VHI), GRBAS scale, Multi Dimensional 

Voice Program (MDVP), MD Anderson Dysphagia Inventory (MDADI) 

questionnaire, videoendoscopy of swallow, and videofluoroscopy 

(both graded according to the Donzelli’s scale). Hospitalization time 

and complication rate were retrospectively evaluated by charts review. 

Results: Endoscopic resections performed, according to the European 

Laryngological Society classification, were as follows: 21 Type III, 1 

Type IV, and 8 Type V cordectomies. Postoperative T category was as 

follows: 17 rT1 (12 rT1a and 5 rT1b), and 13 rT2. At last consultation 

(minimum follow-up, 24 months), 21 patients were free of disease, 2 died 

of disease, and 7 died of unreleated causes. Seven patients underwent 

total laryngectomy for persistent or recurrent disease. Five-year disease 

specific, disease free survivals, and organ preservation rate according 

to the Kaplan-Meier curves were 95%, 63%, and 77%, respectively. The 

mean value of VHI and MDADI were 25 and 88%, respectively. GRBAS 

scale mean values for each domain resulted as follows: 1.7 for G, 1.6 for 

R, 1.2 for B, 1.1 for A, and 1.1 for S. The MDVP parameters were: 3.8 for 

Jitter%, 7.6 for Shimmer%, 0.304 for Noise to Harmonic Ratio, and 7.37 

seconds for Maximum Phonation Time. Grade of aspiration according 

to the Donzelli’s scale for videoendoscopy of swallow was normal in 

50% of patients, with vestibule penetration without aspiration in 25%, 

and with tracheal aspiration in 25%. For videofluroscopy, the distribution 

was 50% with normal swallow and with tracheal aspiration in the other 

50%. Hospitalization time ranged from 3 to 9 days (mean, 4). Early 

complications were not encountered. Three patients experienced late 

thyroid cartilage chondritis (n=1) or chondronecrosis (n=2), which were 

successfully treated by hyperbaric oxygen therapy. One patient needed 

nasogastric feeding tube for persistent dysphagia, which was removed 

1 week later after swallow rehabilitation. Conclusions: TLS for rT1-rT2 

glottic recurrences after RT allows good oncologic outcomes. In spite of 

its mini-invasiveness, swallow can be significantly impacted in case of 

Type V cordectomies, even though prolonged nasogastric feeding tube is 

the exception instead of the rule. 


ENDOCOPIC CO2 LASER SURGERY IN ELDERLY PATIENTS WITH 

EARLY LARYNGEAL CANCER. AUGUSTO CATTANEO, MD, MOHSSEN 

ANSARIN, MD, STEFANO ZORZI, MD, MARIA ANGELA MASSARO, 

PhD, LUIGI SANTORO, MSc, FAUSTO MAFFINI, MD, FAUSTO CHIESA, 

MD; EUROPEAN INSTITUTE OF ONCOLOGY. 

Objective: to evaluate the impact of endoscopic excision of early 

glottic cancer in term of feasibility, disease-free survival (DFS), overall 

survival (OS) and organ preservation in elderly patients. Design: 

retrospective single institution study. Sitting: Tertiary referral center. 

Patients: Between January 2000 and May 2008, 122 patients (male/ 

female ratio 113/9; median age 74 years (70-88 years) with previously 

untreated early laryngeal cancer were treated with CO2 laser at the 

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Division Head and Neck Surgery of European Institute of Oncology 

Milan Italy. Interventions: Inclusion criteria were cTis, cT1 or cT2, no 

contraindications to general anesthesia, aging (≥ 70 years) and signed 

consent. Comorbities and intra-operative risks are assessed using ASA 

criteria. Surgical technique (according to the European laryngological 

classification) was type I–V cordectomies. All operation was with curative 

intent. Resection margins are evaluated and defined negative (> 1 mm 

from the tumour edge), close (≤ 1 mm) and positive (presence of tumour 

tissue on resection margins). Patients with clear margins, and those with 

LIN on the margins underwent clinical follow up in accordance with our 

guidelines. Patients with positive margins suitable for new endoscopic 

resection underwent resection 30–40 days later, and patients with 

positive margins not suitable to further endoscopic resection underwent 

adjuvant radiotherapy. 

Results: The pathological staging were: pT0 (19 patients, 15.6%: 

calculated only in patients with previous biopsy), pTis (18 patients, 

14.7%), pT1a (53 patients, 43.4%), pT1b (16 cases, 13.1%), pT2 (15 

cases, 12.3%) and pT3 for invasion of the paraglottic space in 1 patient 

(0.8%). The median follow up was 57 months, (5-116 months); 102 

patients (83.6%) are alive without disease; 1 patient (0.8%) is alive with 

local disease, while 16 patients (13.1%) died from other causes without 

evidence of loco-regional disease and 3 patients (2.4%) died from the 

laryngeal cancer. There were post-surgical complications in 5 patients: 

subcutaneous emphysema, atrial flutter, respiratory disease and two with 

mental confusion. 

In 11/122 (9%) patients we observed a second primary tumour during 

the follow up period: 9/11 patients are however alive, while 2/11 are 

dead for the second tumour (pulmonary cancer). Main-Outcome: 

Preservation of the larynx was obtained in 118 cases (96.7%), with a 

10-year OS of 84.4 % and a 10-year DFS of 94.3%. No patient died for 

reason correlated to the anaesthesia method. Conclusions: Medical 

conditions are critical to the assessment choice for a open neck 

conservative surgery and in particular pulmonary and heart functions. 

Furthermore, if we consider the choice of an exclusive radiation 

treatment in an old patients, we have also to analyze not only the 

patient’s compliance of a treatment time of 6 or more weeks, but also 

long distance travel to the radiation center and the familiary organizing 

difficulties: all these things, above all nowadays, may prefer short time 

surgery over radiation therapy. In our series, CO2 laser removal of an 

early glottic cancer in elderly patients can be often considered a feasible, 

short hospitalization and no-risk procedure without compromising 

laryngeal preservation, other different treatments and quality of life of the 

patients. 


OUTCOMES AFTER PRIMARY SURGICAL TREATMENT OF T1-T2 

N0 SQUAMOUS CELL CARCINOMA OF THE OROPHARYNX. Tania B 

Souza, MD, Marcos B Carvalho, MD PhD, André L Carvalho, MD PhD, 

Luiz P Kowalski, MD PhD; Hospital A C Camargo, Hospital do Cancer de 

Barretos, Hospital Heliópolis. 

Aims: the purpose of this study was to review the oncologic outcomes 

of patients with early-stage squamous cell carcinoma of the oropharynx 

that underwent surgical treatment with or without postoperative 

radiotherapy at three Head and Neck Surgery Departments. Study 

Design: Retrospective chart review. Material and Methods: The records 

of 92 consecutive patients, 82 (89.1%) men and 10 women with a 

median age of 57.2 years (range: 42-79), who had clinical stage I and II 

SCC of the oropharynx were reviewed. The patients were treated from 

1990 to 2005. All included patients were treated with radical surgery 

followed or not of postoperative radiotherapy. Results: Thirty-five 

patients had tumors at stage I and 57 at stage II. A level I to V neck 

dissection was performed on 20 patients, 18 patients underwent a level 

I to III selective neck dissection and 8 a level I to IV neck dissection. 

Sixty-three patients had surgery only, 29 had surgery and postoperative 

radiotherapy, and 5 had surgery and chemoradiotherapy the median 

hospital stay was 5.47days. Tracheostomy was done in 45 patients, 

and 44 had decannulation. The tracheostomy was needed for a mean 

duration of 38.1 days. Temporary feeding tubes were placed in 52 

patients, for a mean of 40.5 days; of these, 51 had the tubes removed. 

During follow-up, there were 22 (23.9%) local recurrences, 12 neck 

recurrences (13.0%), and 6 distant metastasis (6.5%). Thirty-two 

patients (34, 78%) presented second primary cancers; fifteen died, 12 

are alive and free of disease. Some of these second localizations were 

six oropharynx, six oral cavities, five lung and two larynx/hipopharynx. 

The 5-year rate of cancer specific survival was 81.6%. There was no 

significant difference concerning tumor stage (p=0.761), perineural 

infiltration (p=0.875) and vascular embolization (p=0.384). The 5-year 

cancer specific survival rates for negative and involved margins were 

84.8 and 72.9%, respectively, but the trend toward a poorer prognosis 

was not statistically significant (p=0.478). Conclusions: We concluded 

that surgical approach on T1-T2 N0 oropharyngeal cancers is as efficient 

as radiotherapy. Moreover, surgery alone makes it possible to spare 

patients of long term side effects of radiotherapy. It also allows salvage 

surgery due to loco-regional recurrences or second primary cancers in 

a non-radiated area with lower morbidity and mortality. It is possible to 

keep radiotherapy to treat a second primary cancer if necessary. 


THE MEDICAL PERCEPTION OF QUALITY OF LIFE AND ITS IMPACT 

ON THE CHOICE OF THE TREATMENT IN HEAD AND NECK 

CANCER. Pierre Demez, MD PhD, Alexandre Biermans, MD, Pierre 

Moreau, MD PhD; C.H.U. Sart-Tilman, Liège, Belgium. 

Purpose: Patients with head and neck cancer are willing to undergo 

aggressive treatments and accept alterations in quality of life in order 

to attain recovery or increase longevity. The general practitioners play a 

central role in patient care and can influence treatment choice. It is not 

clear how these physicians perceive alterations in quality of life. This 

study examined whether physicians considered changes in quality of life 

when choosing a treatment for head and neck cancer. 

Materials/Methods: 3000 general practitioners received a questionnaire 

in the mail regarding their opinions on quality of life for patients with 

cancer. They assessed the impacts of symptoms, treatments, and 

side effects. Results: 506 responses were received and evaluated. 

A majority of physicians (85.7%) thought that quality of life must be 

considered when choosing a treatment, even if it meant less chance 

of survival. Moreover, 82.4% felt that proposing no treatment was 

justified if treatment meant an impaired quality of life. Most physicians 

thought that the quality of life was worse for patients with cancer in 

the head and neck than for patients with cancer in any other location. 

Moreover, physicians thought that the patient (98.2%) and the family 

doctor (89%) should participate in deciding on the choice of treatment, 

but also answered that they were not sufficiently informed on head and 

neck cancer (76.3%) and the resulting changes in quality of life (75.2%). 

The symptoms ranked highest for impacting quality of life were pain 

and breathing, followed by feeding requirements, voice, and physical 

appearance. Radiotherapy was thought to offer the best quality of life 

before surgery and chemotherapy. Conclusion: General practitioners 

considered quality of life a very important factor in treating patients with 

head and neck cancer. Compared to the patient’s point of view, quality of 

life seems to have a more important influence on decision-making within 

the medical community. They felt under-informed about head and neck 

cancer and the resulting quality of life. Taking into account the central 

role of these physicians in the management of the patient, improving the 

information given to the general practitioners should be considered a 

high priority. 


ENDOVASCULAR TREATMENT OF HEMORRHAGE IN OF PATIENTS 

WITH HEAD AND NECK CANCER. Candice C Colby, MD, Amy Chen, 

MD MPH FACS; Emory University. 

Introduction: Interventional radiology has evolved to include multiple 

endovascular treatment options for hemorrhage from head and neck 

cancer with improved outcomes over surgical intervention. Study 

Objectives: We describe our experience with endovascular therapy for 

treatment of hemorrhage in head and neck cancer patients at a large 

tertiary center over a ten-year period. Methods: A retrospective chart 

review of hospital records was performed to identify patients with a head 

and neck cancer diagnosis who underwent endovascular intervention 

for hemorrhage from 1999-2009. Data collected included demographics, 

history of cancer diagnosis and treatment, endovascular procedures 

performed, complications, episodes of recurrent bleed, and survival. 

Results: There were a total of 19 patients identified that underwent 

endovascular procedures for hemorrhage from head and neck cancer. 

Our initial success rate is 78%, with an overall success of 89%. There 


Poster Papers 

were two major complications- one cerebrovascular accident and one 

pharyngocarotid fistula following erosion of a stent into the pharynx. 

No patients died as a complication of intervention. Conclusion: We 

observed endovascular therapy to be a highly successful method of 

controlling hemorrhage in head and neck cancer patients with multiple 

advantages over surgical intervention. Interventional radiology is an 

essential resource in treating patients with head and neck hemorrhage. 


FUNCTIONAL AND COSMETIC OUTCOMES OF PATIENTS 

WITH MAXILLECTOMY DEFECTS RECONSTRUCTED WITH 

VASCULARIZED FREE TISSUE TRANSFER. Jamie J Tibbo, MD MSc 

FRCSC, Jeffrey R Harris, MD FRCSC, Jana Reiger, PhD, Hadi Seikaly, 

MD FRCSC; University of Alberta. 

Objectives: To assess the functional and cosmetic outcomes of 

patients with maxillectomy defects reconstructed with vascularized 

free tissue transfer. Methods: We analyzed prospectively collected 

data on 35 patients with maxillectomy defects reconstructed with 

vascularized free tissue transfer (mainly radial forearm and fibula free 

flaps). Functional outcomes after reconstruction was assessed using a 

comprehensive collection of outcomes parameters including: PERCI- 

SARS for assessment of velopharyngeal orofice area, nasometer for 

assessment of nasalance, and standardized recordings for assessment 

of speech inteligibility. Cosmetic analysis was performed using eight 

naïve viewers providing assessment via a 10 point Likert scale. Results: 

In all parameters measured for both functional and cosmetic outcomes, 

results were excellent for free tissue reconstruction. Conclusions: 

Patients and reconstructive surgeons should expect excellent functional 

and cosmetic results with reconstruction of maxillectomy defects with 

free tissue transfer. Our next step will be to compare free tissue transfer 

reconstruction with the gold-standard at most institutions; palatal 

obturator. 


THE IMPACT OF MULTIFOCAL PATTERN OF INVASION ON PATIENT 

OUTCOMES IN ORAL SQUAMOUS CELL CARCINOMA. Michael L 

McNeil, MD, Martin J Bullock, MD FRCPC, Robert D Hart, MD FRCSC, 

Jonathan R Trites, MD FRCSC, S M Taylor, MD FRCSC FACS; Dalhousie 

University. 

Objectives: Multifocal squamous cell carcinoma (MSCC) of the oral 

cavity is thought to be associated with poor patient outcomes. We 

sought to determine the frequency of MSCC and associated outcomes 

to determine if the current standard of treatment is sufficient. Methods: 

70 consecutive patients undergoing hemiglossectomy or total 

glossectomy between January 2000 and August 2008 were identified. 

Worst Pattern of Invasion (WPOI), Histological Risk Assessment (HRA), 

local recurrence (LR) and mortality were determined. Results: WPOI 

suggesting multifocality (grade 5) was associated with higher LR 

and mortality (38%, 25%) when compared to WPOI 1-4 (15%, 15%). 

Further, High HRA was associated with higher LR and mortality (38%, 

38%) compared to combined Low and Intermediate (5.3%, 0%). 

Conclusions: The results suggest that MSCC correlates with both LR 

and mortality. These data may impact standard of care for oral cancer 


THE NATURAL HISTORY OF UNTREATED SQUAMOUS CELL 

CARCINOMA OF THE HEAD & NECK. JEAN-PIERRE JEANNON, MD 

FRCS, ENYI OFU, MD FRCS, RICARD SIMO, MD FRCS; GUY’S & ST 

THOMAS’ NHS FOUNDATION TRUST. 

Introduction: Head & Neck squamous cell carcinoma (HNSCC) remains 

a serious management problem as the mortality is still high despite 

advances in therapeutic techniques. There are several factors which 

are thought to contribute to the poor outcome these include late 

advanced stage at presentation, the presence of significant co-existing 

co-morbidity, patients’ refusal to accept morbid therapies and the high 

incidence of second primary carcinomas. A significant proportion of 

patients may present with one or all of the above factors which may 

render them unsuitable for treatment other then in a palliative care. The 

purpose of the paper is to analyse and present the outcome of patients 

with HNSCC who have not undergone any form of treatment in our 

institution. Methods: The setting of this study is a regional tertiary 

referral cancer centre where all patients with HNSCC in the South East 

London Cancer network are treated in this centre. All patients with a 

primary diagnosis of HNSCC were included in this study if there were 

deemed unsuitable for surgery, chemotherapy or radiotherapy. Patient 

data, TNM stage and co-morbidities were recorded. Multivariate 

analysis was performed. Results: For the study period of 01/01/06 until 

31/12/07, 450 new patients with HNSCC were managed by the head and 

neck multidisciplinary team. From this group 44 (9 %) patients received 

no form of treatment in terms of radiotherapy, surgery or chemotherapy 

and received best supportive care only. The mean patient age was 74 

years range (47-97). The Larynx (51%) was the most commonly involved 

primary tumour site, followed by the Oropharynx (25%), Oral cavity (9%), 

Hypopharynx (9%) and other sites (6%). As expected with this selected 

subgroup advanced primary stage was seen in the majority of cases: 

32/44 (70%) were T4 at presentation, 8/44 (18%) were T3. 

