JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Partial vs Whole Laryngeal Radiotherapy for Clinical Stage T1-2N0M0/Tis Laryngeal Carcinoma.","authors":"Teeradon Treechairusame, Edward Christopher Dee, Caineng Cao, Yingzhi Wu, Yao Yu, Daphna Gelblum, Nadeem Riaz, Sean M McBride, Linda Chen, Achraf Shamseddine, Kaveh Zakeri, Chiaojung Jillian Tsai, Jung Julie Kang, Ian Ganly, Jennifer R Cracchiolo, Snehal Patel, Marc A Cohen, Richard J Wong, Nancy Y Lee","doi":"10.1001/jamaoto.2025.3214","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3214","url":null,"abstract":"<p><strong>Importance: </strong>The current standard treatment for clinical tumor stage 1 to 2 or in situ laryngeal carcinoma without node involvement or metastases (T1-2N0M0/Tis) is whole laryngeal radiotherapy (WLRT), whereas microsurgery typically resects only the tumor-involving vocal cord with a narrow margin. Clinical outcomes of partial laryngeal radiotherapy (PLRT) have not been quantified.</p><p><strong>Objective: </strong>To compare the effectiveness and toxic effects of PLRT vs WLRT in patients with clinical stage T1-2N0/Tis laryngeal carcinoma.</p><p><strong>Design, setting, and participants: </strong>This was a single-institution retrospective cohort study of patients with clinical stage T1-2N0M0/Tis squamous cell carcinoma of the larynx who underwent intensity-modulated RT from January 2013 to December 2024. Data were analyzed from January to February 2025.</p><p><strong>Main outcomes and measures: </strong>Long-term locoregional control, laryngectomy-free survival, distant metastasis, and overall toxic effects. Acute and late radiation toxic effects were graded using Common Terminology Criteria for Adverse Events, version 4.0. Patient-reported swallowing-related quality of life (MD Anderson Dysphagia Inventory) was collected at each visit when feasible.</p><p><strong>Results: </strong>The analyses included 233 consecutive patients with T1-2N0M0/Tis squamous cell carcinoma of the larynx who were treated with intensity modulated radiotherapy (176 with WLRT vs 57 with PLRT). The median (IQR) follow-up in the WLRT group was 60 (28-87) months, and in the PLRT group, 31 (16-64) months. The largest tumor stage-related difference in WLRT was observed in T1b (100%) and Tis (50%) disease, with an absolute difference of 50% (95% CI, 25.4% to 73.2%). There were no important clinical differences between PLRT and WLRT in 3-year locoregional control rates (85.4% vs 90.8%; rate difference, -5.4%; 95% CI, -13.5% to 6.9%), laryngectomy-free survival (93.2% vs 94%; rate difference, -0.8%; 95% CI, -9.1% to 7.5%), distant metastasis-free survival (100% vs 97.6%; rate difference, 2.4%; 95% CI, -0.3% to 4.9%), and overall survival (91.4% vs 88.9%; rate difference, 2.5%; 95% CI, -6.8% to 12.8%). There was no contralateral vocal-fold failure in the PLRT group. There was a large difference in the 3-year locoregional control in T2 tumors between the WLRT (85.1%) and PLRT groups (66.7%), with a difference of 18.4% (95% CI, -5.8% to 21.3%). The incidence of acute dysphagia was lower in the PLRT than in the WLRT group (73.7% vs 92.6%; difference, 18.9%; 95% CI, 6.9% to 30.9%). Median composite scores on the MD Anderson Dysphagia Inventory at 3 and 6 months postradiotherapy were higher in the PLRT group (86 vs 77; difference, 8; 95% CI, 2 to 14; and 96 vs 81; difference, 4; 95% CI, -2 to 8; respectively), although the observed differences may not be clinically important.</p><p><strong>Conclusions and relevance: </strong>This cohort study found that there were no","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Head and Neck Cancer Salvage Surgery in the Era of Immunotherapy and Beyond: A Review.","authors":"Nabil F Saba, Nader G Zalaquett, Saad Rashid, Karthik N Rao, Robert P Takes, Carol Bradford, Remco de Bree, Jonathan J Beitler, Arlene A Forastiere, Jan B Vermorken, Anthea L Hammond, Yong Teng, Nicole C Schmitt, Alfio Ferlito","doi":"10.1001/jamaoto.2025.3204","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3204","url":null,"abstract":"<p><strong>Importance: </strong>Head and neck squamous cell carcinoma (HNSCC) is a challenging malignant condition associated with significant morbidity and mortality. Salvage surgery, in addition to other available treatment modalities, constitutes an important therapeutic intervention for locoregionally recurrent HNSCC, offering the potential for improved locoregional control and survival outcomes. However, the indications for salvage surgery remain diverse and poorly standardized, with reported 5-year survival outcome rates ranging from 10% to 61%. In recent years, the incorporation of immunotherapy into the management of recurrent and locally advanced HNSCC has shown promising potential. Although preoperative immunotherapy has resulted in improved outcomes in other malignant neoplasms, such as non-small cell lung cancer, its integration into HNSCC surgical protocols whether in the primary or salvage setting is still in its early stages. Early single-institution trials suggest combining immunotherapy with salvage surgery may enhance survival, reduce recurrence rates, and improve other outcomes for patients with recurrent or persistent HNSCC.