JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Barriers and Timely Postoperative Radiation Therapy in Head and Neck Cancer.","authors":"Megan T Nguyen, Emily Kistner-Griffin, Reid DeMass, Bhisham S Chera, Chanita Hughes Halbert, Katherine R Sterba, Elizabeth G Hill, Brian Nussenbaum, Anthony J Alberg, Vlad C Sandulache, David J Hernandez, Ryan S Jackson, Sidharth V Puram, Russel Kahmke, Nosayaba Osazuwa-Peters, Gail Jackson, Sue S Yom, Evan M Graboyes","doi":"10.1001/jamaoto.2025.2824","DOIUrl":"10.1001/jamaoto.2025.2824","url":null,"abstract":"<p><strong>Importance: </strong>Initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery is associated with improved outcomes among patients with head and neck squamous cell carcinoma. However, the relationship of barriers to care with timely PORT is unknown.</p><p><strong>Objective: </strong>To categorize barriers to timely PORT, evaluate the association of barriers to care with initiation of timely PORT, and describe the primary reason for delay among patients without timely PORT.</p><p><strong>Design, setting, and participants: </strong>This prospective cohort study at a US academic medical center included adults with head and neck squamous cell carcinoma undergoing curative-intent surgery with an indication for PORT. Patients were recruited for the study from May 19, 2020, to November 6, 2023.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was initiation of timely PORT, defined as starting radiation therapy within 6 weeks of surgery. Barriers to PORT were prospectively collected via patient self-report and the electronic health record. Among patients who did not start PORT within 6 weeks of surgery, the primary reason for delay was defined as the singular barrier category that most directly led to the delay.</p><p><strong>Results: </strong>Among 78 patients (mean [SD] age, 61.5 [10.8] years; 54 males [69.2%]), 32 patients (41%) initiated PORT within 6 weeks of surgery, and 46 patients (59%) did not initiate PORT within 6 weeks of surgery. Each additional barrier was associated with a decreased odds of initiating timely PORT (adjusted odds ratio, 0.81 [95% CI, 0.63-1.01]); patients with 5 or more barriers had a 76% reduction in the odds of starting PORT within 6 weeks of surgery relative to those with 0 to 2 barriers (adjusted odds ratio, 0.24 [95 CI%, 0.06-0.84]) on multivariable analysis. When analyzed by barrier category, patients with a perioperative adverse effects-related barrier were less likely to initiate timely PORT than patients without a perioperative adverse effects barrier (adjusted odds ratio, 0.17 [95% CI, 0.04-0.66]) on multivariable analysis. Among patients without timely PORT, the most common primary reason for delay was a barrier related to poor care coordination (19/46 [41.3%]).</p><p><strong>Conclusions and relevance: </strong>In this prospective cohort study, patients with a greater number of barriers and those with a barrier related to the perioperative adverse effects category were less likely to initiate timely PORT. Among patients without timely PORT, the most common primary reason for delay was a barrier related to poor care coordination. Efforts to improve timely PORT should focus on decreasing the number of barriers, improving surgical quality, and enhancing care coordination.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033413","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":"Oral Lachnoanaerobaculum Levels and Survival in Patients With Head and Neck Cancer.","authors":"Alexander Rühle, Máté Krausz, Elsa Beatriz Monroy Ordonez, Jannis Heyer, Andreas R Thomsen, Henning Schäfer, Athanasios Kafkaletos, Peter Bronsert, Rebecca Kesselring, Ali Al-Ahmad, Nadine Schlueter, Jonas Wüster, Andreas Knopf, Anca-Ligia Grosu, Michele Proietti, Michael Henke, Christopher Berlin, Nils H Nicolay","doi":"10.1001/jamaoto.2025.2816","DOIUrl":"10.1001/jamaoto.2025.2816","url":null,"abstract":"<p><strong>Importance: </strong>The oral microbiome plays a critical role in cancer treatment responses, yet its influence on outcomes in patients with head and neck squamous cell carcinoma (HNSCC) undergoing (chemo)radiotherapy remains poorly understood. Identifying specific microbiome signatures associated with treatment effectiveness could provide novel prognostic biomarkers and therapeutic targets.