OBJECTIVE: To determine survival outcomes and locoregional control rates in patients with locoregional head and neck squamous cell cancer (HNSCC) who failed primary concomitant chemoradiation (CRT) intended for cure and underwent attempted surgical salvage. STUDY DESIGN AND SETTING: Design was a nonrandomized retrospective cohort study. Of 204 patients with HNSCC who received primary concomitant chemoradiation intended for cure between 1995 and 2004, 38 recurred and underwent attempted salvage surgery at a tertiary care academic center. RESULTS: Among the 38 patients undergoing surgical salvage, 12- and 24-month overall survival rates were 60 percent and 27 percent. Locoregional control at 24 months was 42 percent. Lower survival was seen with initial N3 disease ( P = 0.0115). Overall surgical morbidity was 24 percent. CONCLUSION/SIGNIFICANCE: The results of salvage surgery after failed chemoradiation for HNSCC are poor. Those with N3 disease fare least well. Patients should be well informed about the realistic chances of cure and potential morbidity of surgery. © 2007 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved.

Purpose: Cancer cachexia is a devastating and understudied illness in patients with head and neck squamous cell carcinoma (HNSCC). The primary objective was to identify clinical characteristics and serum levels of cytokines and cachexia-related factors in patients with HNSCC. The secondary objective was to detect the occurrence of cytokine and cachexia-related factor gene expression in HNSCC tumors. Experimental Design: For the primary objective, cross-sectional data were obtained from prospectively recruited patients identified as cachexia cases and matching cachexia-free controls. For the secondary objective, a retrospective cohort design with matched controls was used. Results: Clinical characteristics associated with cancer cachexia in HNSCC were T 4 status (P = 0.01), increased C-reactive protein (P = 0.01), and decreased hemoglobin (P < 0.01). Exploratory multiplex analysis of serum cytokine levels found increased interleukin (IL)-6 (P = 0.04). A highly sensitive ELISA confirmed the multiplex result for increased IL-6 in cachectic patients (P = 0.02). Quality of life was substantially reduced in patients with cachexia compared with noncachectic patients (P < 0.01). All tumors of HNSCC patients both with and without cachexia expressed RNA for each cytokine tested and the cachexia factor lipid-mobilizing factor. There were no statistically significant differences between the cytokine and cachexia factor RNA expression of cachectic and noncachectic patients (each P > 0.05). No tumors expressed the cachexia factor proteolysis-inducing factor. Conclusion: We have identified clinical characteristics and pathophysiologic mechanisms associated with cancer cachexia in a carefully defined population of patients with HNSCC. The data suggest that the acute-phase response and elevated IL-6 are associated with this complex disease state. We therefore hypothesize that IL-6 may represent an important therapeutic target for HNSCC patients with cancer cachexia.

To compare the incidence rates of nasopharyngeal carcinoma (NPC) among US black, white, and Asian/Pacific Islander (Asian) populations, with a focus on those diagnosed before age 20 years and between ages 20 and 29 years. Our secondary objective was to determine differences in survival rates between US blacks, whites, and Asians with NPC who were younger than 30 years. Design: Data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) tumor registry system were used to determine incidence and survival rates for cases of NPC diagnosed in the specified age groups between 1973 and 2002. Patients: Blacks, whites, and Asians younger than 30 years with NPC. Main Outcome Measures: Incidence rates and 2-and 5-year survival rates. Results: From 1973 to 2002, incidence rates per 1 million persons, adjusted to the 2000 standard population, for blacks, whites, and Asians younger than 20 years with NPC were 1.61 (n = 43), 0.61 (n = 99), and 0.95 (n=18), respectively. The incidence rate ratio of blacks to Asians younger than 20 years was 1.69 (95% confidence interval [CI], 0.96-3.12) (P =.07), while the rate ratio for blacks to whites was 2.66 (95% CI, 1.82-3.85) (PϽ.001). From ages 20 to 29 years, rates increased slightly in blacks (1.87) and whites (0.96), while increasing dramatically in Asians (7.18). Two-and 5-year relative survival rates in blacks younger than 30 years were 84% and 64%, respectively, with little variation between races in this age group. Conclusions: Blacks younger than 20 years have increased incidence rates of NPC relative to whites and may be the only group having a higher NPC incidence rate than Asians. Two-and 5-year survival rates of blacks, whites, and Asians younger than 30 years with NPC are similar.

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Dietary sodium intake has been shown to influence ␤2-adrenergic receptor (␤2-AR) responsiveness, and the Gly allele of the Arg16/Gly ␤2-AR polymorphism has been associated with hypertension in a linkage analysis in Rochester, MN. We have also shown that Gly homozygotes (GG) have greater forearm ␤2-AR mediated vasodilation than Arg (AA) after a controlled Na + diet (150 mmol • day Ϫ1 ), and the difference is mediated by endothelial NO. The purpose of this study was to test the hypothesis that dietary Na + restriction affects forearm and systemic ␤2-mediated dilation in healthy normotensive humans GG (n = 17) vs AA (n = 15). We measured HR, MAP, and CO (acetylene breathing) responses to intravenous infusion of terbutaline (TRB) before and after 5 days of dietary Na + restriction (10 mmol • day Ϫ1 ). Also following the diet, a brachial artery catheter was placed to measure forearm blood flow (FBF, plethysmography) responses to isoproterenol (ISO) before and after NO inhibition with L-NMMA. There was a main effect of diet (p < .03) on weight loss, increased urine volume, and 24-hour urinary excretion of Na + but no influence from genotype. Diet significantly decreased baseline CO in GG (pre-vs postdiet mean Ϯ SD: 6.4 Ϯ 1.4 to 5.5 Ϯ 1.2 L • min Ϫ1 ; p = .003) but not in AA (5.8 Ϯ 1.3 to 5.6 Ϯ 1.0 L • min Ϫ1 , NS) and increased peripheral resistance in GG (p = .02) but not AA. Baseline HR, MAP, and stroke volume were similar between groups, and the responses of all cardiovascular measures to TRB were not influenced by genotype or diet. In contrast to previous findings after a normal Na + diet, the FBF dose response curves to ISO were not different based on genotype (p = .51). L-NMMA decreased baseline FBF and significantly blunted the response to ISO, but there was no evidence to suggest that the responses were influenced by genotype (p = .89, genotype-by-ISOby-L-NMMA interaction). We conclude that dietary Na + restriction negates the increased forearm NO-mediated, ␤2-AR responsiveness in GG subjects, which may explain the dietevoked baseline increase in peripheral resistance and decrease in CO in this group, providing evidence that Na + intake modulates cardiovascular indices based on the Arg16/Gly ␤2-AR polymorphism.