Majority of the patients in both groups were of stage (TNM 7 th edition) IVa (54% in 3D CRT and 66% in Tomo) followed by stage IVb (10% in each group). Of the patients in 3D CRT, 56.7% received concurrent chemotherapy (95% cisplatin, 5% cetuximab) while 86.8% of Tomo group received chemotherapy (92% cisplatin, 8% cetuximab). In 3D CRT, 67.3% of the patients completed all 6 cycles of chemotherapy compared to that 74.6% in Tomo group. Response was achieved in 93.8% cases in 3D CRT and 97.1% cases in Tomo group. In 3D CRT, 17 patients recurred locally and 8 developed distant metastases as compared to 14 and 10 respectively in Tomo group. With a median follow up of 42 months (range: 1-83), 1year and 5-year disease-free survival were 80% and 63.7% in 3D CRT vs 88.1% and 77.1% in Tomo group. One-year overall survival and 5-year survival were 85.5% and 54.2% in 3D CRT group vs 85.3% and 62.1% in Tomo group. The incidence of acute toxicities was higher in Tomo group given the higher percentage of patients received concurrent chemotherapy. However, there was a trend of lower incidence of late toxicities in the Tomo group: bone necrosis (7 patients in 3D CRT vs 3 in Tomo, PZ.52), complete xerostomia (18 vs 8, PZ.24), and laryngeal cartilage necrosis (5 vs 1, PZ.40). A significant difference was observed in late swallowing dysfunction requiring intervention (27 in 3D CRT vs 5 in Tomo, PZ.02). Conclusion: There was no statistical difference in DFS and OS between two groups; however, we observed a trend of lower incidence of late toxicities in patients treated with Tomotherapy, with a significant difference in late swallowing dysfunction.

No abstract

This pilot study aimed to assess oral microbiome diversity between patients with and without elevated salivary pepsin concentrations. Over 9 months, 85 enrolled subjects (73 symptomatic patients; 12 asymptomatic volunteers) provided salivary samples off acid suppression. Subjects with elevated pepsin (≥25 ng/mL) had significantly greater Shannon entropy diversity compared to subjects with normal pepsin (<25 ng/mL) on 16S rRNA sequencing ( P = .015), indicating increased oral microbiome biodiversity in patients with elevated salivary pepsin. Repeated gastro-esophageal reflux events from the stomach to the oral cavity may contribute to this observed change in oral microbiome diversity with potential implications in symptom generation and/or therapy.

No abstract

The COVID-19 pandemic has created challenges in providing health care throughout the United States. Despite limitations in in-person clinical care aimed at reducing transmission risk and preserving personal protective equipment, patients with head and neck cancer continue to undergo radiation-based treatment, resulting in the need for adapted care pathways. Speech-language pathologists play an instrumental role in the care of patients undergoing head and neck radiation prior to, during, and following the conclusion of treatment. To address the ad hoc need for guidance on speech-language pathologists management of patients with head and neck cancer during the pandemic, the California Head and Neck Consortium constructed recommendations for best practices before, during, and after chemoradiation therapy, based on the combined experience of several academic medical centers. These guidelines aim to provide a model that maintains high quality of care while minimizing risk of viral exposure to patients and clinicians.