</p><p><strong>Objective: </strong>To investigate the association between salivary Lachnoanaerobaculum spp abundance and treatment outcomes in patients with HNSCC undergoing (chemo)radiotherapy and to explore potential mechanisms.</p><p><strong>Design, setting, and participants: </strong>This prognostic study analyzed saliva samples from patients with HNSCC who were enrolled in 2 independent prospective biomarker studies (SALIVA and ZissTrans) and underwent definitive (chemo)radiotherapy. Oral microbiome composition was assessed using 16S rRNA gene sequencing. Tumor-infiltrating lymphocytes (TILs) were evaluated via immunohistochemistry in patients with available data. Findings were further assessed using data from The Cancer Microbiome Atlas and The Cancer Genome Atlas. Sample collection occurred from 2008 to 2011 (SALIVA) and from 2017 to 2022 (ZissTrans), and the data for this study were analyzed from July to December 2024.</p><p><strong>Exposure: </strong>Definitive (chemo)radiotherapy.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was locoregional recurrence-free survival (LRFS) and a secondary outcome was overall survival (OS). Additional secondary analyses evaluated the association between Lachnoanaerobaculum spp levels and TIL levels, and the incidence of severe radiation-induced oral mucositis.</p><p><strong>Results: </strong>The analysis included 92 patients with HNSCC (mean [SD] age, 61.1 [7.9] years; 15 female [16.3%] 77 male [83.7%] individuals) and found that higher Lachnoanaerobaculum spp abundance was associated with substantially improved LRFS (median, 69 vs 11 months; hazard ratio [HR], 0.50; 95% CI, 0.29-0.86) and OS (median, 75 vs 27 months; HR, 0.54; 95% CI, 0.30-0.98). This finding was confirmed by multivariable Cox regression (LRFS: HR, 0.50; 95% CI, 0.25-1.00; OS: HR, 0.37; 95% CI, 0.16-0.85). TILs were evaluated in 76 patients (82.2%) and showed that increased Lachnoanaerobaculum spp levels were associated with higher CD4-positive and CD8-positive TIL counts. Lachnoanaerobaculum spp abundance showed no meaningful association with severe radiation-induced oral mucositis. Data from The Cancer Microbiome Atlas (n = 157) indicated that higher intratumoral Lachnoanaerobaculum spp levels were associated with improved OS (HR, 0.62; 95% CI, 0.39-0.98). Transcriptomic analyses in The Cancer Genome Atlas cohort further supported an immune-stimulated tumor microenvironment in Lachnoanaerobaculum-high tumors.</p><p><strong>Conclusions and relevance: </strong>This prognostic study found that higher salivary Lachn","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033351","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":"Queries and Comments Regarding the Costs and Benefits of Intraoperative Autofluorescence for Identifying Parathyroid.","authors":"Prachi Krisnatrey, Anjali Mishra","doi":"10.1001/jamaoto.2025.3050","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3050","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033364","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":"Patient-Centered Approach to Assessing Voice Impairment.","authors":"Elizabeth G Willard, Thomas L Carroll, Minjee Kim, Ayako Stanlie, Clark A Rosen, Jennifer J Shin","doi":"10.1001/jamaoto.2025.2691","DOIUrl":"10.1001/jamaoto.2025.2691","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The Voice Handicap Index-10 (VHI-10) is an established instrument with clear utility. However, national agencies are emphasizing the importance of patient-centered assessments beyond diagnostic test results. How patients view the VHI-10 and its items is not known.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To understand patients' perceptions of the VHI-10 items and to identify a potential subset of 6 items for use as a shorter patient-centered assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a prospective psychometric and patient-centered study conducted at tertiary care and community-based laryngology practices with consecutive adult patients who presented for laryngology evaluation from January 1, 2023, to December 31, 2024. Consecutive responses to the VHI-10 questionnaire were evaluated using factor and item response theory (IRT) analyses. Participants ranked VHI-10 items and provided qualitative feedback, which was inductively coded. Participants were asked what is \"most important to you and your voice experience\" when evaluating 3 proposed shorter subsets of the VHI-10.