Cervical lymph node involvement was seen in 82% of patients. Distant 

metastases were seen in 21/44 = 47% of patients the majority of these 

were in the lung followed by bony metastases. The reason for no 

treatment other than best supportive care being given was multi-factorial 

and included: multiple distant metastatic disease 21/44 = 47%, severe 

co-morbidity / organ failure 18/44 = 41% and patient refusal 5/44 = 12%. 

Multivariate analysis did not identify any significant factor that affected 

survival. The median survival for untreated patients was 11.5 months 

all patients died within 30 weeks. Conclusion: Up to 9% of patients 

diagnosed with HNSCC are found to be unsuitable for any form of 

treatment due to patient refusal, severe co-morbidity or multiple distant 

metastatic disease. The natural untreated HNSCC is 100% mortality 

within 30 weeks. Multivariate analysis does not appear to identify a 

single factor which significantly alters survival. 


HIGH RATES OF LOCAL AND REGIONAL RECURRENCE IN 

LOCALLY ADVANCED SQUAMOUS CELL CARCINOMA OF THE 

HARD PALATE AND MAXILLARY ALVEOLUS. Luc G Morris, MD, 

Snehal G Patel, MD, Jatin P Shah, MD, Ian Ganly, MD PhD; Memorial 

Sloan-Kettering Cancer Center. 

Introduction: Because squamous cell carcinoma (SCC) of the hard 

palate and maxillary alveolus is uncommon compared with other oral 

cavity subsites, contemporary outcomes data are sparse. The objective 

of this study was to determine survival and recurrence outcomes in 

patients with cancer of the hard palate and maxillary alveolus, and to 

identify factors predictive of these outcomes. Methods: Retrospective 

cohort study of 139 patients with SCC of the hard palate and maxillary 

alveolus treated at Memorial Sloan-Kettering Cancer Center between 

1985 and 2006. Elective neck dissections were not routinely performed. 

Patient, tumor and treatment details were recorded from patient charts. 

Overall survival (OS), disease-specific survival (DSS), recurrencefree 

survival (RFS), local recurrence-free survival (LRFS) and regional 

recurrence-free survival (RRFS) were calculated using the Kaplan-Meier 

method. Successful salvage of recurrence was defined as >24 months 

survival. Factors predictive of these outcomes were identified on Cox 

multivariable regression. Results: The 5 year OS was 57.8%, DSS 

70.7%, and RFS 53.5%. Recurrence occurred in 41.9% of patients; 

24.9% developed local recurrence, and 28.4% developed regional 

recurrence. The 5 year LRFS was 60.4%, and RRFS was 59.2%. 

Recurrence was significantly associated with pathologic T stage: pT4 

patients experienced a cumulative local recurrence rate of 37.0%, and 

regional recurrence rate of 38.1%. Pathologic T stage was the sole 

variable independently predictive of OS, DSS, RFS, LRFS and RRFS 

on multivariable analysis. Successful salvage was achieved in 41.9% 

of local recurrences, and 34.4% of regional recurrences. Conclusion: 

Patients with primary tumors of the hard palate and maxillary alveolus 

staged T2-T4 exhibit high rates of local and regional recurrence, many 

of which are not successfully salvaged. Adjuvant radiation to the 

primary site, and elective treatment of the N0 neck, should therefore be 

considered for locally advanced SCC of the hard palate and maxillary 

alveolus. 

www.ahns.info 

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SQUAMOUS CELL CARCINOMA OF THE ORAL TONGUE IN 

THE PEDIATRIC AGE GROUP: A MATCHED-PAIR ANALYSIS OF 

SURVIVAL. Luc G Morris, MD, Snehal G Patel, MD, Jatin P Shah, MD, 

Ian Ganly, MD PhD; Memorial Sloan-Kettering Cancer Center 

Introduction: Squamous cell carcinoma (SCC) of the oral tongue 

is uncommon in young patients, and rare in the pediatric age group 

(ages 20 and younger). It is believed to exhibit aggressive behavior 

and carry poor prognosis in younger patients. However, outcomes 

of oral tongue SCC in pediatric patients have not been studied. The 

objective of this study was to compare outcomes of a pediatric cohort of 

patients compared with a matched cohort of adult patients. Methods: 

Retrospective matched-pair cohort study of 10 pediatric and 40 adult 

patients diagnosed with SCC of the oral tongue who were treated at 

Memorial Sloan-Kettering Cancer Center. Adult patients were matched 

to pediatric patients 4:1 for gender, tobacco history, tumor status, nodal 

status, distant metastasis status, surgical procedure, and administration 

of adjuvant radiotherapy. Overall survival (OS), disease-specific survival 

(DSS), and recurrence-free survival (RFS) were calculated using the 

Kaplan-Meier method. Results: Five year OS was equivalent in the 

two groups: 70.0% in the pediatric group and 64.0% in the adult group 

(p=0.97) Five year DSS was also equivalent: 80.0% in the pediatric 

group, and 76.0% in the adult group (p=0.90). Five year RFS was 

70.0% in the pediatric group and 78.4% in the adult group (p=0.54). 

Conclusions: When pediatric and adult patients were matched for 

gender, tobacco history, TNM status, surgical procedure and adjuvant 

radiotherapy, outcomes for OS, DSS and RFS were equivalent. Pediatric 

patients with SCC of the oral tongue should be managed similarly to 

adult patients. 


SUBMANDIBULAR GLAND TRANSFER: OUR 10-YEAR EXPERIENCE 

AND A REVIEW OF THE LITERATURE. Jamie J Tibbo, MD MSc 

FRCSC, Naresh Jha, MBBS FRCSC, Jeffrey R Harris, MD FRCSC, David 

Williams, MD FRCSC, Hadi Seikaly, MD FRCSC; University of Alberta. 

Objective: To review our 10-year experience with submandibular gland 

transfer and to review the world literature. Design: Literature Review. 

Background: Radiation therapy is commonly used in the treatment of 

head and neck malignancies. Xerostomia is a permanent devastating 

side-effect of head and neck irradiation. Ten years ago, our group 

described the submandibular gland transfer procedure which involves 

moving a submandibular gland outside the radiation field, forward into 

the submental space. The gland is mobilized by transecting the facial 

artery, with the gland receiving retrograde blood-flow. The gland is 

spared from radiation, and function is preserved. Methods: A 10-year 

review of the submandibular gland transfer procedure was performed. 

The patients’ salivary flow and quality of life was evaluated. A review 

of the world literature of this procedure was performed. Results: At 

our centre, 349 patients had the procedure over the 10 years since 

it description. Xerostomia was prevented in 81% of the patients. A 

review of the literature showed similar results by other investigators. 

Conclusion: Submandibular gland transfer has been used successfully 

in the prevention of radiation-induced xerostoma in our centre for 10 

years. This method has been adopted by several centres across Canada 

and Internationally. 


SURGERY FOR PAPILLARY THYROID CARCINOMA: IS LOBECTOMY 

ENOUGH? Abie H Mendelsohn, MD, David A Elashoff, PhD, Elliot 

Abemayor, MD PhD, Maie A St. John, MD PhD; David Geffen School of 

Medicine at UCLA, Los Angeles. 

Introduction: The optimal surgical treatment for papillary thyroid 

carcinoma (PTC) continues to be controversial. Recently, a populationbased 

study demonstrated improved overall survival (OS) in patients 

undergoing total thyroidectomy over lobectomy for tumors ≥1cm. 

However, questions arise regarding treatment effects on diseasespecific 

survival (DSS), as well as other variables such as histologic 

subtypes and radiation treatment. The objective of this study is to further 

our understanding of treatment of PTC. Methods: The Surveillance, 

Epidemiology, and End Results (SEER) Program database was searched 

for patients who had undergone surgery for PTC. Between 1988-2001 

27,724 patients were included. In our analysis, factors investigated 


included: tumor size, tumor extent, nodal status, age, gender, race, 

surgical extent, radiation therapy, and histology. Hazard Ratios with 

95% CI’s were computed with Cox regression models. Results: Of 

the total 22,724 PTC patients, 5,964 patients underwent lobectomy. 

There were 2,138 total and 471 disease-specific deaths. Multivariate 

analysis revealed no survival difference between total thyroidectomy and 

lobectomy. Increased tumor size, extrathyroidal extent, positive nodal 

status, and increased age displayed significantly (p

Poster Papers 


TREATMENT OF THE N0-NECK IN CANCER OF THE UPPER 

AERODIGESTIVE TRACT: SELECTIVE NECK DISSECTION 

VERSUS “WAIT-AND-SEE”. Wolfgang Steiner, MD, Stefan Plüquett, 

MD, Christoph Matthias, MD, Martina Kron, PhD, Alexios Martin, 

MD; Department of ORL - HNS, University of Göttingen, Germany / 

Department of Surgery, Roland Hospital, Bremen, Germany / Institute 

of Biometrics, University of Ulm, Germany / Department of Phoniatrics, 

Medical University of Berlin, Germany. 

Introduction: Different opinions exist for appropriate management of the 

clinically N0-neck in Cancer of the Upper Aerodigestive Tract (UADT). As 

neck dissections (ND) can result in significant morbidity, especially when 

performed as modified radical ND, it was the purpose of this study to 

determine the circumstances under which a „wait-and-see“ policy could 

safely be applied. Procedures: A retrospective chart review was carried 

out. All patients with cancer of the UADT (pT1-4, except T1a vocal 

cord cancer) and without clinical evidence of neck disease (N0) were 

eligible. Patients with local and loco-regional recurrences were excluded. 

End points for statistical analysis were the occurence of late neck 

metastases and disease specific survival. Results: Four hundred and 

twenty-five (425) patients were eligible for inclusion. Five-year Kaplan- 

Meier estimates: regional control was 92% for patients who underwent 

selective neck dissection and 83% for the „wait-and-see” group 

Statistical analysis regarding tumor localisations and pT-categories was 

carried out and will be discussed, as well as the implications of „waitand-see“ 

on survival. Conclusions: This study indicates that postponing 

elective selective neck dissection (SND) in pT1 and pT2 cancer of the 

UADT should depend on the localisation of the primary tumor. SND 

should be performed in most cases of pT3 and pT4 cancer. Additionally, 

this study supports the notion that cutting through the primary tumor 

with a CO2-laser does not result in a higher rate of neck metastases. 


FUNCTION PRESERVING TRANSORAL LASER MICROSURGERY 

(TLM) FOR CANCER OF THE ORAL CAVITY - AN ANALYSIS OF 203 

CASES. Alexios Martin, MD, Martin C Jäckel, MD, Hans Christiansen, 

MD, Matthias Meyer, MD, Martina Kron, PhD, Wolfgang Steiner, MD / 

Dpt. of ORL, Univ. of Göttingen, Germany / Dpt. of ORL, Helios Hosp., 

Schwerin, Germany / Dpt. of Radiat. Oncol., Univ. of Göttingen, Germany 

/ Inst. of Biometrics, Univ. of Ulm, Germany / Dpt. of Phoniatrics, Medical 

Univ. of Berlin, Germany. 

Objectives: Cancer of the oral cavity poses special therapeutic 

challenges. Open surgery often results in a significant impairment of 

swallowing and speech function and therefore reduces quality of life. 

Purpose of this study was to assess the viability of TLM as a tissue 

sparing and thus function preserving surgical alternative to standard 

treatment and to compare its oncological and functional results to those 

of open surgery and radio(chemo-)therapy. Methods: A retrospective 

chart analysis was carried out. Patients with previously untreated cancer 

of the oral cavity were eligible for inclusion. Exclusion criteria were pretreatment, 

simultaneous second primary cancers and N3 neck disease. 

203 patients matched the inclusion criteria and were treated by TLM with 

or without selective neck dissection and/or postoperative radio(chemo-) 

therapy. Results: All 203 patients were treated by TLM. The median 

follow-up period was 60 months. Recurrence-free survival (5-year 

Kaplan-Meier) ranged between 72 % for stage I and 47 % for stage IV 

tumors. Postoperatively, no nasogastric feeding tube was required by 

54 % of the patients, only 2 % required a permanent gastrostomy tube. 

Conclusions: Transoral Laser Microsurgery is a valid and cost-effective 

alternative in the treatment of oral cavity cancer. Oncological results are 

comparable to standard therapeutic regimen, while functional results 

tend to be better. 

www.ahns.info 


IS ACUTE MUCOSITIS HEALING FREQUENTLY OBSERVED BEFORE 

THE END OF RADIOTHERAPY IN HEAD AND NECK CANCER 

PATIENTS? Andrzej Wygoda, MD PhD, Krzysztof Skladowski, MD PhD, 

Tomasz Rutkowski, MD PhD, Marcin Hutnik, MD, Boleslaw Pilecki, 

MD PhD, Maria Golen, MD PhD, Wieslawa Przeorek, MD PhD, Beata 

Lukaszczyk-Widel, MD; Maria Sklodowska-Curie Memorial Cancer 

Center and Institute of Oncology, Gliwice Branch, Poland. 

Purpose: Acute mucosal reactions (AMR) always accompany 

radiotherapy in patients with head and neck cancer. They reflect different 

intensity and duration in dependence of fractionaction schedule. 

There is well known phenomenon of accelerated repopulation in acute 

responding tissues during radiotherapy and it is also observed within 

healthy mucosa in head and neck region. This report describes types 

of courses of AMR observed during radiotherapy in patients with head 

and neck cancer with particular consideration of healing processess 

before ending of irradiation. Material: Seventy-eight patients in age 

39-74 years with oral cavity (21 pts), pharyngeal (37 pts) and laryngeal 

(20 pts) cancer irradiated with conventional (CF-33 pts), accelerated 

(AF-33 pts), hyperfractionated (HPEFX-8 pts) and hypofractionated 

(HPOFX-4 pts) scheme with radical intention. Methods: Acute mucosal 

reactions were evaluated everyday with modified Dische score system. 

Daily scores (maximum may be 24) were subsequently used to draw 

curves presenting individual patient AMR courses, which were then 

analyzed. There were 3267 examinations during radiotherapy in all 

patients. Results: Latency period between start of radiotherapy and 

onset of AMR was observed in all patients and ranged between 3 and 14 

days - it was 6 days for HPEFX (3-9 days), 7,5 for AF (5-12 days), 8 for 

HPOFX (3-14 days) and 9 for CF (4-14 days). Difference between CF and 

HPEFX or AF was significant, p

Poster Papers 

in patients who have been treated for head and neck cancer, and 

to identify factors associated with this pattern of dysphagia. After 

obtaining IRB approval, we searched our institution’s cancer registry for 

patients treated between January 1995 and December 2007 for cancer 

of the oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, and 

salivary glands. We recorded demographic information and data on 

cancer treatment as well as dysphagia-related procedures, defined as 

esophageal dilation and gastrostomy tube placement. There were 447 

patients that had both a diagnosis of cancer and a dysphagia-related 

procedure, representing about 15% of all registered head and neck 

cancer patients. Fifty of these patients (11%) had their first dysphagiarelated 

procedure more than three years after their diagnosis of cancer, 

and 7% more than 5 years after diagnosis. Of the patients undergoing 

first procedures after 3 years, 68% had larynx and oropharynx primary 

sites. Surgery and radiotherapy was at 49% the most common treatment 

modality of the late-onset group. The data confirm that dysphagia is a 

common problem among head and neck cancer patients. Furthermore, 

they indicate that one year follow up may be insufficient to assess posttherapy 

dysphagia in studies of head and neck cancer. 


REGIONAL FAILURE IN PATIENTS WITH SQUAMOUS CELL CANCER 

OF THE ORAL TONGUE WITH A PATHOLOGICAL NEGATIVE NECK 

DISSECTION SPECIMEN MANAGED WITH SURGERY ALONE. Ian 

Ganly, MD PhD, Jatin Shah, MD, Snehal Patel, MD; Memorial Sloan- 

Kettering Cancer Center, New York, New York. 

Introduction: The objective of this study was to determine the incidence 

of regional failure in patients with T1T2 squamous cell cancer (SCC) 

of the oral tongue, managed by partial glossectomy and elective neck 

dissection, who had a pathological negative neck dissection specimen 

and had no postoperative radiation. We also wanted to identify patient 

and tumor related factors predictive of regional failure. Materials and 

Methods: 110 patients with cT1T2N0 squamous cell cancer of the oral 

tongue, managed by partial glossectomy and elective neck dissection, 

were identified from a pre-existing database of patients with squamous 

cell carcinoma of the oral tongue treated at Memorial Sloan-Kettering 

Cancer Center between the years 1985 and 2005. 70 patients had a 

pathological negative neck dissection specimen and were managed 

without postoperative radiotherapy. This cohort represents the study 

population in this paper. Patient, tumor and treatment characteristics 

were recorded by retrospective analysis of patient charts. Regional 

recurrence free survival (RRFS) and disease specific survival (DSS) were 

calculated using the Kaplan-Meier method. Predictors of regional failure 

were analysed by univariate and multivariate analysis. Results: With a 

median follow up of 72 months (range 1-171), 15 of 70 (21.4%) patients 

developed regional recurrence, of whom 8 (53%) were ipsilateral and 

7 (47%) were contralateral. The rate of regional recurrence stratified by 

tumor status was 14.8% and 25.6% for T1 and T2 tumors respectively. 

