Publications by authors named "Conall Fitzgerald"

Background: Preoperative radiological findings of hypopharyngeal cancers are used to determine suitability for surgical resection. We sought to examine preoperative imaging characteristics to determine how well imaging findings predicted surgical resectability.

Methods: A retrospective case-control study of patients undergoing a pharyngolaryngectomy in a tertiary referral center over a 2-year period was completed.

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Background: The epidemiology and management of thyroid cancer has changed radically in the recent past, with rising international incidence of early-stage papillary thyroid cancer (PTC) in particular. In this paper, we review the epidemiology of thyroid cancer in Ireland.

Methods: A retrospective cohort study of National Cancer Registry of Ireland data, 1994-2019.

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Objectives: Frailty refers to a state of reduced physiological reserve and functional decline. We sought to analyse whether frailty, assessed using the 5-item modified frailty index (5mFI), was associated with increased morbidity and mortality following major mucosal head and neck surgery.

Materials And Methods: We performed a retrospective study of patients undergoing major mucosal head and neck surgical resection over a 2-year period.

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Thyroidectomy can lead to significant challenges such as neck pain, disability, and limited range of motion. Therefore, our objective is to conduct a systematic review and meta-analysis of clinical trials to investigate the clinical effectiveness of neck stretching exercises in alleviating neck pain and self-reported disability immediately after thyroidectomy. We systematically searched PubMed, CENTRAL, Scopus, and Web of Science from inception until July 28th, 2023.

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Background: We evaluate outcomes of SMARCB1-deficient sinonasal carcinomas in the largest single-institution study.

Methods: Retrospective cross-sectional study of patients with SMARCB1-deficient sinonasal carcinoma between 1998 and 2024. Disease-specific survival (DSS) and recurrence-free probability (RFP) at 1 and 5 years were measured by Kaplan-Meier method.

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Major head and neck surgery poses a threat to perioperative airway patency. Adverse airway events are associated with significant morbidity, potentially leading to hypoxic brain injury and even death. Following a review of the literature, recommendations regarding airway management in head and neck surgery were developed with multicenter, multidisciplinary agreement among all Irish head and neck units.

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VEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) is a novel autoinflammatory syndrome. We describe a case of VEXAS syndrome with upper airway and oral cavity involvement which are not well described in the literature.

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Background: Diffuse sclerosing papillary thyroid carcinoma (DSPTC) is an aggressive histopathologic subtype of papillary thyroid carcinoma. Correlation between genotype and phenotype has not been comprehensively described. This study aimed to describe the genomic landscape of DSPTC comprehensively using next-generation sequencing (NGS), analyze the prognostic implications of different mutations, and identify potential molecular treatment targets.

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Background: Worldwide, the incidence of oropharyngeal squamous cell carcinoma (OPSCC) caused by human papillomavirus (HPV), a sexually transmitted virus, is increasing. This increase has yet to be demonstrated in an Irish cohort.

Aims: To evaluate the number of OPSCC presentations locally, to stratify cases by HPV status and to estimate if any changes in the patient population had occurred over a 10-year period.

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Tracheoesophageal puncture and voice prosthesis placement is the preferred method of voice restoration following total laryngectomy. Although this is a safe and effective means of optimizing voice, severe complications can occur. We present the case of a patient who developed cerebritis and ventriculitis secondary to a tracheoesophageal prosthesis eroding his cervical vertebrae 20 years following pharyngo-laryngo-esophagectomy.

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Article Synopsis
  • - The study analyzed trends in the epidemiology and management of oral cavity squamous cell carcinoma (OCSCC) in Ireland from 1994 to 2014, identifying 2725 patients, with the tongue being the most common site affected.
  • - The overall incidence of OCSCC stayed stable at 3.14 cases per 100,000 people annually, but the 5-year disease-specific survival rate improved to 58.6%, particularly for tongue cancers, due to an increase in surgical interventions.
  • - Primary surgery is confirmed as the best treatment option, leading to better survival rates compared to radiation therapy, while the use of chemotherapy showed some benefits in node-positive patients but did not significantly affect disease-specific survival
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Background: Questions exist regarding patient selection for surgery in anaplastic thyroid carcinoma (ATC), particularly with the advent of neoadjuvant-targeted therapeutics. The present scoping review sought to evaluate what extent of surgical resection should be performed in ATC.

Methods: A scoping review was carried out in accordance with Joanna Briggs Institute and the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) protocols.

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Sinonasal and skull base malignancies represent a rare, heterogenous group of pathologies with an incidence of 0.556 per 100,000 persons in the population. Given the numerous critical anatomic structures located adjacent to the sinonasal cavity and skull base, surgery for tumors in this region requires careful pre-operative planning with the assistance of radiological imaging and intraoperative image guidance technologies to reduce the risk of complications.