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;VHI-10 questionnaire and 3 subsets of 6 items each, including item ranking (evaluated by factor analysis and item response theory).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Factor analysis and item response theory were used to produce 3 subsets of the VHI-10 for quantitative and qualitative assessment by participants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analysis included data from 6048 consecutive patients (mean [SD] age, 52.0 [8.4] years; 3326 female [55%] and 2722 male [45%] individuals) with completed VHI-10 questionnaires that were evaluated via factor analysis and item response theory (IRT) assessment. In addition, 461 consecutive patients prioritized the VHI-10 items and 521 rated each of the 3 potential subsets. Factor analysis confirmed unidimensionality and IRT analysis demonstrated that items 4, 3, 6, and 1 had the highest discrimination parameters, while items 6, 7, and 1 were most frequently ranked as most or more important; item 5 was included in all sets because of prior clinician and patient input on its importance. Of the 3 subsets proposed, the patients favored set 1, which was composed of these items from the VH1-10: (1) my voice makes it difficult for people to hear me; (2) people have difficulty understanding me in a noisy room; (3) my voice difficulties restrict personal and social life; (6) I feel as though I have to strain to produce voice; and (7) the clarity of my voice is unpredictable; plus item (5), my voice problem causes me to lose income.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion and relevance: &lt;/strong&gt;This psychometric study identified a shorter version of the VHI-10 that may be more patient-centered and clinically sufficient for assessing patients with voice impairments. These findings may form the foundation for additional assessments that are more patient-cente","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033331","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":"Queries and Comments Regarding the Costs and Benefits of Intraoperative Autofluorescence for Identifying Parathyroid-Reply.","authors":"Hazel G Serrao-Brown, Alexander J Papachristos, Stanley B Sidhu","doi":"10.1001/jamaoto.2025.3053","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.3053","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033370","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":"Preexisting Psychiatric Risk Factors and Any and Long-Term Opioid Use in Head and Neck Cancer.","authors":"Nosayaba Osazuwa-Peters, May Z Gao, Russel R Kahmke, Shreya P Ramkumar, Nicole E Bates, Jeffrey F Scherrer","doi":"10.1001/jamaoto.2025.2649","DOIUrl":"10.1001/jamaoto.2025.2649","url":null,"abstract":"<p><strong>Introduction: </strong>Head and neck cancer (HNC), one of the most emotionally distressing cancers, carries a significant burden of psychiatric comorbidities. While opioids are commonly prescribed in cancer care, the association between preexisting psychiatric risk factors and prescription opioid use in HNC remains unclear.</p><p><strong>Objective: </strong>To test the hypothesis that preexisting psychiatric risk factors are associated with any opioid prescription and long-term opioid therapy in patients with HNC.</p><p><strong>Design, setting, and participants: </strong>This retrospective longitudinal cohort study used deidentified data from the Optum electronic health record database, comprising a random sample of 5 million patients across the US between January 2010 and December 2018. Eligible patients were adults diagnosed with HNC. Using a 2-year look-back prior to the index date of HNC diagnosis, patients who used prescription opioids prior to HNC diagnosis were excluded. The data analysis was conducted between July 2022 and July 2023.</p><p><strong>Main outcomes and measures: </strong>Outcomes of interest were receipt of any prescription opioid within 12 months of index HNC and long-term opioid therapy (LTOT), defined as 10 or more opioid prescriptions within 12 months of index HNC. Psychiatric risk factors included anxiety disorders, depression, smoking/nicotine dependence, substance use disorders, and benzodiazepine prescription. Multivariate logistic regression estimated the odds of opioid use based on preexisting psychiatric factors.