The 5 year RRFS and DSS for all patients was 76.3% and 87.1% 

respectively. Patients who recurred in the neck had a significantly 

poorer DSS (46% versus 98%, p 0.05) although patients with low PTPN13 expression 

had a lower rate of recurrence (20.6% vs. 35.0%). A significant increase 

in survival was noted for patients with HPV positive tumors compared 

to those with HPV negative tumors. Conclusions: These findings 

suggest that decreased PTPN13 expression does not predict improved 

survival in this subset of patients with HPV related, advanced stage 

OP-SCCA. Additional analysis of patients with less advanced disease 

at presentation may be warranted to further determine the prognostic 

significance of this tumor marker. 


SALVAGE PHARYNGECTOMY FOLLOWING RADIATION AND 

LARYNGECTOMY: A RECONSTRUCTIVE CHALLENGE. Kiran 

Kakarala, MD, Kevin S Emerick, MD, Derrick T Lin, MD, James W Rocco, 

MD PhD, Daniel G Deschler, MD; Massachusetts Eye and Ear Infirmary, 

Boston, MA, USA; Divsion of Head and Neck Surgery, Department of 

Otology and Laryngology, Harvard Medical School, Boston, MA, USA. 

Background: Salvage pharyngectomy in patients who have a history 

of previous distant radiation therapy and laryngectomy presents 

unique challenges for the reconstructive surgeon. Free tissue transfer 

offers several options for reconstruction in this setting; however 

the vessel-depleted neck can be problematic. In order to better 

understand the challenges of reconstruction in this setting, we describe 

our experience with salvage pharyngectomy using a cohort of total 

laryngopharyngectomy patients as a basis for comparison. Methods: 

Retrospective review of prospectively collected free flap data was 

performed. Procedures were performed between 2007-2009 at a tertiary 

academic medical center. Two cohorts were created. Patients in group 

one underwent total laryngopharyngectomy with free flap reconstruction 

either upfront or following treatment failure of chemotherapy and 

radiation. Patients in group two had a history of radiation therapy and 

laryngectomy and subsequently underwent salvage pharyngectomy with 

free flap reconstruction. Data extracted included type of free flap utilized, 

demographics, tumor staging, microvascular anastomosis, free flap 

complications, and voice and swallowing status. Results: There were 6 

patients in each group (group 1: total laryngopharyngectomy; group 2: 

salvage pharyngectomy). Patients ranged in age from 46-70; there were 

5 females and 7 males. Tumors were stage T3 or T4 in 9 of 12 patients. 

All patients underwent preoperative chemotherapy and radiation 

therapy except 1 who had postoperative chemoradiation. Patients in the 

salvage pharyngectomy group had undergone treatment (radiation and 

laryngectomy) an average of 9.5 years prior (range 4-15 years). The radial 

forearm free flap was utilized in 11 of 12 patients, and the anterolateral 

thigh free flap in 1 patient. The facial artery was used for microvascular 

anastomosis in 5 of 6 patients in group 1, and in 2 of 6 patients in group 

2. There was 1 peri-operative return to the operating room in group 1 

(hematoma) versus 3 in group 2 (1 arterial thrombosis and 2 hematomas). 

There were no cases of complete free flap loss. 3 patients in group 1 

and 2 patients in group 2 had postoperative pharyngocutaneous fistula. 

3 patients in group 1 and 2 patients in group 2 were g-tube dependent 

post-operatively. Tracheoesophageal puncture was performed in 4 

patients in group 1 and 3 patients in group 2. Conclusions: Salvage 

pharyngectomy presents a unique reconstructive challenge. The defect 

is often smaller than at the time of total laryngopharyngectomy, limiting 

room for excess reconstructive tissue. The neck is often vessel depleted 

and all possible vessels must be explored and considered. Microvascular 

free tissue transfer can be problematic in the vessel depleted neck 

due to prior surgery and irradiation. Vessels are often embedded in 


Poster Papers 

scar and have radiation related intimal damage, which may increase 

anastomotic complications. Impaired wound healing, manifesting as 

pharyngocutaneous fistula, continues to be a common complication 

in the irradiated neck. The radial forearm free flap, which can easily be 

tailored in size and has a reliable pedicle with several venous options, 

seems to provide the best tissue for reconstruction in this setting. 


RISK FACTORS OF FREE FLAP COMPROMISE IN 247 CASES OF 

MICROVASCULAR HEAD AND NECK RECONSTRUCTION: A SINGLE 

SURGEON’S EXPERIENCE. Min-Sik Kim, MD PhD, Young-Hoon 

Joo, MD, Kwang-Jae Cho, MD PhD, Jun-Ook Park, MD; The Catholic 

University of Korea. 

Background: The aim of this study was to evaluate relationships 

between free flap compromise and perioperative risk factors. Methods: 

A retrospective review was conducted of 237 patients who underwent 

247 microvascular free flap reconstructions after head and neck ablative 

surgery. Results: Twenty-one (8.5%) cases of free flap compromise 

due to a vascular obstruction were identified, and 11 flaps were lost 

(4.5%); an overall success rate of 95.5%. A significant correlation 

was found between diabetes mellitus and free flap compromise 

(p=0.048). Preoperative irradiation was also found to influence free 

flap compromise, but with borderline significance (p=0.052). However, 

multivariate analysis revealed a significant association between free flap 

compromise and diabetes mellitus (odds ratio = 4.9 (95% CI, 1.1 to 22.8, 

p=0.041)). Conclusions: Diabetes mellitus was found to be a risk factor 

of free flap. The presence of diabetes mellitus may require more attention 

to improve patient management and free flap outcomes. 


THE FACTORS IN PREDICTION OF FISTULA FOLLOWING RADIAL 

FOREARM FREE FLAP RECONSTRUCTION FOR HEAD AND NECK 

CANCER. Min-Sik Kim, MD PhD, Young-Hoon Joo, MD, Kwang-Jae 

Cho, MD PhD, Jun-Ook Park, MD; The Catholic University of Korea. 

Objectives: To evaluate the relationship between postoperative fistula 

and perioperative risk factors after radial forearm free flap (RFFF) 

reconstruction for head and neck cancer. Study Design: Retrospective 

cohort study. Methods: A total of 180 patients underwent RFFF 

reconstruction after head and neck ablative surgery from October 1993 

to July 2009. Age, gender, systemic disease, smoking status, tumor 

stage, preoperative radiotherapy, reconstruction site, concurrent neck 

dissection, flap shape and size, and partial or complete flap necrosis 

were recorded as the prognostic variables. 

Results: Twenty-one (11.7%) of the 180 patients developed fistula. 

Significant correlations were found between diabetes mellitus (p=0.015), 

preoperative radiotherapy (p=0.029) and fistula. Reconstruction of 

hypopharynx influenced fistula with borderline significance (p=0.057). 

The multivariate analysis showed a significant association of the 

fistula with diabetes mellitus (odds ratio = 5.4 [95% CI, 1.0-27.6]) 

and preoperative radiotherapy (odds ratio = 5.9 [95% CI, 1.1-32.6]). 

Spontaneous closure was noted in 10 patients, whereas a surgical 

closure with a local flap or pectoralis major myocutaneous flap was 

necessary in 11 patients. Conclusions: Diabetes mellitus, preoperative 

radiotherapy were risk factors for fistula in patients undergoing RFFF 

reconstruction for head and neck cancer. 


PARTIAL AND CIRCUMFERENTIAL PHARYNGOESOPHAGEAL 

RECONSTRUCTION USING SUPRACLAVICULAR ARTERY ISLAND 

FLAP. Ernest S Chiu, MD, Paul L Friedlander, MD; Tulane University 

Health Sciences Center. 

Purpose: Pharyngoesophageal oncologic resections produce complex 

reconstructive problems requiring reliable, robust flaps inorder to 

restore function. The goals of pharyngoesophageal reconstruction are 

to allow quick recovery, restore swallowing/speech, and withstand 

chemoradiation therapy. Both regional (deltopectoral, pectoralis, 

trapezius) and free (jejunum, forearm, anterolateral thigh, ileocolon) flaps 

have been successfully used to reconstruct these complex defects. 

In this study, we report the utility of the supraclavicular artery island 

(SAI) flap, a new regional fasciocutaneous flap option, in reconstructing 

partial and circumferential pharyngeal defects. Methods: Partial and 

circumferential pharyngeal oncological defects were reconstructed 

www.ahns.info 

with pedicled SAI flaps. Complications and functional outcomes were 

assessed. Results: Over a three year period (2006-2009), twenty 

(n=20) patients underwent oncologic pharyngeal (partial or complete 

circumferential) reconstruction using the SAI flap. The majority of 

patients (18/20) had previous failed chemoradiation therapy. Patients 

ranged from 38 to 80 years (average 68.3 years). The flaps ranged 

in size from 6X18 to 8X21 cm. All flaps were harvested in less than 1 

hour; there were no flap losses. All donor sites were closed primarily 

and did not require surgical revision. Shoulder function abnormality 

was not observed. Early complications observed included one patient 

who developed shoulder wound dehiscence followed by cellulitis did 

not require surgical intervention. Interestingly, 4/20 (20%) patients 

noted referred sensation to the shoulder when swallowing food. 

6/20 (30%) patients developed early pharyngeal leaks, but all cases 

resolved on their own. 16/20 (80%) patients were able to perform 

PO intake after 3 months. Anastomotic strictures were noted in 2/20 

(10%), and were successfully treated with ballooned dilatation by a 

gastroenterologist. Electrolaryngeal speech could be performed by all 

patients. Trans-esophageal puncture was also offered to all patients, 

and successfully surgically performed by puncturing the SAI flap with 

minimal complications. TEP speech was superior to electrolaryngeal 

speech as judged by patients and independent observers. Conclusion: 

Supraclavicular artery island flap is a safe, reliable, easy-to-harvest, 

low morbidity, one-stage, sensate, fasciocutaneous regional flap option 

for reconstructing partial and circumferential pharyngoesophageal 

defects. Our early experience suggests that complications and functional 

outcomes are similar to other reported regional and free tissue transfer 

pharyngoesophageal reconstruction techniques. Additional techniquebased 

comparative studies may be warranted. 


A NEW OPTION IN HEAD AND NECK RECONSTRUCTION: THE 

FREE SUPRACLAVICULAR TRANSVERSE CERVICAL ARTERY 

PERFORATOR (STCAP) FLAP. Cesare Piazza, MD, Johnny Cappiello, 

MD, Francesca Del Bon, MD, Stefano Mangili, MD, Piero Nicolai, MD; 

Department of Otorhinolaryngology - Head and Neck Surgery, University 

of Brescia, Italy. 

Introduction: The free STCAP flap has been recently introduced as an 

innovative option for facial and oral reconstruction. Cadaveric studies 

have demonstrated its vascular anatomy as based on perforators 

coming from the transverse cervical artery (TCA) vascularizing the skin 

of the posterior triangle of the neck. By contrast, its drainage is through 

the superficial cervical and external jugular (EJV) veins. The main 

attractive of this flap is represented by its easy access for head and neck 

surgeons, fast harvesting, and very low donor site morbidity. Purpose 

of the Study: To describe harvesting technique, complication rate, and 

functional outcomes of this flap. Material and Methods: Between 

December 2007 and October 2008, we applied the free STCAP flap for 

reconstruction of 6 head and neck cancer patients (4 males, 2 females; 

age range, 51-75 years): 4 oral cavities (3 floor of the mouth and 1 hemimobile 

tongue) and 2 external ears and skin of the parotid region. None 

of them had been previously treated by radiotherapy (RT) and all were 

cN0. Results: Flap harvesting mean time was 40 minutes. Mean size 

of the skin paddle was 6 x 8 cm and every neck donor site was closed 

primarily. Mean length of pedicle was 8 cm (vessels caliber of 2 mm for 

TCA and 5 mm for EJV). One patient developed an oral fistula managed 

by primary suture under local anesthesia. No flap failure occurred. Scar 

on the lower part of the neck always resulted inconspicuous 2 months 

after surgery. Conclusions: Texture and pliability of this flap render it an 

ideal reconstructive option for middle-sized soft tissues oral and facial 

defects. Essential prerequisites are no previous neck dissection of level 

III-V or RT. Another potential limit can be represented by the need for 

relatively close recipient vessels due to the short pedicle. In the hands 

of experienced head and neck surgeons, STCAP flap represents an 

expeditious, reliable, and safe procedure. No donor site morbidity has 

been observed. 

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Poster Papers 


SENSORY RECOVERY OF NONINNERVATED FREE RADIAL 

FOREARM FLAP IN LOWER ORAL CAVITY RECONSTRUCTION 

AND ITS INFLUENCE ON ORAL FUNCTION: LONGITUDINAL 

ASSESSMENT OF TWENTY-FIVE PATIENTS. Mohamed A Ellabban, 

John Devine, Taimur Shoaib, Geremy McMahon, Stephen Morley, David 

Soutar; Canniesburn Plastic Surgery Unit, Glasgow Royal Infrmary, 

Glasgow, United Kingdom. 

Introduction: Sensory recovery of noninnervated free radial forearm 

flap is uncommon, unpredictable and variable. The aim of the present 

study was to address sensory recovery of free radial forearm flap used 

for lower oral cavity reconstruction and its influence on oral function. 

Subjects and Methods: A total of 25 patients who underwent lower 

oral reconstruction with noninnervated free radial forearm were studied 

for one year postoperatively. The sensory modalities examined were 

pin prick, light touch, hot and cold temperature and static two-point 

discrimination. Oral function was assessed using \\\’Functional Intraoral 

Glasgow Scale\\\’ and \\\’University of Washington Health Related 

Quality of Life questionnaire\\\’. Patients were assessed preoperatively, 

two months, six months and one year postoperatively. Results: 

Our results showed gradual improvement of sensory recovery during 

the postoperative period up to one year except light touch. Five (20%) 

patients had complete sensory recovery and 13(52%)patients didn\\\’t 

achieve any recovery at one year. Partial recovery was recorded in 

seven(24%)patients. Patients with complete sensory recovery recorded 

the best functional scores as compared to patients with insensate 

flaps. Conclusions: There was a positive correlation between sensory 

recovery of free radial forearm flap and oral function. Therefore, the use 

of innervated free radial forearm flap is highly recommended for better 

oral function. 


RECONSTRUCTIVE OPTIONS FOR THE LATERAL TEMPORAL 

BONE DEFECT. Alicia M Quesnel, MD, Vasu Divi, MD, Derrick Lin, MD; 

Massachusetts Eye and Ear Infirmary. 

Purpose: To compare the clinical outcomes of reconstructive procedures 

used for obliteration and coverage of the defect from lateral temporal 

bone resection. To develop a framework for selecting the best suited 

reconstructive procedure, ranging from free fat grafts to pedicled flaps 

to free tissue transfer, for the lateral temporal bone defect. Methods: 

Retrospective case review of patients undergoing a reconstructive 

procedure after lateral temporal bone resection and/or auriculectomy 

between January, 1989 and November, 2009. Patient and operative 

variables included age, medical comorbidities, extent of cutaneous, 

parotid, and/or auricular resection, length of hospital stay, use of 

preoperative and/or postoperative radiotherapy, pathologic diagnosis. 

Clinical outcomes included major wound complications, minor wound 

complications, donor site complications, medical complications, number 

and types of revision surgeries. Results: There were 46 patients who 

underwent lateral temporal bone resections requiring 50 reconstructive 

procedures during the stated period. Types of reconstruction included 

abdominal fat obliteration only (20), temporparietal fascial flap (7), 

occipital flap (1), pectoralis major flap (9), anterolateral thigh free flap 

(7), rectus abdominus free flap (1), radial forearm free flap (3), and 

latissimus dorsi free flap (2). The length of hospital stay ranged from 2 to 

12 days, with an average of 2 days for patients undergoing abdominal 

fat obliteration as the only reconstruction, an average of 6 days for 

patients undergoing pedicled tissue transfer, and an average of 8 days 

for patients undergoing free tissue transfer. Major wound complications 

occurred in 1 patients. Minor wound complications occurred 4 

patients, and donor site wound complications occurred in 3 patients. 

Conclusions: For patients undergoing lateral temporal bone resection 

with or without parotidectomy and auriculectomy, there are multiple 

options for reconstruction. We present our algorithm for selecting the 

reconstructive procedure based on patient characteristics, defect, and 

expected complication rates. 


FACTORS CONTRIBUTING TO RECURRENCE AFTER RESECTION 

OF ANTERIOR SKULL BASE MALIGNANCIES: A SINGLE- 

INSTITUTION REPORT. Marc A Cohen, MD, Jason M Leibowitz, 

MD, Evan R Ransom, MD, Alexander G Chiu, James N Palmer, MD, 

M S Grady, MD, John YK Lee, MD, Bert W O’Malley Jr, MD, Jason G 

Newman; University of Pennsylvania Medical Center. 

Introduction: Since the introduction of primary surgery for tumors of 

the anterior skull base 50 years ago, the outcomes for those undergoing 

treatment for these lesions have improved. These improvements have 

been as a result of the formation of more experienced multidisciplinary 

teams of clinicians, as well as the advancement of technique and 

surgical tools, such as the endoscope. Despite advances, a large 

percentage of patients with lesions of the anterior cranial base continue 

to experience disease recurrence. We evaluated 90 patients treated 

primarily with endoscopic, open, or combined approaches for anterior 

skull base malignancies to assess for factors correlated with tumor 

recurrence. Methods: We conducted a review of 90 patients undergoing 

surgical treatment for malignancies involving the anterior cranial base 

from November 2000 to November 2008. All clinical data was obtained 

retrospectively, with margin status assessed per final pathology and 

recurrences based on the presence of disease up to the last follow up. 