</p><p><strong>Observations: </strong>This review explores the evolving landscape of HNSCC salvage surgery in the era of immunotherapy by assessing current evidence, clinical implications, and future directions for this integrated approach.</p><p><strong>Conclusions and relevance: </strong>Advances in immunotherapy and the development of future clinical trials incorporating immunotherapy in the HNSCC salvage setting have the potential to enhance patient selection and optimize surgical outcomes.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Benefit of Inferior Turbinate Reduction With Adenotonsillectomy for Obstructive Sleep Apnea.","authors":"Smile Kajal","doi":"10.1001/jamaoto.2025.3163","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3163","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Otolaryngology Training Through Sports Psychology-The Mental Game.","authors":"W Jack Palmer, Dylan Bertoni, Arielle Thal, Elizabeth E Cottrill, Colin T Huntley","doi":"10.1001/jamaoto.2025.2896","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2896","url":null,"abstract":"<p><strong>Importance: </strong>Otolaryngologists share many important characteristics with elite athletes, including specialized skill development through rigorous training, complex motor activity under pressure, and performance with high stakes. Applied sports psychology emerged to help athletes develop the intangible skills necessary to succeed in this environment. This body of literature represents a valuable opportunity for the otolaryngology community, where mental training is yet to be fully integrated. Today's otolaryngologists can particularly benefit from these lessons, as they contend with an increasing workload and expanding responsibilities in an ever-evolving health care landscape.</p><p><strong>Observations: </strong>Mental imagery, mindfulness, and growth mindset are 3 core techniques with demonstrated benefits in sports and increasing evidence in surgery. Mental imagery helps establish preoperative confidence and neural preparedness. Mindfulness bolsters focus during performance and resilience throughout one's career. A growth mindset fosters adaptability and perseverance in response to setbacks. Randomized studies have shown these interventions can enhance technical performance, mitigate stress, and prevent burnout in surgical trainees. Evidence suggests that residency programs can best teach these techniques through formal instruction and expert-led practice. There may also be a benefit to training educators in growth-focused coaching.</p><p><strong>Conclusions and relevance: </strong>As the field of otolaryngology continues to advance clinically and technologically, it must also innovate in how it educates its surgeons. Mental skills training is a feasible, evidence-based method to optimize surgical performance and surgeon well-being. These skills promote confidence, adaptability, focus, and resilience-all qualities that enable safer patient care and more sustainable careers. By embracing these insights from sports psychology, otolaryngology programs can better prepare their trainees to meet the demands of modern practice.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Dizziness Among Patients With Vestibular Schwannoma.","authors":"Tyler Wilson, Dorina Kallogjeri, Belinda Sinks, Lauren English, Pawina Jiramongkolchai, Matthew Shew, Jacques Herzog, Craig Buchman, Jay Piccirillo, Nedim Durakovic","doi":"10.1001/jamaoto.2025.2849","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2849","url":null,"abstract":"<p><strong>Importance: </strong>Patients with vestibular schwannoma (VS) commonly present with neurological symptoms such as hearing loss, tinnitus, and dizziness. However, factors associated with dizziness at presentation are not well understood.</p><p><strong>Objective: </strong>To evaluate the baseline features of adults diagnosed with VS associated with subjective dizziness using a validated instrument.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included adults with radiologically diagnosed VS who completed vestibular testing at Washington University (St Louis, Missouri) between June 2004 and January 2025. Baseline dizziness was measured using the Dizziness Handicap Inventory (DHI).</p><p><strong>Exposures: </strong>Anxiety associated with a VS diagnosis.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was severity of dizziness based on DHI score.</p><p><strong>Results: </strong>A total of 109 patients were included; the mean (SD) age was 61 (14) years, 57 (52%) were female, and 52 (48%) were male. The mean (SD) DHI score was 27 (24) points. Participants with a history of anxiety had a DHI score that was 13.7 points (95% CI, 4.2-23.2 points) higher than those with no such history. For every additional point in severity of anxiety measured using the Generalized Anxiety Disorder-7 (GAD-7) scale, DHI score increased 2.6 points (95% CI, 2.0-3.3 points). After controlling for covariates, for every 1-point increase in GAD-7, DHI score increased by a mean of 1.9 points (95% CI, 1.3-2.6 points). On average, patients with a history of anxiety had a DHI score 10.6 points (95% CI, 2.4-18.7 points) higher than those with no such history.