</p><p><strong>Results: </strong>Of 20 286 patients with an HNC diagnosis, 11 335 met all eligibility criteria. Patients in the analytic cohort had a mean (SD) age of 57.1 (15.5) years, and 55.4% were female. Within 12 months of HNC diagnosis, 23.4% received an opioid prescription, and 4.9% received LTOT. In fully adjusted models, depression (adjusted odds ratio [aOR], 1.21; 95% CI, 1.01-1.45), nicotine dependence (aOR, 1.56; 95% CI, 1.40-1.73), and benzodiazepine comedication (aOR, 1.44; 95% CI, 1.22-1.70) were associated with increased odds of receiving any opioid prescription. Furthermore, male patients had 49% greater odds of receiving opioid prescriptions (aOR, 1.49; 95% CI, 1.36-1.64). Only smoking/nicotine dependence was associated with increased odds of LTOT (aOR, 1.77; 95% CI, 1.21-2.61).</p><p><strong>Conclusions and relevance: </strong>Preexisting psychiatric comorbidities, especially depression and smoking/nicotine dependence, were associated with increased odds of prescription opioid use and LTOT in patients with HNC in this longitudinal cohort study. Screening for these comorbidities during the management of patients with HNC can be impactful in informing clinical decisions that contribute to safer opioid prescribing.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992495","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":"Socioeconomic Status, Voice Disorder Risk, and Voice-Related Handicap Across Childhood.","authors":"Robert Brinton Fujiki, Susan L Thibeault","doi":"10.1001/jamaoto.2025.2633","DOIUrl":"10.1001/jamaoto.2025.2633","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Both voice disorders and socioeconomic deprivation can limit quality of life in pediatric populations. However, the association between socioeconomic status (SES), voice disorder prevalence, and voice-related handicap in children and adolescents has not been well understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the association between SES and voice disorder prevalence across childhood, as well as the association between SES and voice-related handicap.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this cross-sectional study, a sample of adolescents (age 13 to 17 years) and caregivers acting as proxies for school-aged children (age 4 to 12 years) were recruited from across the US and surveyed regarding vocal health between March and June 2023. Voice disorder prevalence was compared across SES proxies collected from caregivers, including annual household income, parent educational level, race and ethnicity, and residence information. Adolescents completed the Voice Handicap Index (VHI) and caregiver proxies completed the Pediatric Voice Handicap Index (P-VHI) on behalf of their school-aged children. Voice-related handicap was compared across participants with and without voice disorders as well as across SES proxies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Adolescents were surveyed regarding voice status, voice-related handicap, and proxies of SES.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 1656 children and adolescents in this study (mean [SD] age, 10.1 [4.1] years; 845 [51%] children identified as male, 792 [47.8%] female, 11 [0.7%] nonbinary, 5 [0.3%] transgender female, and 3 [0.2%] transgender male), those from homes making less than $30 000 annually were 82% more likely to report a voice disorder than those from homes making more than $100 000 annually (odds ratio, 1.82; 95% CI, 1.24-2.67). Both VHI and P-VHI scores were significantly larger in participants with voice disorders (mean [SD] VHI, 26.1 [22.3], mean [SD] P-VHI, 16.6 [15]) compared with those with healthy voices (mean [SD] VHI, 9.9 [15.1], Cohen d = 0.94; 95% CI, 0.73-1.15; mean [SD] P-VHI, 5.1 [10.1]; Cohen d = 1.06). In adolescents with voice disorders, VHI scores were significantly larger (worse) for those from homes making less than $30 000 (mean [SD], 35.3 [10.4]) compared with adolescents from homes making more than this amount (mean [SD], 23.6 [17.8]; Cohen d = 0.55; 95% CI, 0.34-0.75). For children, P-VHI scores were larger for those living in households making under $60 000 a year (mean [SD], 17.8 [7.5]) compared with children from higher-income homes (mean [SD], 11.3 [5.7]; Cohen d = 1.1; 95% CI, 0.90-1.29).