The mean age was 56.9. Mean follow up was 20.0 months. The most 

common tumor origin was maxillary sinus (29), followed by ethmoid 

sinus (25) and nasal cavity (25). All tumor stages were included, with 

61% (55) being stage IV lesions. There were 48 open procedures, 23 

entirely endoscopic procedures, and 19 combined procedures. There 

were 37 total recurrences. 

Results: The rate of recurrence was 41.0%. Primary nasal cavity lesions 

had the significantly lowest rate of recurrence at 24.0% (p=0.04). 

Patients with positive margin status had a higher rate of recurrence 

at 56.4% than those with negative margins (p=0.01). There was also 

correlation of recurrence with both advanced disease and medical 

comorbidity (p=0.03 and p=0.03). When controlled for tumor stage, 

there were no differences in recurrence rates depending on the surgical 

modality modality used (open, endoscopic, or combined) (p=0.47). 

Conclusion: In our single institutional study, we have found anterior skull 

base malignancy recurrence correlates with positive margins, advanced 

disease, and medical comorbidity. However, the lack of association with 

chosen modality of therapy indicates that in the appropriate patient, a 

less morbid, endoscopic procedure may be performed, even in those 

with advanced disease. In the future, prospective studies should focus 

on evaluation of factors predisposing to anterior skull base malignancy 

recurrence. 


A COMPLETELY TRANS-NASAL ROBOTIC APPROACH TO THE 

ANTERIOR SKULL BASE. Jason G Newman, MD, John Y Lee, MD, 

Greg S Weinstein, MD, M Sean Grady, MD, Brad C Lega, Bert W 

O’Malley; University of Pennsylvania. 

Objective: To develop a new two surgeon (Otolaryngologist and 

Neurosurgeon) approach to the anterior skull base using a completely 

trans-nasal robotic surgery. Study Design: A total of 6 surgical 

procedures and approaches were performed on one live canine mongrel 

and four human cadavers. Methods: Experimental procedures were 

performed using a 2-surgeon, 4-handed technique in the dissection of 

live canine and cadaver models. All procedures were performed in an 

approved training facility using the da Vinci Surgical Robot. Previous 

experience with trans-oral robotic surgery (TORS) paved the way for our 

current studies, including the use of a bedside assistant who acts as 

co-surgeon. In the current set of experiments we teamed-up with our 

skull-base neurosurgeons to demonstrate that a 2-surgeon approach to 

these regions was feasible and beneficial (without cervical incisions). The 

anterior cranial base, from the planum sphenoidale to the frontal bone 

was dissected in the cadaver models and access to the intracranial and 

neurovascular space was achieved. The primary surgeon was at the 

robotic console while the secondary surgeon assisted at the bedside 

using the view achieved on the robotic monitor. Angles of approach and 

optimal positioning of the robotic arms were determined. Results: The 

two team approach, incorporating Otolaryngologist and Neurosurgeon, 

is feasible using trans-nasal robotic surgery to the skull base. Working 


Poster Papers 

in concert, we were able to approach and dissect the anterior skull base 

with excellent visibility and access. We were able to maximize exposure 

and access to these regions without the need for cervical incisions. 

Conclusions: A 2-team approach to the anterior skull base using robotic 

surgery was achieved in live canine and human cadaver models. We plan 

to continue our investigations into robotic surgery of the skull base, and 

believe that continued evolution of techniques and instrumentation will 

expand the indications for this surgery. 


SURGICAL EXPERIENCE IN SECOND TUMOR OF THE HEAD AND 

NECK AFTER INITIAL TREATMENT OF RETINOBLASTOMA. Thomas 

Jouffroy, MD, Angélique Girod, MD, Hervé Boissonnet, MD, José 

Rodriguez, MD; Institut Curie. 

Second tumor in irradiated field are a major cause of morbidity 

and mortality in patients who were previously treated for hereditary 

retinoblastoma. 42 cases treated at the Institut Curie between 1971 and 

2006 were studied in a retrospective review. The median time interval 

between the diagnosis of retinoblastoma and second tumor was 18,2 

years (range 3,8-38,2 years). Histopathological diagnoses included: 

40 sarcomas, 1 carcinoma and 1 meningioma. The initial treatment for 

retinoblastoma was a conservative treatment (radiation therapy and 

chemotherapy alone) in 7 cases, and a non conservative treatment (with 

surgery) in 35 cases. The treatment of the second tumor was surgery 

in 28 cases always associated with chemotherapy except in the case 

of meningioma. 14 non operable cases were treated by chemotherapy 

or re-irradiation. 8 patients have been reoperated for local recurrence. 

Tumor locations were orbito-maxillary in 16 cases, base of skull or 

infra-temporal fossa in 15 cases and ethmoido-maxillary in 11 cases. 

Surgical resection was complete in 14 cases and necessitated both 

head and neck and neurosurgical approach in 17 cases. 15 free flaps 

were performed including 12 for tumor resection and 3 for cosmetic 

reconstruction. 18 patients are still alive with a median follow up of 8,8 

years, 5 among them have residual disease. All other patients died with 

a median survival of 2,6 year. The cause of the death was local failure 

in 16 cases. This base of skull surgery in irradiated field can be done 

more frequently with the use of free flaps. The goal of the treatment is 

to include surgery when feasible. All patients still alive without known 

residual disease are those who have been operated with complete 

microscopic resection or those who had complete response after 

chemotherapy. 


INTERNAL CAROTID ARTERY (ICA) CONTROL FOR THE SAFE 

RESECTION OF EXTRACRANIAL SKULL BASE TUMORS. John P 

Leonetti, MD, Sam J Marzo, MD, Chad A Zender, MD, James J Jaber, 

MD; Department of Otolaryngology - Head and Neck Surgery, Loyola 

University Medical Center. 

Objective: The main goal of this investigation is to outline three 

surgical methods for the exposure and control of the ICA in patients 

with large tumors of the infratemporal fossa and parapharyngeal 

space. Study Design: Retrospective case review. Setting: Tertiary 

care, academic medical center. Patients: All patients with tumors 

of the skull base requiring additional superior ICA exposure prior to 

definitive resection of the lesion. Intervention: The transparotidtransstyloid, 

transmastoid or subtotal petrosectomy techniques were 

chosen according to the intraoperative assessment of the superior 

tumor extension. Main Outcome Measure: The surgical team’s ability 

to expose and control the ICA prior to inferior tumor dissection, thus 

reducing the risk of inadvertent arterial injury. Results: Of the 119 

patients reviewed there were 69 females and 50 males with a mean 

age of 53.1 years. The most commonly encountered tumors were 

schwannomas, paragangliomas, and parotid tumors. The transparotidtransstyloid 

technique was used in 23 cases, the transmastoid method 

in 60 individuals, and the remaining 36 patients underwent a subtotal 

petrosectomy. Total tumor resection was achieved in 106 of 119 patients 

(89%) and no patients developed carotid artery related complications. 

Conclusions: Contemporary lateral skull base techniques should be 

utilized for the exposure and control of the ICA in patients undergoing 

the surgical resection of large tumors of the infratemporal fossa and 

parapharyngeal space. 

www.ahns.info 


CLASSIFICATION OF APPROACHES FOR ENDONASAL 

ENDOSCOPIC RESECTION OF INFRATEMPORAL FOSSA TUMORS. 

Stephen A Wheless, BS, Anand V Germanwala, MD, Carl H Snyderman, 

MD, Ricardo L Carrau, MD, Adam M Zanation, MD; University of North 

Carolina Hospitals, University of Pittsburgh Hospitals. 

Background Objectives: Tumors of the infratemporal fossa have 

routinely been approached via a transcervical approach, a transparotid 

approach, or a larger transcranial transzygomatic approach. These 

approaches have the advantage of excellent exposure, but have the 

disadvantage of placing the superficial facial nerve, parotid, and the 

cosmetically sensitive structures of the zygomatic arch and orbital rim 

at risk. All of these approaches also require a cosmetically sensitive 

skin incision. As expanded endoscopic endonasal skull base surgery 

has advanced, more complex tumors and more complex locations 

have begun to be accessed. The transpterygoid approach to the 

lateral sphenoid recess for CSF leaks and encephaloceles is well 

documented; however, to date there is no description or classification 

of endoscopic approaches to infratemporal fossa tumors via an 

endoscopic endonasal route. Our objectives are to describe the three 

types of endoscopic approaches to the infratemporal fossa, describe 

potential pitfalls and complications, and to discuss cases as they relate 

to these outcomes. Methods: Retrospective chart review with anatomic 

classification. Results: We have divided the endoscopic approach to 

the infratemporal fossa for tumor resection into three classifications: 

(1) a transpterygopalatine fossa approach; (2) a transmedial pterygoid 

plate approach; and (3) a translateral pterygoid plate approach. Each 

approach comes with its own inherent risks and some expected 

sequelae; these are discussed. A small case cohort of our initial ten 

patients with endoscopic infratemporal fossa resections are discussed, 

as well as stratification of their outcomes and complications based on 

the classification system above. Conclusion: An endonasal endoscopic 

approach to infratemporal fossa tumors is technically feasible and 

safe for selected lesions. No carotid injuries or major complications 

were noted; however, approach-related sequelae can be expected, as 

determined by the individual corridor of approach. 


THE MANAGEMENT OF SINONASAL MALIGNANCIES IN THE 

PEDIATRIC POPULATION. Jose P Zevallos, MD, Nicholas B Levine, 

MD, Franco DeMonte, MD, Dianna B Roberts, PhD, Ehab Y Hanna, 

MD, Michael E Kupferman, MD Department of Head and Neck Surgery, 

Department of Neurosurgery, University of Texas; MD Anderson Cancer 

Center, Houston, TX, Bobby R Alford Department of Otolaryngology/ 

Head and Neck Surgery, Baylor College of Medicine, Houston, TX. 

Introduction: Sinonasal malignancies in children are rare, histologically 

diverse, and aggressive tumors. The treatment of sinonasal malignancies 

is challenging and often associated with complications and longterm 

treatment sequelae. The purpose of this study is to review the 

experience of a single cancer center in the management of pediatric 

sinonasal malignancies. Methods: A ten-year retrospective review was 

conducted of pediatric patients with sinonasal malignancies treated 

at a single institution. The diagnosis, treatment, and outcomes were 

reviewed. Results: 44 patients were identified. The median age was 

12 years (range 2-17), and 38% were female. Thirty-three patients 

presented with sinonasal sarcomas (75% rhabdomyosarcoma), 8 with 

carcinomas (4 squamous cell, 1 adenoid cystic, 1 adenocarcinoma, 1 

carcinoma ex pleomorphic), and 3 esthesioneuroblastomas. The majority 

(47%) of patients with sarcomas were treated with chemoradiation alone. 

Ninety-five percent of patients with nonsarcomatous malignancies were 

treated surgically with 50% undergoing postoperative radiotherapy. 

The five-year recurrence rate (RR), disease-specific survival (DSS), and 

overall survival (OS) for the entire group was 43%, 81%, and 71%, 

respectively. In the sarcoma group, RR was 51%, DSS 79%, and OS 

71%. In the carcinoma group, RR was 25%, DSS 88%, and OS 100%. 

Conclusions: Pediatric sinonasal malignancies are rare, aggressive 

tumors often requiring multimodality therapy. Sarcomas account for the 

majority of pediatric sinonasal malignancies, and a shift has occurred 

towards nonsurgical management of these malignancies with improved 

outcomes compared to historical data. Surgery remains the mainstay of 

treatment for sinonasal carcinomas and other nonsarcomatous tumors 

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Poster Papers 

in children. The risks of surgical resection in the sinonasal region and 

skull base, as well as long-term effects of radiation therapy in this region, 

are important considerations when treating children with sinonasal 

malignancies. 


HEPARIN-BINDING EGF-LIKE GROWTH FACTOR AND ITS 

REGULATOR, MIR-212, ARE ASSOCIATED WITH ACQUIRED 

CETUXIMAB RESISTANCE IN HEAD AND NECK SQUAMOUS CELL 

CARCINOMA. Hiromitsu Hatakeyama, MD PhD, Yan Gao, Robbert 

J Slebos, PhD, Deric L Wheeler, PhD, Paul M Harari, MD, Wendell G 

Yarbrough, MD, Christine H Chung, MD; Vanderbilt University. 

Background: We hypothesized that chronic inhibition of epidermal 

growth factor receptor (EGFR) by cetuximab, a monoclonal anti-EGFR 

antibody, induces up-regulation of its ligands resulting in resistance, 

and microRNAs (miRs) play an important role in the ligand regulation 

in head and neck squamous cell carcinoma (HNSCC). Experimental 

Design: Whole genome-wide changes in gene and miR expression 

were determined in cetuximab-sensitive cell line, SCC1, and its resistant 

derivative 1Cc8 using DNA microarrays and RT-PCR. The effects of 

differentially expressed EGFR ligands and miRs were examined by 

MTS assay, cell growth assay on matrigel, ELISA and western blots. 

Additional 33 cell lines examined for Heparin-binding EGF-like growth 

factor (HB-EGF) and miR212 expression. Results: HB-EGF and 

its regulator, miR212, were differentially expressed with statistical 

significance when SCC1 and 1Cc8 were compared for gene and miR 

expression. Stimulation with HB-EGF induced cetuximab resistance in 

sensitive cell lines. Inhibition of HB-EGF and addition of miR-212 mimic 

induced cetuximab sensitivity in resistance cell lines. Akt activation was 

the dominant downstream pathway in 1Cc8 while MAPK activation was 

dominant in SCC1. miR-212 and HB-EGF expression were inversely 

correlated in 33 other cell lines. The average plasma HB-EGF levels 

in patients with recurrent tumors after treatment with chemo/radiation 

therapy was more than 5 times higher than those in patients with 

newly diagnosed tumors. Conclusion: Up-regulation of HB-EGF and 

down-regulation of miR-212 are one of the mechanisms of cetuximab 

resistance. Combination of EGFR ligand inhibitors or miR modulators 

with cetuximab may improve the clinical outcomes of cetuximab therapy 

in HNSCC. 


QUALITY OF LIFE ASSESSMENT IN PATIENTS WITH RECURRENT 

WELL-DIFFERENTIATED THYROID CANCER TREATED WITH 

EXTERNAL-BEAM RADIATION THERAPY. Michele Streeter, MD, 

Thomas J Gal, MD MPH, Mahesh Kudrimoti, MBBS MD, Joseph 

Valentino, MD; University of Kentucky Chandler Medical Center. 

Objectives/Hypothesis: The objective is to examine the effect of 

the addition of external beam radiotherapy (XRT) on quality of life 

(QOL) in patients with recurrent well-differentiated thyroid cancer 

(WDTC). The hypothesis is that an appreciable decrease in QOL will 

be observed in comparison to patients treated with thyroidectomy 

alone or thyroidectomy plus radioactive iodine (RAI). Study Design: 

Cross-sectional analysis using validated QOL instruments. Methods: 

Patients who received XRT between 1992 and 2008 for recurrent 

WDTC at the University of Kentucky Department of Radiation Oncology 

were identified and offered study participation. Control groups for 

comparison, based on appropriate sample size calculations, consisted 

of patients treated with total thyroidectomy with postoperative RAI 

for WDTC, or total thyroidectomy alone. The Quality of Life Radiation 

Therapy Instrument (QOL-RTI) and the Head and Neck (H&N) companion 

module were administered retrospectively. Parametric (ANOVA), nonparametric 

(Kruskal Wallis), and multivariate logistic regression analysis 

were used to examine differences across groups. Results: Of the 36 

patients identified as receiving XRT for WDTC, 13 agreed to participate. 

No significant differences were observed for overall QOL across all 

three groups. Overall QOL was reported as 8 out of 10 for all groups. 

Statistically significant decreases in QOL were observed in the XRT 

group for appearance, skin discomfort, as well as embarrassment 

eating in public when compared to patients treated with postoperative 

RAI (N=11) or thyroidectomy alone (N=10). A significant, incremental 

impairment in the ability to swallow solids was observed in both the 

XRT and postoperative RAI groups when compared to thyroidectomy 

alone, corresponding to a significant difference in mucous viscosity. 

Conclusions: The addition of XRT to the therapy regime for WDTC does 

not appear to negatively impact the overall QOL. However, XRT does 

appear to result in decreases in swallowing and appearance related 

parameters. While treatment with RAI does result in a measurable 

difference in swallowing related QOL when compared to surgery alone, 

an even greater impact is observed with the addition of external beam 

radiotherapy. 


MINIMALLY INVASIVE VIDEO ASSISTED THYROIDECTOMY: 

EXPANDED INDICATIONS. Alyn J Kim, MD, Jeffrey C Liu, MD, Ian 

Ganly, MD, Dennis Kraus, MD; Memorial-Sloan Kettering Cancer Center. 