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Background: Intraoperative frozen section histopathology (IFSH) in sinonasal and skull base surgery although widely used is not well studied.

Methods: We reviewed a database of sinonasal and anterior skull base tumors, between 1973 and 2019, and identified 312 suitable operative cases. Clinicopathologic data was collected and analyzed, in addition to descriptive data for histopathological reports classified as "ambiguous," or "limited/insufficient-quality/quantity.

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Article Synopsis
  • Salivary gland cancers (SGCs) are rare and aggressive, often lacking effective treatments when they spread, prompting a phase 2 trial of nivolumab and ipilimumab in 64 metastatic SGC patients.
  • Results showed some success in "other SGCs" cohort (16% response) but limited efficacy in adenoid cystic carcinoma (6% response), with notable adverse events occurring in 38% of patients.
  • Genetic and immune cell analyses indicated that responding tumors had active T cell responses and certain neoantigens, suggesting a potential path for treatment in non-ACC SGCs like salivary duct carcinomas.
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Article Synopsis
  • Recurrent and metastatic head and neck squamous cell carcinoma (HNSCC) has poor survival rates and limited effectiveness of immune checkpoint blockade (ICB) therapies, with current biomarkers like tumor mutational burden (TMB) offering only modest predictive value.
  • A study of 133 ICB-treated patients identified 6 distinct molecular subtypes of HNSCC tumors, which showed varied response rates to treatment and were separately validated in another patient group.
  • Researchers developed a predictive model using clinical and genomic features that more accurately forecasted patient outcomes compared to TMB alone, establishing a tool that can improve risk stratification for patients eligible for ICB treatment.
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Background: The clinical behaviour and oncologic outcome of diffuse sclerosing papillary thyroid carcinoma (DS-PTC) is poorly understood. The objectives of this study were to compare the clinicopathological characteristics and oncological outcomes of DS-PTC to classic PTC (cPTC) and tall cell PTC (TC-PTC).

Methods: After institutional review board approval, 86 DS-PTC, 2,080 cPTC, and 701 TC-PTC patients treated at MSKCC between 1986 and 2021 were identified.

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Background: Solid organ transplant recipients are recognized to carry a high burden of malignancy and frequently this cancer develops in the head and neck region. Furthermore, cancer of the head and neck post-transplant carries a significantly increased mortality. In this study, we aim to conduct a national retrospective cohort study to investigate the impact of head and neck cancer in terms of frequency and mortality in a large group of solid organ transplant recipients over a 20 year time span and compare the mortality in transplant patients to non-transplant patients with head and neck cancer.

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Background: The tall cell variant of papillary thyroid carcinoma has traditionally been treated more aggressively than classic papillary thyroid carcinoma. However, this may not be justified in patients with T1/T2 tall cell variant node-negative tumors.

Methods: We evaluated well-differentiated thyroid cancers treated surgically between 1985 and 2015 at our institution.

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Objectives: Pharyngocutaneous fistula (PCF) is a major morbidity of salvage total laryngectomy (TL). Understanding the factors predicting PCF is fundamental to managing laryngeal cancer. We aim to assess factors associated with PCF following salvage TL in a multicenter, international retrospective cohort study of academic centers in the US and Canada.

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Background: The purpose of this study was to report incidence, clinicopathologic behavior, management, and outcome of pediatric patients treated surgically for salivary gland (SG) malignancies.

Methods: Patients who underwent surgery for SG malignancies from 1985 to 2015 were identified. Clinical, pathological, treatment and outcomes data were collected.

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Importance: Methods of assessing final margin status in patients undergoing surgery for oral cavity squamous cell carcinoma, such as intraoperative frozen section histopathology (IFSH) taken from the tumor bed, may have limitations in accuracy.

Objective: To evaluate the accuracy and implications of using IFSH samples to assess tumor bed margins in patients undergoing surgery for oral cavity squamous cell carcinoma (SCC).

Design, Setting, And Participants: This cross-sectional study included 1257 patients who underwent surgery for oral cavity SCC between January 1, 2000, and December 31, 2015, at an academic cancer center.

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Defects in pathways governing genomic fidelity have been linked to improved response to immune checkpoint blockade therapy (ICB). Pathogenic POLE/POLD1 mutations can cause hypermutation, yet how diverse mutations in POLE/POLD1 influence antitumor immunity following ICB is unclear. Here, we comprehensively determined the effect of POLE/POLD1 mutations in ICB and elucidated the mechanistic impact of these mutations on tumor immunity.

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This cohort study analyzed the safety and efficacy of immune checkpoint inhibitors in patients with cancer and autoimmune disease, and examined whether immune-related toxic effects were associated with outcomes.

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