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this study, children and adolescents from lower-SES homes reported higher voice disorder prevalence and greater voice-related handicap than their peers from higher-income homes. Future research is needed to elucidate the mechanisms underlying these findings an","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992505","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":"A Young Male With Enlarging Facial Swelling.","authors":"Pranjal Rai","doi":"10.1001/jamaoto.2025.2717","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2717","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992522","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":"Radiotherapy for Growing Vestibular Schwannomas.","authors":"Mantegh Sethi, Shravan Gowrishankar, James Tysome, Neil Donnelly, Patrick Axon, Manohar Bance, Richard Mannion, Mathew Guilfoyle, Juliette Buttimore, Nicola Gamazo, Simon Duke, Raj Jena, Katherine Burton, Sarah Jefferies, Umberto Fornezza, Zeno Perini, Cristina Mari, Luca Gazzola, Sammy Schouten, Inge Compter, Daniëlle B P Eekers, Henricus P M Kunst, Rohan Bassi, Samuel MacKeith, Sanjeeva Jeyaretna, Gillian Whitfield, Catherine McBain, Rovel Colaco, Angus Hotchkies, Simon Lloyd, Rupert Obholzer, Ya Fang Amanda Cheang, Nick Thomas, Sinan Barazi, Eleni Maratos, Jonathan Shapey, Sheila Hassan, Kazumi Chia, Cornel Tancu, Neil Kitchen, John P Marinelli, Matthew L Carlson, Michael J Link, Daniele Borsetto","doi":"10.1001/jamaoto.2025.1953","DOIUrl":"10.1001/jamaoto.2025.1953","url":null,"abstract":"<p><strong>Importance: </strong>In the literature, there is a lack of data reporting tumor control rates after radiotherapy in actively growing vestibular schwannomas (VS). Data for this rarely studied population are needed.</p><p><strong>Objective: </strong>To estimate tumor control rates in radiologically growing VS treated with first-line radiotherapy.</p><p><strong>Design, setting, and participants: </strong>This international, multicenter cohort study used prospectively collected data from patients with growing unilateral VS treated first-line with radiotherapy between January 2000 and December 2023 from 8 tertiary referral skull base units. The data were analyzed in June 2025.</p><p><strong>Exposures: </strong>Radiotherapy as an initial treatment for VS.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was treatment failure, ie VS growth postradiotherapy, which was predefined as an increase in maximum intracranial tumor diameter (ICTD) of 3 mm or greater within the first 2 years after radiotherapy or 2 mm or greater thereafter. Secondary outcomes were treatment failure based on different definitions of VS growth: (1) an increase in ICTD of 2 mm or greater, (2) an increase in ICTD of 3 mm or greater, and (3) conversion to surgery.</p><p><strong>Results: </strong>A total of 1883 patients (975 female individuals [51.8%]; median age at diagnosis, 63 years [IQR, 53-71 years]) were included in the study. Using the primary definition of treatment failure (an increase in ICTD of ≥3 mm within the first 2 years postradiotherapy or ≥2 mm thereafter), the Kaplan-Meier estimate yielded a 10-year tumor control rate of 76.1% (95% CI, 72.7%-79.2%). For secondary outcome definitions, 10-year tumor control rates were 60.1% (95% CI, 57.5%-64.3%) for an ICTD increase of 2 mm or greater, 78.3% (95% CI, 75.0%-81.2%) for an increase of 3 mm or greater, and 92.6% (95% CI, 90.4%-94.3%) for conversion to surgery. Neither pretreatment tumor size nor tumor location (intracanalicular vs extracanalicular) were significantly associated with treatment failure.</p><p><strong>Conclusions and relevance: </strong>The results of this cohort study provide tumor control outcomes for radiologically growing VS treated with radiotherapy using several clinically relevant definitions of growth. By focusing exclusively on this rarely isolated subgroup, the findings offer targeted data to potentially inform treatment expectations and future research.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992563","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":"Addressing Stakeholder Gaps and Systemic Barriers in Intersystem Medical Error Discovery Reporting.","authors":"Shiven Sharma, Jennifer M Lavin, Christopher H Rassekh","doi":"10.1001/jamaoto.2025.2657","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.2657","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992500","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}