Background: Minimally invasive video assisted thyroidectomy (MIVAT) 

provides a less invasive means for performing thyroidectomy with 

the benefit of a smaller incision, less extensive surgical field, and 

potentially decreased postoperative pain. As with any new technique, 

the indications for its application have been conservative while its 

safety and efficacy are being evaluated. Our goal was to report our 

experience with MIVAT and expanded indications for its application. 

Study Design: A retrospective chart review of a single surgeon’s initial 

experience with MIVAT. Setting: Tertiary academic medical center. 

Results: 54 patients were identified, 40 underwent total thyroidectomy 

and 14 underwent hemithyroidectomy. 43 (80%) were women with an 

overall average age of 51 years. Average BMI was 27, including 9 obese 

patients. Average thyroid volume on preoperative ultrasound was 33cm3. 

Nodule size ranged from 0.9 to 5.4 cm with an average nodule size of 

3.2cm. Previous anterior cervical discectomy was not a contraindication 

to minimally invasive technique. Incision length averaged 3.9cm. 

Surgical time averaged 140 minutes. Eight cases (14.8%) necessitated 

an increased surgical incision but MIVAT technique continued to be 

employed in this setting. Parathyroid reimplantations were performed in 

three patients. Average hospital stay was 1.4 days. The average followup 

was 3 months post-op. The most common finding on pathology 

was well-differentiated papillary thyroid cancer (68.9%) followed by 

benign hurthle lesions and goiter (9.3% each). Benign follicular and 

follicular lesions were 7.4% and 1.9%, respectively and there was one 

patient with poorly differentiated cancer (1.9%). Forty-one percent of 

patients had evidence of thyroiditis. The most common complication 

was temporary vocal cord paralysis (17%) with only one case of vocal 

cord paralysis persisting greater than 6 months (1.9%). Eight patients 

(15%) experienced temporary hypocalcemia requiring postoperative 

calcium supplementation and no patients experienced permanent 

hypocalcemia. Eleven patients received postoperative radioactive iodine 

as part of management for their thyroid malignancy. On limited followup, 

there were no cases of recurrence. Conclusions: The use of MIVAT 

compared with traditional open thyroidectomy show comparable rates of 

permanent hypocalcemia and vocal cord injury. The preliminary results of 

this study show the safety of MIVAT with expanded indications and add 

further support for its safety and adaptability. As with any new surgical 

procedure, a learning curve exists and improved efficiency should 

occur over time. The authors will highlight common pitfalls of their early 

surgical experience. 


IDENTIFICATION OF THE RECURRENT LARYNGEAL NERVE AT THE 

CRICOTHYROID JOINT- A TECHNIQUE REVISITED. Ram Moorthy, 

FRCS, D Olaleye, MRCS, D Mitchell, FRCS, I M Black, FRCS; East Kent 

University Hospitals NHS Trust. 

Introduction: Surgical management of benign and malignant thyroid 

disease involves undertaking a (near) total thyroidectomy or hemithyroidectomy. 

In the UK alone nearly 10000 thyroid procedures were 

undertaken in 2008-2009. Surgical technique has become more refined 

since thyroid surgery was popularised in the 19 th century. There had been 

a significant fall in operative mortality due to sepsis and haemorrhage by 

the early 20th century. Damage to the recurrent and superior laryngeal 

nerve and the subsequent impact on voice continues to be a problem 

addressed in the literature. Studies have demonstrated that identification 

of the recurrent laryngeal nerve (RLN) reduces the rate of RLN palsy and 

exposure of the RLN in its cervical course may also be beneficial. The 

most frequent techniques recommended in operative texts to identify 

the RLN invovle using Beahr’s triangle or tubercle of Zuckerkandl, which 


Poster Papers 

can be variable especially with a non-recurrent laryngeal nerve. A less 

commonly described technique is to identify the RLN as it enters the 

larynx, which is more constant. In the case series described below in 

all cases the RLN was identified as it entered the larynx and followed 

distally only as far as required to enable the gland to be dissected free. 

This represents a large series of patients undergoing identical operative 

technique by a single surgeon. Aim: The primary aim of the study was 

to investigate the rate of recurrent laryngeal nerve damage in a single 

surgeon series of thyroid surgery. Material and Method: The senior 

author (IMB) maintains a prospective database of patients undergoing 

thyroid surgery for benign and malignant conditions between July 2007 

and December 2009. In all cases the RLN was identified as described 

above. All patients underwent post-operative vocal cord assessment. 

Results: 121 procedures were undertaken: Age: Mean Age at operation 

51 years (range 17-90 ). Gender: Female 101 (83.5%); Male 20 (16.5%). 

Procedure: Hemi-thyroidectomy 65 (53.7%); Completion thyroidectomy 

35 (29.0%); Total Thyroidectomy 20 (16.5%); Isthmusectomy 1 (0.8%). 

Recurrent Laryngeal Nerves at Risk: 140. Recurrent laryngeal Nerve 

Palsy: Temporary 2 (1.4%); Permanent 0. Discussion: The analysed 

data confirms that this is a safe method to identify and preserve the 

RLN. The temporary palsy rate of 1.4% compares very favourably to 

other published studies. The permanent palsy rate of 0% highlights 

the effectiveness of the technique. The identification of the nerve at 

a constant anatomical landmark minimises inadvertent damage and 

minimises problems caused by known anatomical variations in the 

cervical course of the RLN. Minimising the exposure of the nerve which 

is possible in this technique minimises the risk of devascularisation of 

the RLN and inadvertent damage to the nerve as it is being exposed. 

Conclusion: Identification of the RLN at its consistent entry point into 

the larynx is a safe and effective technique to prevent RLN palsy. We 

recommend that surgeons undertaking thyroid surgery are aware and 

practiced in this technique. 


THE ROLE OF SURGERY IN ADVANCED STAGE ANAPLASTIC 

THYROID CANCER. Shaum S Sridharan, MD, Mark D DeLacure, MD; 

New York University. 

Hypothesis/Objective: Advanced stage Anaplastic Thyroid cancer, 

though rare, is an almost always lethal disease and poses many 

management dilemmas to physicians and their patients. Surgery alone 

has shown little to no efficacy in improving survival in these patients, and 

multimodality treatments remain controversial at this time. Often, Head 

and Neck surgeons, medical oncologists, and radiation oncologists must 

discuss end-of-life measures with patients suffering from anaplastic 

cancer which has widely metastasized. This review aims to discuss 

surgical efficacy in extending overall survival, improving terminal 

quality of life, and airway management in stage IV anaplastic thyroid 

cancer. Methods: A review of the literature was performed to identify 

relevant publications dealing with advanced stage anaplastic thyroid 

cancer. A MEDLINE search using keywords associated with advanced 

anaplastic thyroid cancer were employed including: molecular biology, 

airway management, palliative care in head and neck cancer, nutritional 

goals in head and neck cancer, neoadjuvant chemotherapy, surgical 

measures and de-bulking, radiation therapy, combined chemoradiation 

therapy, prognostic factors, SEER database. Results: A consensus is 

not apparent amongst current literature regarding a multidisciplinary 

approach to advanced disease. In many studies, a platinum-based 

chemotherapeutic agent was used in combination with another agent, 

while radiation therapy focused on local and, sometimes, distant 

disease. A meta-analysis of available data proved to be difficult due to 

the lack of significant numbers of patients and comparable protocols 

for the multimodality treatment. While retrospective reviews from single 

institutions have shown benefit from combined therapy, a comprehensive 

SEER review has not shown a statistically significant increase in survival. 

Before treatment is begun, a frank discussion on the toxic side effects of 

chemotherapy and radiation therapy must be discussed. Overall survival 

can be improved but sometimes at a prohibitive cost to terminal quality 

of life. Survival benefit from surgical tumor excision is occasionally 

shown in patients with a good response to primary chemoradiation 

therapy. In many advanced stage cases, surgeons become first 

involved in airway management. In patients needing urgent/emergent 

airway protection, tracheotomy has been traditionally performed, but 

www.ahns.info 

cricothyrotomy may be effective with larger tumors in the neck base. 

The use of long tracheotomy tubes and tracheal stents have shown 

efficacy though do not affect overall survival. In addition, gastrostomy 

feeding tube placement is often indicated in patients wishing to 

undergo combined chemoradiation therapy to maintain nutritional 

status. Conclusion: Multimodality treatment and airway protection in a 

carefully chosen patient may improve terminal quality of life and overall 

median survival in advanced stage anaplastic thyroid cancer. Thoughtful 

discussion must be frank regarding expectations, and patient-driven 

health care decisions must remain a priority. 


THE MANAGEMENT OF THE CENTRAL NECK IN FOLLICULAR 

VARIANT OF PAPILLARY THYROID CANCER. Sachin Gupta, MD, 

Daisuke Nonaka, MD, Keith Heller, MD, Kepal N Patel, MD; Department 

of Otolaryngology, Department of Pathology, Department of Surgery, 

New York University Langone Medical Center. 

Background: Prophylactic central-compartment neck dissection (CCND) 

for differentiated thyroid cancer (DTC) is controversial. The revised 

2009 ATA Guidelines recommend that prophylactic CCND (ipsilateral or 

bilateral) may be performed in patients with papillary thyroid carcinoma 

(PTC) with clinically uninvolved central neck lymph nodes, especially 

for advanced primary tumors (T3 or T4). The recommendation however 

does not make a distinction between classical PTC and follicular 

variant of PTC (FVPTC). The aim of this study was to evaluate central 

nodal metastasis in patients with FVPTC. This will allow for a better 

understanding of the natural history of this disease and help delineate 

the role of CCND for FVPTC. Methods: A retrospective chart review of 

352 patients undergoing initial surgery for DTC from 1/1/07 – 11/10/09 

was performed. 75 patients with FVPTC were identified. From this 

group, 33 patients with pathological central compartment lymph node 

data were included in the study. Pathology was reviewed for size, the 

presence of encapsulation, extrathyroidal extension, lymphovascular 

invasion and extranodal disease. Results: Encapsulated FVPTC 

(EFVPTC) was found in 14 patients (42%). The mean tumor size was 22.9 

mm with 0% (0/36) positive central lymph nodes. Non-encapsulated 

follicular variant of papillary thyroid carcinoma (NFVPTC) was found in 

19 patients (58%). The mean tumor size was 17.5 mm with 22% (19/88) 

positive central lymph nodes. However, in this group all of the positive 

central lymph nodes were found in 2 patients who pre-operatively had 

clinical and radiographic evidence of central and lateral neck lymph node 

involvement. In the remaining 17 patients with NFVPTC, with no clinical 

or radiographic evidence of central lymph node involvement, there were 

no (0/55) positive central compartment lymph nodes. Conclusion: As 

prophylactic central-compartment neck dissection becomes an option 

for patients with PTC, it is important to identify patients unlikely to have 

metastatic central nodal disease. This study shows that unlike classical 

PTC, FVPTC rarely metastasizes to the central-compartment lymph 

nodes. Only patients with clinical and/or radiographic evidence of nodal 

metastasis had positive central neck disease. The low incidence of 

central lymph node metastases in these patients suggests that a centralcompartment 

neck dissection should not be performed in patients with 

FVPTC who lack clinical or radiographic evidence of nodal metastasis. 


PARATHYROID HORMONE AS A PREDICTOR OF POST- 

THYROIDECTOMY HYPOCALCEMIA. Laura Del Rio, MD, Alejandro 

Castro, MD, Ricardo Bernaldez, MD, Antonio Del Palacio, MD, Carolina 

Del Valle, MD, Javier Gavilan, MD; La Paz University Hospital. 

Objective: To determine the best timing for the sample and cut-off point 

in the decrease of parathyroid hormone (PTH) levels in order to predict 

the development of post-thyroidectomy hypocalcemia. Material and 

Methods: Ninety patients underwent total or completition thyroidectomy 

at our department since February until November 2009. Patients with any 

condition that could interfere with calcium homeostasis were excluded 

from the survey. Thus, 73 patients were considered for analysis. PTH 

and serum calcium levels were determined preoperatively, inmediatly 

after surgery and a number of hours after surgery (delayed PTH levels: at 

8 p.m. if patient underwent surgery in the morning, or at 8 a.m. if patient 

underwent surgery the previous afternoon or evening). Results: Mean 

stay at hospital was 4.1 days, ranging from 3 to 10 days. Treatment for 

hypocalcemia was required in 13.7% of patients. A decrease higher 

77

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than 70% in PTH levels inmediatly after surgery has a sensibility of 

100% (95%CI: 75.7%-100%) and a specificity of 72.9% (95%CI: 60.4%- 

82.6%) for detecting the need of treatment for hypocalcemia. Mean 

time from surgery to delayed PTH sample was 8.75 hours, ranging 

from 5 to 24 hours. A 85% o higher decrease in delayed PTH levels 

has a sensibility of 100% (95%CI: 74.1%-100%) and a specificity of 

96.6% (95%CI: 88.5%-99.1%) for detecting the need of treatment for 

hypocalcemia. Using this test, 81.4% of the patients could have been 

discharged home 24 hours after surgery. Conclusions: The decrease 

in PTH levels is a good predictor of post-thyroidectomy hypocalcemia, 

specially if post-surgical PTH levels are obtained a number of hours after 

the end of surgery. A decrease of 85% or more in delayed PTH levels is 

a test with excelent sensibility and specificity. However, more patients 

should be included in order to reduce the 95% confidence interval. 


PARATHYROID GLANDS DYE WITH METHYLEN BLUE TO PREVENT 

HYPOCALCEMIA AFTER TOTAL THYROIDECTOMY: PROSPECTIVE 

RANDOMIZED STUDY. Matias Lavin, MD, Nicolas Avalos, MD, Luis 

Marin, MD, David Cohn, MD, Jorge Plasser, MD, Gerardo Mordojovich, 

MD; Fundacion Arturo Lopez Perez. 

Hypoparathyroidism is the most frequent complication after total 

thyroidectomy. To prevent this complication some authors use methylen 

blue for parathyroid gland dyed, trying to increase the rate of parathyroid 

gland detection. There is a lake in the literature regarding the real utility 

of methylen blue to identify parathyroid gland and prevent postoperative 

hypocalcemia. The aim of our study is to demonstrate the real capacity 

of methylen blue parathyroid gland dyed to prevent clinical hypocalcemia 

after total thyroidectomy. In this prospective randomized study, we 

enroll patients selected to total thyroidectomy. Exclusion criteria were 

renal failure, heart failure, non-controlled hypertension, selective 

serotonin reuptake inhibitors drugs use and hyperparathyroidism. We 

randomized patients in control group and methylen blue dye group. 

Three head and neck surgeons with the same operative technique 

operated all the patients. In the dye group, the protocol was 5 mg/kg 

weight intravenous infusion with anesthesia induction. Plasmatic level of 

intact parathormone (iPTH) was measured preoperative and 6 hours post 

operative. Clinical hypocalcemia, number of parathyroid gland identified, 

number of parathyroid gland dye blue, number of autotransplanted 

glands were recorded. We used statistic software STATA 10.1 for 

analysis. We studied 29 patients. Fourteen patients in the methylen 

blue group and 15 patients in the control group. The demographic data 

between groups were similar. The iPTH post surgery were 34,28 ± 27,43 

in control group and 40,82 ± 29,56 in the methylen blue group (p=0,22). 

The number of parathyroid glands identified by group were 2,66 ± 0,97 

and 2 ± 0,1 (p=0,12). In the postoperative setting we had 33,3% of iPTH 

below normal value in control group and 21,43% in the methylen blue 

group. But clinical hypocalcemia were 13,33% and 7,1% (p=1). The 

number of parathyroid gland autotransplantation were 6,67% in control 

group and 14,29% in the methylen blue group. In the methylene group 

we had a great number of complications (50%), principally migraine, 

dizziness, hypertension crisis and persistent nausea. Two patients had 

prolonged hospital stay because complications. We concluded that 

methylen blue does not add better parathyroid gland identification and 

does not diminish post thyroidectomie hypocalcemia rate. Additionally 

methylen blue had a high rate of complications, so we don’t recommend 

using it. 


CLINICOPATHOLOGICAL FEATURES AND TREATMENT OUTCOMES 

FOR PRIMARY AND RECURRENT HüRTHLE CELL CARCINOMA. 

Jeffrey R Janus, MD, Matthew Carlson, MD, Amy Saleh, MD, Jan 

Kasperbauer, MD; Mayo Clinic Department of Otorhinolaryngology. 

Background & Objective: Hürthle Cell Carcinoma (HCC) is a well 

differentiated thyroid carcinoma that is quite rare, but has established 

itself as its own clinical entity. Of thyroid malignancies, HCC accounts 

for approximately 3.6% of cases. It is generally defined as a solitary, 

well-encapsulated tumor that is composed of greater than 75% Hürthle 

cells, with one or more of the following features: full thickness capsular 

invasion; spread to adjacent tissue; vascular invasion; and local or 

distant metastases. Though included with the follicular cell cancers, 

HCC has manifested distinct clinical and pathological features that 

culminate in a more aggressive clinical course. These include decreased 

radioiodine uptake, increased locoregional spread, increased distant 

metastasis, and increased mortality. The low incidence of these cancers 

has resulted in a relative paucity of information about them, with even 

less written about recurrent disease. We report our department’s 

experience with HCC with respect to clinicopathological features and 

treatment outcomes for both primary and recurrent disease. Design: 

Retrospective chart review (1998-2008). Setting: Tertiary academic 

referral center; single surgeon’s experience. Patients: Twenty-three 

cases of primary HCC with nine recurrences were analyzed. 