</p><p><strong>Conclusions and relevance: </strong>This retrospective cohort study suggests a psychological association between anxiety and dizziness might exist among patients with VS that has not previously been explored. Further studies examining this association are needed in this patient population.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Benefit of Inferior Turbinate Reduction With Adenotonsillectomy for Obstructive Sleep Apnea-Reply.","authors":"Derek J Lam","doi":"10.1001/jamaoto.2025.3166","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3166","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Model for Imaging-Based Extranodal Extension Detection and Outcome Prediction in Human Papillomavirus-Positive Oropharyngeal Cancer.","authors":"Gabriel S Dayan, Gautier Hénique, Houda Bahig, Kristoff Nelson, Coralie Brodeur, Apostolos Christopoulos, Edith Filion, Phuc-Felix Nguyen-Tan, Brian O'Sullivan, Tareck Ayad, Eric Bissada, Paul Tabet, Louis Guertin, Antoine Desilets, Samuel Kadoury, Laurent Letourneau-Guillon","doi":"10.1001/jamaoto.2025.3225","DOIUrl":"10.1001/jamaoto.2025.3225","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Although not included in the eighth edition of the American Joint Committee on Cancer Staging System, there is growing evidence suggesting that imaging-based extranodal extension (iENE) is associated with worse outcomes in HPV-associated oropharyngeal carcinoma (OPC). Key challenges with iENE include the lack of standardized criteria, reliance on radiological expertise, and interreader variability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To develop an artificial intelligence (AI)-driven pipeline for lymph node segmentation and iENE classification using pretreatment computed tomography (CT) scans, and to evaluate its association with oncologic outcomes in HPV-positive OPC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a single-center cohort study conducted at a tertiary oncology center in Montreal, Canada, of adult patients with HPV-positive cN+ OPC treated with up-front (chemo)radiotherapy from January 2009 to January 2020. Participants were followed up until January 2024. Data analysis was performed from March 2024 to April 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Pretreatment planning CT scans along with lymph node gross tumor volume segmentations performed by expert radiation oncologists were extracted. For lymph node segmentation, an nnU-Net model was developed. For iENE classification, radiomic and deep learning feature extraction methods were compared.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;iENE classification accuracy was assessed against 2 expert neuroradiologist evaluations using area under the receiver operating characteristic curve (AUC). Subsequently, the association of AI-predicted iENE with oncologic outcomes-ie, overall survival (OS), recurrence-free survival (RFS), distant control (DC), and locoregional control (LRC)-was assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 397 patients (mean [SD] age, 62.3 [9.1] years; 80 females [20.2%] and 317 males [79.8%]), AI-iENE classification using radiomics achieved an AUC of 0.81. Patients with AI-predicted iENE had worse 3-year OS (83.8% vs 96.8%), RFS (80.7% vs 93.7%), and DC (84.3% vs 97.1%), but similar LRC. AI-iENE had significantly higher Concordance indices than radiologist-assessed iENE for OS (0.64 vs 0.55), RFS (0.67 vs 0.60), and DC (0.79 vs 0.68). In multivariable analysis, AI-iENE remained independently associated with OS (adjusted hazard ratio [aHR], 2.82; 95% CI, 1.21-6.57), RFS (aHR, 4.20; 95% CI, 1.93-9.11), and DC (aHR, 12.33; 95% CI, 4.15-36.67), adjusting for age, tumor category, node category, and number of lymph nodes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This single-center cohort study found that an AI-driven pipeline can successfully automate lymph node segmentation and iENE classification from pretreatment CT scans in HPV-associated OPC. Predicted iENE was independently associated with worse oncologic outcomes. External validation is required to assess generalizability and the potential for impleme","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acid-Resistant Oral Microbiome on Oral Cancer Development.","authors":"Kohei Okuyama, Souichi Yanamoto","doi":"10.1001/jamaoto.2025.3044","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3044","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Palliative Care for Patients With Head and Neck Cancer.","authors":"Christine G Gourin, Thomas J Smith, Rebecca A Gersten","doi":"10.1001/jamaoto.2025.2688","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2688","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acid-Resistant Oral Microbiome on Oral Cancer Development-Reply.","authors":"Brittany Barber, Holly Harris","doi":"10.1001/jamaoto.2025.3047","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3047","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}