Publications by authors named "Kevin Contrera"

CD8 tumor-infiltrating lymphocytes (TILs) are increasingly used in oncology as a prognostic and predictive tool to guide patient management. This review summarizes current literature on CD8 TILs in head and neck squamous cell carcinoma (SCC). Published meta-analyses and clinical trials evaluating CD8 TILs were analyzed.

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Purpose: Outcomes after primary surgery for advanced sinonasal squamous cell carcinoma (SCC) are poor. We tested whether induction chemotherapy (IC) can improve disease control or organ preservation.

Patients And Methods: A phase II trial evaluated previously untreated patients with stage II to IV, M0 sinonasal SCC.

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  • * One of the complications that can arise after surgery is venous congestion, which might lead to losing the reconstructed flap, and addressing this issue often requires additional surgical intervention.
  • * This text discusses the use of the anticoagulant bivalirudin, a drug that has recently gained attention in treating venous congestion, based on a series of cases involving 7 patients treated by the authors' team.
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Objectives: The primary goal for reconstruction of oral tongue defects is to improve speech and swallowing. The purpose of this study is to present a new reconstructive metric that uses volume displacement to measure oral cavity obliteration and correlate this metric to outcomes of speech and swallowing.

Methods: 47 patients underwent resection and primary closure or free-tissue reconstruction of oral tongue defects.

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Objective: We describe a novel technique for endoscope-assisted (EA) transcervical (TC) approach for resection of parapharyngeal space (PPS) tumors and compare perioperative outcomes of this approach to standard TC approaches.

Study Design: Retrospective chart review.

Setting: Single tertiary care center.

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  • Malnutrition is a significant risk factor for surgical outcomes, particularly in head and neck cancer patients undergoing total laryngectomy with free flap reconstruction, necessitating a focus on preoperative nutritional indicators like prealbumin and albumin levels.
  • A review of 83 HNC patients from 2016 to 2022 showed that low preoperative prealbumin levels (≤20 mg/dL) were linked to a higher rate of wound healing complications, with a 33.7% complication rate overall.
  • The study concluded that monitoring prealbumin levels and implementing nutritional interventions could potentially reduce complications after surgery.
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Objective: Anterior 2/3rds glossectomy results in significant patient morbidity due to speech and swallowing impairment. Microvascular free flap reconstruction compensates for large volume defects. Flap volume is based on the adipose content of the donor site and varies by patient body mass index (BMI) and donor site location.

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Background: Advancements in immunotherapy for recurrent head and neck cancer have necessitated a better understanding of salvage surgical outcomes. This study aimed to determine patterns of failure following salvage head and neck surgery.

Methods: A retrospective cohort study was conducted of 280 patients who underwent salvage surgery for recurrent mucosal squamous cell carcinoma from 1997 to 2018.

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Background: This study describes patient-reported outcome measures (PROMs) and associated factors in patients who underwent surgery for malignant parotid tumors (MPT).

Methods: This is a retrospective study of all surgically treated MPT patients in a multidisciplinary head and neck cancer (HNC) survivorship clinic (2017-2023). PROMs included University of Washington Quality of Life Questionnaire (UW-QOL), Eating Assessment Tool (EAT-10), Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Neck Disability Index (NDI), and Insomnia Severity Index.

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  • Osseous and osteocutaneous fibular free flaps are commonly used for jaw reconstruction, and since 2019, a new technique involving the Spider Limb Positioner has been introduced for their harvest.
  • This study details the use of the Spider Limb Positioner in 61 procedures, highlighting its effectiveness and the benefits of improved ergonomics and visibility during surgery.
  • The results showed no nerve compression injuries or complications from positioning in patients, suggesting that this technique enhances the safety and efficiency of the flap harvesting process.
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Recently published and ongoing trials are helping to define the role of transoral robotic surgery for oropharyngeal cancer. Evidence to date supports the use of surgery as a valuable tool in the multidisciplinary deescalation of low-risk human papillomavirus-related oropharyngeal squamous cell carcinoma.

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Objective: Allergen immunotherapy (AIT) is the therapeutic exposure to an allergen or allergens selected by clinical assessment and allergy testing to decrease allergic symptoms and induce immunologic tolerance. Inhalant AIT is administered to millions of patients for allergic rhinitis (AR) and allergic asthma (AA) and is most commonly delivered as subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). Despite its widespread use, there is variability in the initiation and delivery of safe and effective immunotherapy, and there are opportunities for evidence-based recommendations for improved patient care.

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Objective: Allergen immunotherapy (AIT) is the therapeutic exposure to an allergen or allergens selected by clinical assessment and allergy testing to decrease allergic symptoms and induce immunologic tolerance. Inhalant AIT is administered to millions of patients for allergic rhinitis (AR) and allergic asthma (AA) and is most commonly delivered as subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). Despite its widespread use, there is variability in the initiation and delivery of safe and effective immunotherapy, and there are opportunities for evidence-based recommendations for improved patient care.

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Objective: Examine outcomes for lateral arm autologous tissue transfer in head and neck reconstruction.

Study Design: Retrospective cohort study.

Setting: Tertiary cancer center.

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Background: Sinonasal NUT carcinoma is an extremely rare, lethal malignancy with limited literature.

Methods: A case series was conduction of all patients with sinonasal NUT carcinoma at a single institution between 2010 and 2022. Survival and associated were evaluated.

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  • - The study aimed to evaluate the safety of induction chemotherapy (IC) for patients with sinonasal cancers that have invaded the brain or caused neurological deficits, analyzing data from 460 patients treated at a cancer center from 1992 to 2020.
  • - Out of the 341 patients who received IC, 40 had brain invasion and 31 had neurological deficits; most patients experienced either partial or complete responses to treatment, with notable improvements in neurological symptoms for some.
  • - Notably, none of the patients had to stop treatment due to worsening neurological conditions, indicating that IC was effectively and safely administered without significant complications related to brain involvement or neurological implications.
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  • Limited studies exist on pituitary dysfunction in adults who had radiation therapy for anterior skull base tumors, prompting this research.
  • In a study of 50 patients with sinonasal or nasopharyngeal cancer, 46% exhibited abnormal pituitary hormone levels, with hyperprolactinemia being the most common issue.
  • Higher doses of radiation to specific brain regions were linked to hormonal dysfunction, indicating a possible dose-dependent effect of radiation on pituitary health.
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Objective: Patients with head and neck paragangliomas who are positive for the SDHD p.Pro81Leu (P81L) mutation are thought to have a distinct phenotype from other SDHx mutations, but few studies have focused on this mutation. The objective of this study was to determine the hazard of developing a second primary, metastatic, or recurrent paraganglioma in SDHx patients with or without P81L.

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The objective of this study was to report outcomes for 19 consecutive patients with SMARCB1 (INI-1)-deficient sinonasal carcinoma. Patients were treated from 2014 to 2021 and followed for a median of 22.3 months.

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Background: Cancer centers are regionalizing care to expand patient access, but the effects on patient volume are unknown. This study aimed to compare patient volumes before and after the establishment of head and neck regional care centers (HNRCCs).

Methods: This study analyzed 35,394 unique new patient visits at MD Anderson Cancer Center (MDACC) before and after the creation of HNRCCs.

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Background: Advanced thyroid disease involving the mediastinum may be managed surgically with a combined transcervical and transthoracic approach. Contemporary analysis of this infrequently encountered cohort will aid the multidisciplinary team in personalizing treatment approaches.

Methods: Retrospective review of patients undergoing combined transcervical and transthoracic surgery for thyroid cancer at a single high-volume institution from 1994 to 2015.

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