Interventions: Thyroidectomy (total, partial, completion), neck dissection 

(central, lateral, substernal), and concomitant therapy (radioiodine, 

chemotherapy, external beam radiation therapy; adjuvant versus nonadjuvant). 

Main Outcome Measure(s): Age, sex, survival, tumor size 

(initial versus recurrent disease), node positivity, TNM stage (primary 

and recurrent disease), time from initial surgery to recurrence. Results: 

Twenty-three total cases of HCC were analyzed; 10 (43.5%) were male 

and 13 (56.5%) female. The mean age at surgery was 59.8 years (SD 

15.5 years). Deaths were 3 (13.0%); of the 3 that died, 2 suffered from 

recurrent disease. Median time from surgery to death was 6.3 years. 

Recurrences occurred in 9 (39.1%) patients. Median time from surgery 

to first recurrence was 2.1 years. Median time from surgery to follow-up/ 

death (for those with no recurrence) was 2.5 years. Four (17.4%) cases 

had positive lymph nodes as of the date of initial surgery; 1 (4.3%) 

additional person went on to develop positive lymph nodes with their 

first recurrence. Two (8.7%) cases had extracapsular extension (ECE) 

during primary surgery. None went on to have ECE involvement after 

their initial surgery. Kaplan-Meier estimates for disease free survival 

were then conducted integrating the various modalities of intervention. 

Conclusions: HCC, though considered well differentiated, is quite 

aggressive. Of the patients studied, most recurrences occurred in just 

over two years. Data from our cohort put survival free of recurrence at 

a mere 57%. This propounds the notion HCC of the Thyroid demands 

aggressive monitoring and treatment, particularly in the case of recurrent 

disease. 


IS LEVEL VI NECK DISSECTION NEEDED IN ALL CASES THYROID 

DIFFERENTIATED CARCINOMA METASTATIC TO THE NECK? 

Roberto A Lima, MD PhD, Ullyanov B Toscano, MD, Fernando L Dias, 

MD PhD, Jacob Kligerman, MD, Mauro M Barbosa, MD, Jose R Soares, 

MD, Emilson Q Freitas, MD; Department of Head and Neck Surgery of 

the Brazilian National Cancer Institute, Rio de Janeiro. 

Background: In the treatment of well-differentiated thyroid cancer 

(WTC), supplementary lymph node dissection (LND) is not well 

standardized. Histopathologic evidence of metastatic lymph nodes 

has been treated with therapeutic neck dissection. Total resection of 

the metastatic disease depends on the neck levels resected with an 

en bloc resection. The significance of metastatic nodes with respect to 

regional recurrence and overall survival remains controversial. Decisions 

regarding the extent of lymphadenectomy that is necessary for the 

treatment of regional metastasis from WTC should be made based on 

predictable drainage patterns. Objectives: The aim of the study was 

to show the efficacy of neck dissection in initial treatment of WTC and 

patterns of failure in neck. Study Design: Retrospective chart review 

of patients with WTC treated at the Brazilian National Cancer Institute/ 

INCA. Patients and Methods: From 1993 to 2002, 512 charts of WTC 

were reviewed. One hundred twenty seven patients (24.8%) were treated 

primarily with thyroidectomy plus neck dissection (ND), patients that 

developed neck metastases after initial treatment were excluded (42 

patients). Eight-five patients with initial clinical presentation of WTC 

and neck nodes were included in this study. Patient characteristics 

(age and gender), tumor factors (pathology, size of tumor, multifocality) 

and type of neck dissection, related to neck recurrences were analyzed 

using the chi-square method. The overall survival was estimated by 

the Kaplan–Meier method. Results: The most frequent histology was 

papillary thyroid carcinoma, in 81 cases (95.3%). The mean age was 

44 years old. Sixty-nine (81.2%) patients were women. Thirty-eight 

patients underwent to a selective neck dissection (SND) (level II-IV), 29 

patients SND (level II-VI), 14 patients central compartment ND, and 4 

patients radical neck dissection (RND). Thirty-five patients (41.2%) had 

neck nodes metastasis in central and lateral compartments. Thirty-two 


Poster Papers 

(37.6%) patients had neck nodes metastasis only lateral compartment 

and 18 (21.2%) patients only in central compartment. Twenty-one 

(24.7%) patients had complications after surgery. Sixteen patients 

(18.8%) had recurrences, 3 local and 13 neck lymph nodes recurrences. 

All patients were salvaged by surgery, none patients died from thyroid 

cancer. Ten patients (24.4%) with extra thyroidal spread and 13 patients 

with vascular invasion (23.6%) had neck nodes recurrences, p=0,025 

and p=0.004, respectively. Patients who underwent to a SND (II-IV) 

and central ND had recurrences in neck nodes, 26.3% and 21.4%, 

respectively. (p=0.02) None patient who underwent to a SND (II-VI) or 

RND had neck nodes recurrences.The mean time of follow-up was 84 

months. The 10-year overall survival was 94%. Conclusion: Vascular 

invasion and extra thyroidal disease influenced the occurrence of neck 

recurrences. The extent of neck dissection influenced the incidence of 

neck nodes recurrences. Our data suggests that less than SND (levels II 

to VI) increase the occurrence of neck nodes recurrences. 


THYROID CANCER TREATMENT CONCERNS ABOUT COST. Glaucia 

R Roque, Pharm D, Joao G Filho, MD PhD, Luiz P Kowalski, MD PhD; A 

C Camargo Hospital. 

Objective: To evaluate the cost of treatment of patients with thyroid 

carcinoma in its first year of treatment, considering its pretreatment, 

treatment and follow-up period. Patients and Methods: A retrospective 

cohort study was performed using a prospectively maintained database 

of treatment costs of 115 patients with thyroid carcinoma treated in the 

period from July 1, 2007 to June 30, 2008, at a tertiary cancer hospital 

in a developing country. The cost analysis data were obtained from the 

computerized data base stored in prospective format, related to the 

number of procedures in a detailed, individualized form (consultations, 

surgery, anesthesia, outpatient nursing care), complementary 

exams (laboratory and imaging), adjuvant therapy and treatment of 

complications that occurred in the study period. All the patients were 

classified according to the American Society of Anesthesiologists 

(ASA) in the preanesthesia evaluation and according to the presence of 

comorbidity, using the adult comorbidity evaluation index (ACE-27). The 

treatment period comprised costs about surgical treatment of the thyroid 

carcinoma until the end of adjuvant treatment when indicated or thirty 

days after surgery when who did not have it performed. Results: The 

total cost of treatment in the first year ranged from US$ 2,804 to US$ 

17,554 with a mean value of US$ 6,683 per patient. The pretreatment 

period corresponded only 5.8% of total costs with treatment. In this 

period the costs of imaging exams accounted for 68% of the total 

expenditure. Whereas, the treatment period accounted for the highest 

cost, corresponding to 87% of the total expenditure. The follow-up 

period accounted for 7.2% of total cost with the costs of laboratorial 

exams accounted for 55% of the expenditure in this period. The increase 

in treatment cost was significantly related like length of stay, extension of 

surgery, postoperative complications, and need for adjuvant treatment. 

However, no statistically significant differences were observed among 

the treatment costs and patients´ gender and age, anesthetic risk 

evaluation (ASA) or presence of comorbidities (ACE-27). Conclusion: A 

description of the costs helps to evaluate expenditures and rationalize 

the use of resources. A guideline can reduce unnecessary expenditure 

on exams and prolonged hospitalization, as well as the indication of 

adjuvant treatment in patients without any real benefit valuated by 

evidence-based medicine. Control of these factors would contribute 

significantly to avoid a rise in the costs of treatment. 


THE ROLE OF TOTAL LARYNGECTOMY IN THE MANAGEMENT 

OF INVASIVE WELL-DIFFERENTIATED THYROID CANCER. 

Matthew L Carlson, MD, Jeffery R Janus, MD, Amy M Saleh, MD, Jan L 

Kasperbauer, MD; Mayo Clinic, Rochester, MN. 

Background & Objective: Patients presenting with well-differentiated 

thyroid carcinoma (WDTC) limited to the thyroid gland carry an 

excellent prognosis and generally can anticipate a near normal life 

expectancy. Extrathyroidal extension is rare (

Poster Papers 

2001 to October 1, 2009 was performed. Demographic data, thyroid 

histopathology and lymph node positivity was examined. 

Results: 125 cases were reviewed, of which 30.4% were positive for 

malignant neoplasm, while 69.6% had benign disease. Level VI lymph 

nodes were present in 64% (n=80) of all cases where 92.5% (n=74) 

were found to be negative for metastatic disease. In the remaining 

7.5% (n=6) patients that were found to have malignant LN, all were 

diagnosed with papillary carcinoma. On average, 4.2 LN were found 

through neck dissection in patients with positive nodes, compared to 

2.5 LN in those with negative nodes. However, patients with positive 

nodes had smaller average tumor size (1.3cm) compared to those with 

negative nodes (2.2cm). Conclusions: In patients undergoing diagnostic 

hemothyroidectomies, routine Level IV neck dissection was able to 

identify thyroid carcinoma metastatic to nodes in 7.5% of patients. 

Tumor size was a poor predictor of node positivity, while node number 

was a strong predictor of positive node disease. 


A CONTEMPORARY NOMENCLATURE SYSTEM FOR LOCALIZING 

PARATHYROID ADENOMAS. Mauricio A Moreno, MD, Glenda G 

Callender, MD, Elizabeth G Grubbs, MD MPH, Katherine Woodburn, 

MD, Beth S Edeiken-Monroe, MD, Jeffrey Lee, MD, Nancy D Perrier, 

MD; University of Arkansas for Medical Sciences; MD Anderson Cancer 

Center. 

Background: Despite major advances in the treatment of 

hyperparathyroidism, there is no accepted nomenclature for the 

anatomic location of abnormal parathyroid glands. We have developed 

a nomenclature system that succinctly specifies the location of 

parathyroid adenomas in the neck and report the experience in a 

large, contemporary cohort. Methods: The system describes 7 

common locations for parathyroid glands; sites A, B, and C describe 

superior glands and sites D, E, F and G describe inferior glands 

(figure). We reviewed 271 patients operated upon for sporadic primary 

hyperparathyroidism between January 2006 and May 2008. Results: 

According to our nomenclature system, gland locations included: 12.5% 

A(adherent to posterior thyroid capsule); 17.3% B (behind thyroid, in 

tracheoesophageal groove); 13.7% C (close to clavicle, prevertebral 

space); 12.2% D(directly over the recurrent laryngeal nerve); 25.8% 

E (easy to identify, near the inferior thyroid pole); 7.4% F (fallen into 

thymus); 0.4% G (within thyroid gland). 10.7% of the patients presented 

with multigland disease, with type A and E glands being the most 

frequently involved. Type F glands were associated with a longer 

operative time (p=0.0487) and type E glands with a shorter postoperative 

observation period (p=0.0195). Cure was achieved in 96.3% of the 

patients. Conclusions: A nomenclature system that provides a simple 

means to describe the location of parathyroid adenomas, predicts 

operative time and accurately identifies patients who may need longer 

postoperative observation. Importantly, this novel system has allowed 

surgeons, endocrinologists, radiologists and pathologists to speak a 

common language when communicating about these patients. 


SENSITIVITY AND SPECIFICITY OF ULTRASOUND AS THE PRIMARY 

SCREENING MODALITY FOR LOCALIZATION OF PRIMARY 

HYPERPARATHYROID DISEASE. Joshua M Levy, Emad Kandil, MD 

FACS, Lillian C Yau, PhD, Jonathan D Cuda, MD, Ralph P Tufano, MD 

FACS; Tulane University and Johns Hopkins University. 

Introduction: Advances in the preoperative localization of parathyroid 

adenomas have made it possible to perform minimally invasive 

parathyroid surgery for the treatment of primary hyperparathyroidism. 

Prior studies have identified technetium-99m-sestamibi scintigraphy 

and ultrasonography as the most accurate screening modalities, and 

as a result many surgeons advocate the use of both techniques to 

localize disease. The goal of this study was toindependently evaluate 

both ultrasound and sestamibi as single modality preoperative screening 

tools for the localization of primary parathyroid adenomas. Methods: 

This is aretrospective chart review of 440 patients undergoing surgery 

for primaryhyperparathyroidismin a single academic institution between 

1999 and 2009.. Patients receiving ultrasound and sestamibi as part 

of their preoperative workup were included for analysis, with both 

modalities independently compared to surgical findings. Results: 

Adjusted for age and gender, 440 patients were found to meet inclusion 

criteria and were included in the analysis. Sensitivities for correct 

localization of a single parathyroid adenoma for sestamibi versus 

ultrasound were: 83% (95% CI 78 to 86) vs. 72% (95% CI 67 to 76), 

while specificities for the two techniques were 47% (95% CI 31 to 62) 

and 58% (95% CI 0.42 to 0.72) respectively. Ultrasound surpisingly 

identified 31% of the patient withnodular thyroid disease requiring 

further investigation. Conclusion: Ultrasonography alone is useful as 

a first line test for the localization of parathyroid adenomas in patients 

with primary hyperparathyroidism.Although the sensitivity is less than 

Tc99 mibi, the similar specificity and the ability to detect concomitant 

thyroid pathology lead us to recommend the use of ultrasound as the 

initialscreening modality for localization of parathyroid adenomas in 

primary hyperparathyroidism.Sestamibi scans should be reserved for 

cases where ultrasound gives equivocal localization results. 


TRANSAXILLARY GASLESS ROBOTIC THYROID SURGERY WITH 

NERVE MONITORING: INITIAL EXPERINCE IN A NORTH AMERICAN 

CENTER. Emad Kandil, MD, Xin Zhong, BS, Paul Friedlander, MD, Ryan 

Winters, MD, Charles Bellows, MD, Christopher Holsinger, MD; Tulane 

University, M.D.Anderson. 

Background: Minimally invasive thyroid surgery using various 

techniques is well described. Recently, robotic thyroidectomy with 

gasless transaxillary technique has been FDA approved. The present 

study reviews our initial experience with the technique with added 

intraoperative monitoring to assess its safety and feasibility. Methods: 

The study group consisted of 10 consecutive patients with suspicious 

thyroid nodules who were candidates for thyroid lobectomy from 

September to December 2009. All procedures were successfully 

completed with intraoperative nerve monitoring. No cases were 

converted to an open procedure. All patients underwent intraoperative 

nerve integrity monitoring and postoperative direct laryngoscopy 

on their postoperative visit. The patients’ demographic information, 

comorbidities, operative times, learning curve, complications, and 

postoperative hospital stay were evaluated. Results: The mean 

age was 46 years (range 29-69) and nine of the ten patients were 

females. The mean operating time was 131 minutes (range 101-203 

minutes) and the mean operating time with the da Vinci system was 

55 minutes. All patients were discharged home after an overnight stay. 

One patient developed transiet radial nerve neuropathy that resolved 

spontaneously after few days. There were no other postoperative 

complications. None of the patients complained of postoperative neck 

pain. Postoperative laryngoscopy showed intact mobile vocal cords in all 

patients. Conclusions: Robotic endoscopic thyroid surgery with gasless 

transaxillary approach is feasible and safe in the treatment of suspicious 

thyroid nodules. Monitoring of the RLN during this approach is feasible. 


Certificate of Incorporation 

Certificate of Incorporation of 

The American Head and Neck Society, Inc. 

Under Section 803 of the Not-for-Profit Corporation Law 

1. The name of the Corporation is THE AMERICAN HEAD AND 

NECK SOCIETY, INC. 

2. This Corporation has not been formed for pecuniary profit 

or financial gain, and shall not be conducted or operated for 

profit, and no part of the assets, income or net earnings of 

the Corporation is distributable or shall inure to the benefit of 

the directors, officers, or other private persons, except to the 

extent permitted under the Not-for-Profit Corporation Law. 

Upon the dissolution of this Corporation, no director, officer, 

or other private person shall be entitled to any distribution 

or division of its remaining property or its proceeds, and the 

balance of all money and property of the Corporation shall 

pass to, or shall inure to the benefit of, those organizations 

described in Section 201 of the Not-for-Profit Corporation 

Law and Section 501(c)(3) of the Internal Revenue Code of 

1986, which are not private foundations described in Section 

509(a) of such Code. Any such assets not so disposed of 

shall be disposed of by the Supreme Court of the State of 

New York for the County in which the principal office of the 

Corporation is then located, as provided by law, exclusively 

for such purposes or to such organization or organizations 

as said Court shall determine, which are organized and 

operated for the purposes set forth in Paragraph “3” below. 

3. The purposes for which the Corporation is formed and the 

powers which may be exercised by the Corporation, in 

addition to the general powers set forth in Section 202 of the 

Not-for-Profit Corporation Law of the State of New York, are: 

(a) to advance knowledge relevant to medical and surgical 

control of neoplasms of the head and neck; 

(b) to solicit, obtain, apply for, and spend funds in 

furtherance of any activities or purposes of the Corporation; 

(c) in general, to do any and all acts or things and to exercise 

any and all powers which may now or hereafter be lawful 

for the Corporation to do or exercise under and pursuant 

to the laws of the State of New York for the purpose of 

accomplishing any other purpose of the Corporation as set 

forth herein; 

(d) to engage in any and all lawful activities incidental to any 

of the foregoing purposes of the Corporation. 

4. The Corporation is organized exclusively to achieve public 

objectives, including for such purposes, the making of 

distributions to organizations that qualify as exempt 

organizations described in Section 115 or Section 501(c) 

(3) of the Internal Revenue Code of 1986, provided that 

such organizations are not private foundations described in 

Section 509(a) of such Code. The Corporation shall not carry 

on any other activities not permitted to be carried out by a 

corporation exempt from federal income tax under Section 

501(c)(3) of such Code or by a corporation contributions to 

which are deductible under Section 170(c)(2) of such Code 

(or the corresponding provisions of any future United States 

Internal Revenue Law.) 

5. Nothing contained herein shall authorize this corporation 

to undertake or to carry out any of the activities specified 

in paragraphs (b) through (u) of Section 404 of the Not-for- 

Profit Corporation Law, or to establish, maintain or operate 

a hospital or to provide hospital service or health-related 

service, a certified home health agency, a; hospice, a; 

health maintenance organization, or a comprehensive health 

services plan, as provided for by Article 28, 36, 40 and 44, 

respectively, of the Public Health Law or to solicit, collect 

or otherwise raise or obtain any funds, contributions or 

grants from any source, for the establishment, maintenance 

or operation of any hospital or to engage in the practice of 

medicine or any other profession required to be licensed by 

Title VIII of the Education Law. 

6. No substantial part of the activities of this Corporation shall 

consist of carrying on propaganda or otherwise attempting 

to influence legislation, and the Corporation shall not 

participate in, or intervene in (including the publication or 

distribution of statements), any political campaign on behalf 

of any candidate for public office. 

7. The Corporation is a corporation as defined in subparagraph 

(a)(5) of Section 102 of the Not-for-Profit Corporation Law, 

and it is a Type B Corporation. 

8. The principal office of the Corporation is to be located in the 

City of Syracuse, County of Onondaga and State of New 

York. 

9. The territory in which the Corporation’s activities are 

principally to be located is the territorial limits of the United 

States of America, the Domain of Canada and the Pan- 

American countries. 

10. The number and manner of election or appointment of 

the directors constituting the Board of Directors shall be 

as provided in the Bylaws, except that the number of said 

Board members shall not be less than three (3). Members of 

the Board of Directors need not be residents of the State of 

New York. The names and addresses of the Directors of the 

Corporation who shall act until the first meeting of the Board 

of Directors, all of whom are over the age of eighteen (18) 

and are citizens of the United States, are: 

Names 

Addresses 

[Names and Addresses omitted.] 

11. Management of the business and affairs of the Corporation 

is vested in the Board of Directors which shall use its 

best efforts to carry out in good faith the purposes of the 

Corporation. 

12. To further the Corporation’s objectives and purposes, the 

Corporation shall have and may exercise all of the powers 

conferred by the New York Not-for-Profit Corporation Law 

in pursuit of the purposes expressed in Paragraph THREE 

hereof. Without limiting the generality of the foregoing, 

the Corporation shall have power to sue and be sued, to 

www.ahns.info 

81

Certificate of Incorporation 

own, take title to, receive and hold, lease, sell and resell, in 

fee simple or otherwise, property real, personal or mixed 

wherever situated and however acquired, without limitation 

as to amount or value. The Corporation shall have authority 

to encumber property by deed of trust, pledge or otherwise; 

to borrow money and secure payment of same by lien or 

liens of the realty or personal property of the Corporation; 

to lease, build, erect, remodel, repair, construct and/or 

reconstruct any and all buildings, houses or other structures 

necessary, proper or incident to its needs and proposes; 

and to do any and all things incident to the carrying out of 

the objectives and purposes as stated and as limited herein. 

The Corporation shall have full powers or management, 

investment and reinvestment and the collection of all rents, 

revenues, issues and profits arising therefrom. 

13. The Corporation is to have members. 

14. The Corporation is to be divided into such classes of 

members as the By-Laws provide. The designation of each 

class of members, the manner of election or appointment, 

and the qualification and rights of the members of each class 

(including conferring, limiting, or denying the right to vote) 

shall be set forth in the By-Laws. 

15. The Secretary of State of the State of New York is hereby 

designated as the agent of the Corporation upon whom 

process may be served, and the post office address to which 

the Secretary of State shall mail a copy of any such process 

served upon him is as follows: c/o Richard R. Gacek, M.D., 

Professor and Chairman, Department of Otolaryngology, 

State University of New York Health Science Center, 750 

East Adams Street, Syracuse, New York 13210. 

Mission Statement 

The purpose of this Society is 

• to promote and advance the knowledge of diagnosis, 

treatment and rehabilitation of patients with neoplasms and 

other diseases of the head and neck 

• to promote and advance the knowledge of prevention of 

neoplasms and other diseases of the head and neck 

• to promote and advance research in diseases of the head 

and neck, and 

• to promote and advance the highest professional and ethical 

standards. 


Constitution 

Article I 

Section 1. The name of the Corporation shall be The American 

Head and Neck Society, Inc. 

Article II 

Section 1. The purpose of this Society is to promote 

and advance the knowledge of diagnosis, treatment and 

rehabilitation of patients with neoplasms and other diseases of 

the head and neck and the prevention of neoplasms and other 

diseases of the head and neck. 

Section 2. It is the objective of this Society to promote and 

advance research in neoplasms and other diseases of the head 

and neck. 

Section 3. It is the objective of this Society to promote the 

highest professional and ethical standards. 

Article III 

Section 1. Members of this Society shall be designated as 

Fellows, and shall consist of six classes 

(a) Active 

(b) Honorary 

(c) Corresponding 

(d) Senior 

(e) Associate 

(f) Candidate 

Section 2. Active Fellows of this Society shall be those who 

maintain a license to practice medicine and who are actively 

engaged in diagnosis, treatment and rehabilitation of patients 

with neoplasms and other diseases of the head and neck and the 

prevention of neoplasms and other diseases of the head and neck. 

Section 3. Qualifications for Active Fellowship. An applicant for 

Active Fellowship shall be a Diplomate of a particular specialty 

board, or have credentials that are equivalent to those issued by 

member boards of the American Board of Medical Specialties. 

Surgeons must be a member of the American College of 

Surgeons, a Fellow of the Royal College of Surgeons (Canada), 

or have similar credentials. A significant portion of practice 

shall be concerned with managing patients with neoplasms and 

other diseases of the head and neck. Further qualifications and 

requirements for Active Fellowship are contained in the By-Laws, 

Article VI, Sections 1 and 2. 

Section 4. Qualifications for Honorary Fellowship. Honorary 

Fellowship shall be a distinction bestowed by the Society on an 

individual who has made outstanding contributions to the field of 

head and neck oncology. 

Section 5. Qualifications for Corresponding Fellowship. 

Corresponding Fellowship shall be granted to those who, in the 

judgment of the Council, are actively engaged in the prevention, 

diagnosis, treatment and rehabilitation of patients with 

neoplasms and other diseases of the head and neck and who 

reside in a country other than the United States or Canada. 

Section 6. Qualifications for Senior Fellowship. Any Active 

Fellow, upon cessation of active practice, may request by writing 

to the Secretary a change in status to Senior Fellowship. 

Section 7. Qualifications for Associate Fellowship. A candidate 

for election to Associate Fellowship shall be a physician, dentist 

or allied scientist who has demonstrated a special interest in the 

field of head and neck oncology. 

Section 8. Qualifications for Candidate Member. The trainee 

currently enrolled in, or a graduate of, an approved residency 

www.ahns.info 

program in Otolaryngology, Plastic Surgery, or General Surgery 

or in a Fellowship Program approved by the Joint Training 

Council may become a Candidate Member. This nonvoting 

membership is subject to fees established by the Council. The 

membership shall expire if the candidate member has not made 

application for Active Fellowship in The American Head and 

Neck Society, Inc. five years after the completion of training. 

Section 9. Privileges of Members. All members shall have the 

same rights and privileges except that only Active Fellows in 

good standing shall have the privileges of voting in the conduct 

of the affairs and business of the Society or of holding office or 

of chairing Standing Committees. 

Article IV 

Meetings 

Section 1. The annual meeting of this Society shall be held at 

such time and place as may be fixed by the Council at its annual 

meeting. 

Section 2. The annual meeting shall consist of at least one 

scientific session and one business session. 

Section 3. The scientific session shall be open to all Fellows of 

the Society and members of the medical profession. Attendance 

at any business session is limited to Fellows of the Society. 

Section 4. Only Active Fellows in good standing shall have the 

privilege of a vote in conduct of the affairs and business of the 

Society. 

Article V 

Officers 

Section 1. The officers of this Society shall be President, 

President-Elect, Vice-President, Secretary, and Treasurer. 

Article VI 

Board of Directors 

Section 1. The governing body of this Society shall be the 

Council, consisting of the President, President-Elect, Vice- 

President, Secretary, Treasurer, and Past Presidents (for a period 

of three years following the termination of term of office). In 

addition, there shall be nine Fellows-at-Large, three of whom 

shall be elected each year to serve terms of three years each. 

At no time shall the Council exceed eighteen in number. The 

manner of election of officers and members of the Council is 

stated in the By-Laws, Article VII, Sections 1 and 2. 

Article VII 

Amendments to the Constitution or Bylaws 

Section 1. A proposed amendment to the Constitution or By- 

Laws must be submitted to the Secretary in writing not less 

than two months before a meeting of the Council, and must 

be signed by at least two Active Fellows. The Secretary shall 

forward the proposed amendment to the Constitution and 

Bylaws Committee for review and comment. The Constitution 

and Bylaws Committee will make a periodic review of the 

Constitution and Bylaws and recommend modification which 

may be submitted as amendments. Any proposed amendment 

must first be acted upon by the council. The Secretary shall mail 

a copy of any proposed amendment to each Active Fellow not 

less than one month prior to the annual meeting of the Society. 

Two-thirds vote of the Active membership present at the meeting 

shall be required for acceptance. 

83

Bylaws 

Article I 

Rights and Duties of Members 

Section 1. Any Active Fellow shall have all the rights of 

Fellowship, shall be subject to all the duties, roles and 

responsibilities incumbent upon the members of any scientific 

parliamentary body. 

Article II 

Delinquents 

Section 1. Unless excused by the Council, a Fellow 

delinquent in dues for two consecutive years, or attendance 

for four consecutive years, shall be dropped from Fellowship. 

Delinquency in dues is defined as failure to pay by the end of the 

calendar year. 

Article III 

Dues 

Section 1. The amount of the Society’s dues shall be determined 

by the Council. The Council shall have the authority to establish 

an initiation fee or special assessment. 

Article IV 

Order of Business 

Section 1. The regular order of business at annual meetings 

shall be carried out in a manner prescribed by the Council. 

Article V 

Special Provisions 

Section 1. All conditions, circumstances, emergencies or 

contingencies not covered by this Constitution and its Bylaws 

shall be dealt with and administered by the directive of the 

Society’s Council, subject to approval by the membership at the 

next annual meeting. 

Article VI 

Qualifications for Fellowship 

Section 1. Candidates desiring election to Fellowship in any 

class other than Associate Fellow must hold a valid, unrestricted 

license to practice medicine in the state or country in which they 

reside and shall be proposed by two Active Fellows with at least 

one from the applicant’s local geographical area. A special form 

will be provided by the Secretary for this purpose. Both of the 

sponsors must submit letters of recommendation pertaining to 

the qualifications of the candidate. 

Section 2. Special Qualifications for Active Membership. 

A. In addition to fulfilling the requirements under the 

Constitution, Article III, Section 3, surgeon candidates must 

submit evidence that they have the skill and capacity to 

diagnose and treat neoplasms and other diseases of the 

head and neck. 

B. An applicant for Active Fellowship shall provide 

documentation that he or she has received adequate training 

in the management of patients with head and neck tumors 

and that a significant portion of current professional activity 

is devoted to the care of such patients. Such documentation 

will include a description of experience during residency and/ 

or fellowship training, a summary of subsequent post training 

experience, and a listing of at least 35 patients with head 

and neck tumors managed during preceding year. Additional 

evidence of academic activity such as one paper published 

on cancer of the head and neck is required. 


C. Active Fellows must be members of the American College of 

Surgeons or its equivalent. 

D. Active Fellows are expected to uphold ethical standards. 

Section 3. Special Qualifications for Corresponding Fellowship. 

A. Corresponding Fellows shall be physicians who, by their 

professional associations and publications, would appear 

in the judgment of the Council to be qualified to treat 

neoplasia and diseases of the head and neck. All proposals 

for candidates for Corresponding Fellowship shall be 

accompanied by a curriculum vitae of the candidate, a letter 

of recommendation from at least two Active Fellows. The 

delinquent clause relative to failure to attend meetings will 

not pertain to this class of membership. 

Section 4. Election to Fellowship 

A. All proposals for candidates for any class of Fellowship shall 

be sent to the Council through the Secretary. Subsequent to 

approval by the Council, nominees’ names must be circulated 

to the membership at least 120 days before the annual 

meeting. Fellows shall be given an opportunity to make written 

objections at least 60 days in advance of the annual meeting. 

Objections will be investigated by the Credentials Committee 

and presented to the Council for a vote. The Council will use 

the AMA Code of Ethics as a guide in this matter. 

B. Election to any class of membership shall require threefourths 

favorable vote of the Council. 

C. A candidate for Active Fellowship must be present at the 

annual meeting to be inducted. 

ARTICLE VII 

Officers of the Society 

Section 1. Election of Officers. The officers of the Society shall 

be a President, President-Elect, Vice-President, Secretary, 

and Treasurer, who shall be elected at regular annual business 

meetings of the Society. 

Section 2. Accession to Office. The newly elected officers shall 

assume their duties before the adjournment of the meeting at 

which they have been elected. 

Section 3. Tenure of Office. 

A. The President and President-Elect, and Vice-President shall 

serve for a term of one year. The Secretary and the Treasurer 

shall serve for a term of three years and may be elected to 

one additional term. 

B. An outgoing President (Past President) automatically 

becomes a member of the Council to serve for a period of 

three years. A past-president’s membership on the Council 

which shall be terminated by death or other incapacity to 

serve shall remain vacant until filled by regular succession. 

Section 4. Vacancies in Office. Vacancies in office occurring 

between elections shall be filled by appointment by the 

President. These appointments shall be subject to written 

approval of a majority of the Council. Should the office of 

the President become vacant between elections, it shall 

automatically be filled by the President-Elect. Should the offices 

of both President and President-Elect become vacant, these 

offices will be served by the Secretary. 

Article VIII 

Duties of the Officers 

Section 1. Duties of the President. 

A. The President shall preside at meetings of the Society and 

shall have the power to preserve order and to regulate the 

proceedings according to recognized rules.

Bylaws 

B. The President shall serve as Chairman of the Council. 

C. The President shall appoint standing and special 

committees, except the Nominating Committee. See Article 

X, Section 2. 

D. The President shall fill vacancies in offices that occur in the 

interim between regular meetings subject to approval by a 

Council majority. 

E. The President shall be an ex-officio member of all standing 

committees. 

Section 2. Duties of the Vice President. 

A. The Vice-President shall serve and assist the President and 

President-Elect. 

B. The Vice-President shall oversee the work of the committees 

and shall direct, plan and implement the long range and 

strategic planning retreat of the Council listed in Article IX 

section 2E. 

Section 3. Duties of the President-Elect. 

A. The President- Elect shall perform all duties that may be 

delegated to him or her by the President. 

B. In the absence of the President, the President-Elect shall 

perform all duties of the President and shall preside at all 

meetings. 

Section 4. Duties of the Secretary. 

A. The Secretary shall keep or cause to be kept in permanent 

form an accurate record of all transactions of the Society. 

B. The Secretary shall send due notice of all meetings to 

members; notice of at least 15 days shall be provided prior 

to Council meetings. 

C. The Secretary shall notify all committee members of their 

appointments and the duties assigned to them. 

D. The Secretary shall notify all applicants for membership of 

the action taken by the Society. 

E. The Secretary shall keep a correct alphabetical list of 

members, together with their current addresses and shall 

supply application forms to members who apply for same. 

F. The Secretary shall act as custodian of all papers of the 

Society and its committees. 

Section 5. Duties of the Treasurer. 

A. The Treasurer shall collect, receive and be accountable for 

funds accrued by the Society from dues or other sources. 

B. The Treasurer shall deposit all moneys in a special bank 

account under the official name of the Society, in a city of his 

choice. 

C. The Treasurer shall disburse from the treasury such funds as 

may be necessary to meet appropriations and expenses of 

the Society. 

D. The Treasurer’s financial records shall be audited at each 

regular annual meeting by a specially appointed auditing 

committee, who will report at the business session. 

E. The Treasurer shall prepare and submit an annual budget for 

the following year to the Finance committee for subsequent 

approval of the Council at the fall meeting. 

ARTICLE IX 

The Council 

Section 1. Composition of the Council. The Council shall consist 

of the officers, the three immediate Past Presidents, and nine 

Fellows at Large, three of whom shall be elected annually to 

serve staggered three-year terms. A Fellow at Large elected to 

the Council may not succeed himself or herself. 

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Section 2. Duties of the Council. 

A. The Council shall conduct the affairs of the Society during 

the interim between sessions. 

B. The Council shall pass on all applicants for Fellowship and 

present its recommendations to the Society at one of its 

business sessions so that necessary action may be taken. 

C. The Council shall report to the members at regular business 

sessions all decisions and recommendations made so as to 

obtain approval of the whole membership of its actions. 

D. Should the membership disapprove of any action of the 

Council the questions shall be referred back for further 

consideration and reported at the next business meeting. 

E. The Council shall have a long range and strategic planning 

retreat at least every three years. 

Section 3. Quorum and Manner of Acting. 

A. A majority of officers and Council members shall constitute 

a quorum. A majority of the quorum at any meeting of 

the Council shall constitute action by the Council unless 

otherwise provided by law or by these By-Laws. 

B. Any action required or permitted to be taken at a meeting of 

the Council may be taken without a meeting if a consent in 

writing setting forth the action to be taken shall be signed by 

all Council members entitled to vote. 

C. Meetings may be conducted by telephone provided that 

all officers and Council members participating in such a 

meeting may communicate with each other. A majority of 

officers and Council members shall constitute a quorum for 

telephone meetings and the act of a majority of the quorum 

shall constitute action by the Council. 

D. Officers and Council members shall not receive 

compensation for their services, but, by action of the 

Council, expenses may be allowed for attendance at 

meetings of the Council or for official representation of the 

Society and the Council may underwrite any activities that it 

deems essential to the functioning of the Society. 

ARTICLE X 

Committees 

Section 1. Other than as specifically stated below, The President 

shall appoint committee members to serve for three years. Initial 

appointments shall be staggered such that approximately onethird 

of committee members shall change each year (other than 

the Scientific Program Committee and Nominating Committee). 

Section 2. Scientific Program Committee. This committee shall 

be appointed by the President to serve for one year and shall 

consist of at least three Active Fellows. It shall be the duty of this 

committee to establish a scientific program at the Annual Meeting. 

Section 3. Nominating Committee. The Nominating Committee 

shall consist of the three immediate past presidents and two 

Active Fellows elected at the business meeting. The Nominating 

Committee shall be chaired by the immediate past President. 

This committee shall prepare a slate of officers and membersat-large 

of the Council for vote at the next annual meeting. (See 

Article VII, section 2). 

Section 4. Credentials Committee. This committee shall be 

chaired by the President and shall additionally consist of the two 

immediate Past Presidents plus two Active Fellows appointed by 

the President. In addition, the Secretary shall be a member, ex 

officio. The Credentials Committee shall advise the Council on 

the credentials of candidates for membership. 

85

Bylaws 

Section 5. Education Committee. This committee shall consist 

of at least three Active Fellows. It shall be the duty of this 

committee to develop appropriate educational activities for the 

Society. 

Section 6. Research Committee. This committee shall consist of 

at least six Active Fellows. It shall be the duty of this committee 

to: increase the quality and quantity of research conducted 

in head and neck oncology; encourage the design and 

implementation of new research protocols; review applications 

for research funds; and suggest possible new methods of 

research funding. 

Section 7. Council for Advanced Training in Oncologic Head and 

Neck Surgery. This committee shall consist of ten Active Fellows, 

each to serve a five-year term, with appointments staggered 

so that two Active Fellows are appointed to membership on 

this committee each year. The President’s appointments to this 

committee shall be submitted for approval by the Council. It 

shall be the duty of this committee to evaluate training programs 

as to whether they qualify for Phase III training and to make 

recommendations to this Society concerning what constitutes 

adequate training in head and neck oncologic surgery. 

Section 8. Constitution and By-Laws Committee. This 

committee shall consist of at least five Active Fellows, with the 

Secretary serving ex-officio. It shall be the duty of this committee 

to completely evaluate the Constitution and By-Laws every three 

years to maintain their relevance. 

Section 9. Finance Committee. This committee shall consist of 

three Active Fellows elected at the business meeting to serve 

three year terms so that one member is elected each year. The 

Treasurer shall be an ex officio member. It shall be the duty 

of this committee to audit the financial records of the Society 

and review investments and to report at the annual business 

meeting. This committee shall review the financial reports of the 

Treasurer prior to the presentation to the Council. 

Section 10. CME Compliance Committee. This committee 

should consist of at least three Active Fellows. It shall be the 

duty of this committee to monitor and ensure compliance 

with the CME requirements of the Accreditation Council for 

Continuing Medical Education; to review and improve the quality 

of the educational programs of the Society; and to review 

annually, prior to the annual meeting, any potential financial 

conflict of interest of members of the Program Committee, 

Program Chairs, faculty, and presenters. 

Section 11. Quality of Care Committee. This committee should 

consist of at least three Active Fellows. It shall be the duty of this 

committee to formulate quality of care standards for patients 

with head and neck neoplasms; to promote compliance with 

these standards as a framework for the measurement of quality 

head and neck care; to disseminate these standards to the 

membership of the Society; and to provide AHNS representation 

to the applicable committees of other head and neck medical 

societies that are charged with the development of specialty 

specific quality standards upon which pay-for-performance 

benchmarks may be based. 

Section 12. Publications Committee. This committee should 

consist of at least three Active Fellows appointed by the 

President. This committee shall be chaired by the Associate 

Editor for the Head and Neck Section of the Archives of 

Otolaryngology-Head and Neck Surgery. In addition, the 

Archives of Otolaryngology-Head and Neck Surgery Editor, if a 

member of the Society, shall be a member of this committee, 

ex-officio. The Secretary and President will be members of 

this committee. It shall be the duty of this committee to assure 

manuscript submission to the official journal of the Society, the 

Archives of Otolaryngology-Head and Neck Surgery, prior to 

presentation at the annual meeting; to assure rapid peer review 

of submitted manuscripts; and to facilitate the timely publication 

of the proceedings of the annual meeting in a dedicated issue of 

the official journal of the Society. 

Section 13. Prevention and Early Detection Committee. This 

committee shall consist of at least six Active Fellows. It 

shall be the duty of this committee to: develop, facilitate the 

implementation, and participate in programs directed toward 

the prevention and early detection of oral and head and neck 

cancers and to cooperate with national and international 

organizations in these efforts. 

Section 14. Endocrine Surgery Committee. This committee 

should consist of at least three Active Fellows. It shall be the 

duty of this committee to increase research and education 

related to head and neck endocrine disorders, to encourage 

endocrine-related contributions to the annual meeting, and to 

foster interaction between the Society and other societies and 

organizations with interests in endocrine disorders. 

Section 15. Website Committee. This committee shall consist 


committee to recommend and implement newer methods to 

optimize communication or dissemination of information within 

the organization. The committee shall develop and showcase 

new and emerging technologies and shall also be responsible for 

updating and revising the AHNS web site and making sure it is 

kept with the most current and accurate information. 

Section 16. Awards Committee. This committee shall consist 

of at least six active fellows, including the Chair. Committee 

members are appointed by the President of the AHNS. It shall 

be the duty of this committee to evaluate manuscripts submitted 

for awards to be given at the annual meeting of the AHNS. An 

author may submit only one manuscript per award category. 

Fellows are not eligible for resident awards. Manuscripts will be 

redacted of all author and institutional identifying information by 

the chair prior to being send to committee members for scoring. 

Manuscripts should be scored by at least five committee 

members. Manuscripts will not be scored by a committee 

member if he/she is an author on the paper. The Chair may 

request a scoring by another qualified AHNS fellow; if not 

enough committee members are available to score a manuscript. 

Deadlines for submission of manuscripts will be determined 

annually and announced during the call for abstracts. Authors of 

abstracts accepted for oral presentation will be invited to submit 

a manuscript for an award. The Chair will work with the Program 

Committee to ensure that award-winning papers are given 

podium time for oral presentations. 

Section 17. History Committee. This committee shall consist 


committee to preserve the history of the society by conducting 

interviews of past leaders, researching and organizing past 

records and promoting historical information on the web site and 

through other mediums. 

Section 18. Humanitarian Committee. This committee shall 

consist of at least three active Fellows. It shall be the duty of 

this committee to encourage and support volunteer efforts of 


Bylaws 

AHNS members to assist in the care of underserved populations 

and to develop information, communication, and organizational 

resources regarding humanitarian outreach activities. 

Section 19. Standing Committees. Other standing Committees 

shall be constituted as described in the Policies and Procedures. 

Section 20. Ad hoc Committee(s). As necessary, the President 

may appoint one or more Ad Hoc committees to serve for one 

year. 

ARTICLE XI 

Quorum 

Section 1. A quorum for any meeting of the Council shall be 

a majority of those persons then serving as members of the 

Council. 

Section 2. A quorum for the regular business session of the 

society shall be 18 Active Fellows. 

ARTICLE XII 

Society Assets 

Section 1. The interest in the funds property and other assets of 

the Society of any member whose membership shall terminate 

for any reason except the dissolution of the Society shall, 

ipso facto, immediately cease and such members and the 

representatives of such member shall have no claim against the 

Society or against the other members of their representatives or 

any of them. 

Section 2. In the case of dissolution of the Society, the funds, 

property, and other assets shall be used for the purpose of 

furthering the expressed purposes for which this Society was 

formed and no member shall be entitled to receive any of the 

assets upon liquidation. 

Section 3. If the Society’s annual receipts exceed the annual 

expenses in any given year, the Council may, by a majority vote, 

elect to distribute the surplus for such scientific or educational 

uses as the Council shall deem to be most consistent with the 

Society’s purposes; or it may, should it reasonably anticipate a 

need for operating surplus to meet future expenses, accumulate 

such surplus in an interest bearing account or otherwise. 

ARTICLE XIII 

Indemnification 

Section 1. The Society shall indemnify any and all of the 

directors or officers former directors or officers, employees, 

agents, or any person who may have served at its request 

or by its election as a director or officer of another society or 

association, or his heirs, executors and administrators, against 

expenses (including attorney fees, judgments, fines and amounts 

paid in settlement) actually and necessarily incurred by them in 

connection with the defense or settlement of any action, suit or 

proceeding in which they, or any of them, are made parties or a 

party, by reason of being or having been directors or a director, 

officer, employee or agent of the Society or of such other Society 

or association, except in relation to matters as to which any such 

action, suit or proceeding to be liable for willful misconduct in 

the performance of duty and to such matters as shall be settled 

by agreement predicated on the existence of such liability. The 

termination of any action, suit, or proceeding by judgment, order, 

settlement, conviction, or upon a plea of nolo contendere or 

its equivalent shall not, of itself, create a presumption that the 

person is engaged in willful misconduct or in conduct in any way 

opposed to the best interests of the Society. The provisions of 

this section are severable, and therefore, if any of its provisions 

shall contravene or be invalidated under the laws of a particular 

state, country or jurisdiction, such contravention or invalidity 

shall not invalidate the entire section, but it shall be construed 

as if not containing the particular provision or provisions held 

to be invalid in the particular state, country, or jurisdiction and 

the remaining provisions shall be construed and enforced 

accordingly. The foregoing right of indemnification shall be 

in addition to and not exclusive of other rights to which such 

director, officer, employee or agent may be entitled. 

ARTICLE XIV 

Merger Provisions 

To facilitate the merger of the Society with The Society of Head 

and Neck Surgeons, an Illinois nonprofit corporation (“SHNS”), 

pursuant to an agreement calling for the SHNS to be dissolved 

and its assets transferred to the Society and the Society recast 

as The American Head and Neck Society, Inc. (“AHNS”) to 

serve as a successor of both entities, notwithstanding any other 

provision of the Constitution or these By-Laws to the contrary: 

1. The Council shall be expanded as necessary to include the 

officers and directors of the SHNS, who shall serve on the 

Council with their voting status as provided by the SHNS 

bylaws until their term of office within the SHNS shall expire. 

The Council shall return to its size and with its composition 

provided in Article IX hereof through the passage of time. 

2. The President-Elect of the SHNS shall become as President- 

Elect of the AHNS following the completion of his term as 

President-Elect of the SHNS. The President-Elect of the 

Society shall become President of the AHNS to serve a term 

of six months (i.e., from May 15, 1998 through November 14, 

1998), whereupon the said President-Elect of the SHNS shall 

serve as President of the AHNS to serve a term of six months 

(i.e., from November 15, 1998 through the membership 

meeting in May of 1999 or until his successor shall assume 

office). During the combined one-year term of office, the two 

said individuals shall regularly consult and cooperate with 

each other on all meaningful and significant decisions to be 

made during the year so that it may appear that they are 

serving as co-presidents for the full year, provided, however, 

that the AHNS shall have only one President in office at one 

time. At the conclusion of this one-year term, the President- 

Elect next in line shall succeed to the Presidency. 

3. The members of the SHNS shall be admitted to the Society 

recast as the AHNS in the membership category that 

correspond to that which they hold in the SHNS. More 

specifically, Active Members of the SHNS shall become 

Active Fellows of the AHNS; Senior Member of the SHNS 

shall become Senior Fellows of the AHNS. Consulting 

Members of the SHNS shall become Associate Fellows of 

the AHNS. International Corresponding Members of the 

SHNS shall become Corresponding Members of the AHNS. 

Honorary Members of the SHNS shall become Honorary 

Fellows of the AHNS. Candidate Members of the SHNS shall 

become Candidate Members of the AHNS. 

4. The Council shall act to preserve the unique heritage and 

history of the SHNS and the ASHNS. 

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87

AHNS Program Index 

FACULTY/PRESENTER PAGE # 

Abuzeid, Waleed.....................................28 

Andrews, Genevieve...............................25 

Basu, Devraj............................................28 

Benlyazid, Adil........................................25 

Bergmann, Christoph..............................30 

Blair, Elizabeth.........................................24 

Bonner, James........................................23 

Bradford, Carol.......................................27 

Brock, Rachel..........................................24 

Calabrese, Luca......................................25 

Califano, Joseph.....................................27 

Cernea, Claudio......................................25 

Chard, Rachel.........................................27 

Chaturvedi, Pankaj..................................28 

Comis, Robert.....................................8, 23 

Davis, Samantha.....................................27 

Day, Terry................................................29 

Disa, Joseph...........................................26 

Duh, Quan-Yang......................................29 

Dwivedi, Raghav.....................................24 

Ebrahimi, Ardalan....................................28 

El-Naggar, Adel...................................7, 27 

Eisele, David.....................................28, 29 

Ferris, Robert..........................................27 

Fingeret, Michelle....................................26 

Forastiere, Arlene..............................24, 25 

Funk, Gerry.............................................26 

Futran, Neal.............................................26 

Goldenberg, David..................................29 

Gourin, Christine.....................................29 

Har-El, Gady............................................23 


Hanasono, Matthew................................26 

Hanna, Ehab...........................................26 

Holsinger, Floyd “Chris”....................23, 30 

Howell, Lori.............................................26 

Iyer, N. Gopalakrishna.............................26 

Jatana, Kris.............................................27 

Jordan, Wolf Oliver..................................25 

Kannabiran, Vishnu.................................25 

Kim, Min-Sik............................................26 

Kim, Se-Heon..........................................30 

Kubicek, Gregory....................................24 

Kupferman, Michael................................28 

Kutler, David............................................25 

Lai, Stephen............................................27 

Lamarre, Eric...........................................24 

Langerman, Alexander............................24 

Lewis, Carol............................................24 

Lin, Derrick..............................................26 

Lydiatt, William........................................29 

Maghami, Ellie...................................28, 29 

Magnuson, Jeffrey..................................23 

McHenry, Christopher.............................29 

McIver, Bryan..........................................29 

Mizrachi, Aviram......................................29 

Moquete, Rachel.....................................29 

Mouw, KW...............................................26 

Mydlarz, Wojciech...................................25 

Nathan, Cherie-Ann..........................27, 30 

Orloff, Lisa...............................................29 

Patel, Kepal.............................................25 

Patel, Snehal...........................................24 


Patel, Urjeet............................................26 

Pinho, Jorge............................................28 

Pfister, David.....................................24, 29 

Ridge, John.......................6, 23, 24, 27, 28 

Rivera-Serrano, Carlos............................30 

Rocco, James.........................................27 

Rosenthal, Eben......................................26 

Samant, Sandeep...................................26 

Schiff, Bradley.........................................26 

Schwartz, David......................................28 

Shah, Manish....................................26, 29 

Shaha, Ashok..........................................29 

Singh, Bhuvanesh.........................6, 23, 24 

Smith, Richard........................................26 

So, Yoon Kyoung....................................29 

Spanos, William......................................27 

Stepanek, Vanda.....................................28 

Sturgis, Erich...........................................24 

Surati, Millie............................................28 

Teknos, Theodoros..................................30 

Trotti, Andy..................................10, 23, 24 

Vermorken, Jan.......................................25 

Wansom, D..............................................30 

Wax, Mark.........................................10, 26 

Weber, Randal.........................................23 

White, Hillary.....................................26, 30 

Wolf, Gregory..........................................25 

Wong, Richard........................................26 

Wu, Arthur...............................................29 

Yueh, Bevan......................................23, 29 

Zafereo, Mark..........................................30 


Notes 

www.ahns.info 

89

Notes

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