ANNUAL NEWS LETTER

         

 

      MAY 2014

FOUNDATION FOR HEAD & NECK ONCOLOGY  

President`s Message Dear all,

PATRON Dr. R.M. Tiwari

Greetings from President’s office

President Dr. Jyoti Dabholkar

It has been 6 months since I took over the office as President and time just flies and one thinks what we have achieved and what is yet to be achieved.

Secretary Dr. Alok Thakar Treasurer Dr. Vikram Kekatpure Governing Council Dr. Ashok Shenoy Dr. Sudhir Bahadur Dr. Subramania Iyer Dr. Anil D’Cruz Dr. Madan Kapre Executive Committee Members Dr. Rajendra Toprani Dr. JP Agarwal Dr. Atul Sharma Dr. Pranay Gaikwad Dr. Devendra Chaukar Dr. Deepak Sarin Dr. Indranil Chatterjee Dr. Bharath Rangarajan Dr. SV Kane Dr. Amritha Suresh Academic / Journal Committee Dr. Pankaj Chaturvedi Dr. Satish Rao Dr. PSN Murthy Dr. P. Arun Dr. Krishna Kumar Training Fellowship Committee Dr. Pilloo Hakim Dr. Rajiv Sharan Membership Cell Dr. Ranjan Raychowdhury Dr. Mathan Mohan A Web Management Dr. Daxesh Patel Dr. Sudhir VR Dr. Prathmesh Pai Dr. Prashant Pawar 2014 Conference Organization Dr. Naresh Panda Dr. Shushmita Ghoshal Dr. Jaymanti Bakshi

 

It gives us all a lot of pleasure in fulfilling the main objectives of FHNO of imparting Evidence based management of Head and Neck Cancers. We had teaching activities at many centres around the country including Mumbai, Nagpur, Mysore, Jalandhar, Delhi, Cochin till date and we were pleasantly surprised at the participation and appreciation of such meetings. There has been a surge in the membership of our organization to more than 500 members enrolled till date and this proves the strength of our organization. I urge all my fellow colleagues to help us increase our strength further. HNCOG activities are picking up pace now, with us having reviewed the possibility of starting of three multicentric trials addressing the burning issues of Head and Neck Cancers. Our website is now active and updated and considering the impact of mass media, we will also be launching a facebook link soon. I also feel overwhelmed to inform you that Mch Programme has been started at TMH and Amrita and many more centres will follow soon, which will ensure fully trained and competent surgeons to tackle the burden of Head and Neck Cancer in our country. This is a indeed a huge milestone ! My main dream is to have a state of the art FHNO journal for which negotiations are on to tie up with other prestigious indexed journals dealing with oncology as official partners. Dr. Panda, Dr. Goshal and their team are working in full swing to host the next FHNO conference at Chandigarh . It sure will be a great academic feast with luminaries in our field from all over attending this conference. There will be a preconference CME where Dr. Jatin Shah will be demonstrating surgeries on cadavers. I request you all to actively participate in the conference and the details for registration are on the FHNO website. Our FHNO Banner will be flying high at IFHNOS 5th World congress meeting at New York in July this year, with participation of our own 40 members from India. Through our childhood we have heard of the classic tortoise and the hare story wherein they run as a team in the last race, and have a greater sense of satisfaction than they’d felt earlier while they ran individually. Similarly, our fellow Radiation and medical oncologists are an integral part of our team without whom we would be incomplete too!!! At the end, I feel your valid suggestions to improve the functioning standards of our association will be always welcome and you can forward the same to me or Dr. Alok Thakar. Last but not the least, I want to acknowledge the efforts and the hard work of Dr. Alok Thakar (Hon. Secy) and Dr. Vikram Kekatpure (Hon. Treasurer) , and am sure as a team we would be able to achieve our targets and dreams of FHNO. Looking forward to meet you all at Chandigarh soon!! Dr. Jyoti Dabholkar

Correspondence Address  Dr. Alok Thakar, Dept of Otolaryngology, Head & Neck Surgery, Room no – 4058, 4th Floor,  AIIMS, Ansari Nagar, N Delhi – 29, Email : [email protected], Website : www.fhno.org 

Secretary’s Message

An idea whose time has come

 

In the Clinical Treatment of Head-Neck Cancer, the atmosphere among various treating specialties has moved from competition and confrontation towards co-operation. Multimodality treatment with radiation therapy, chemo therapy, surgical therapy and biological therapy is the norm for advanced cancers. A similar move is noted with less advanced lesions. Patient evaluations routinely involve immunohistochemistry, molecular imaging, genetic testing, sectional imaging, functional imaging and a host of other specialties. The Foundation of Head-Neck Oncology is the one National Association which aims to bring all such specialties together. Our membership today includes Otolaryngology & Head Neck Surgeons, General Surgeons, Surgical Oncologists, Maxillofacial surgeons, Radiation Therapists, Medical Oncologists, Radiologists, Pathologists, Basic Science workers, Rehabilitationists, Prosthodontists, Plastic surgeons , physiotherapists, community activists … Each specialty brings a few new dimensions to our understanding of this illness and gains from the other. We are all trying to keep up with the rapid evolutions in this specialty. The FHNO is the forum which brings us all together and enables us to improve on the services we provide to our patients. We have recently seen an increasing enthusiasm among all specialties to join us at the FHNO. This convergence provides us invaluable opportunities for education, and also for the advocacy of our specialty and our patients, and advocacy against the multivarious factors contributing to Head-Neck Cancer in the subcontinent. Our membership is now inching towards 700 members. Head- Neck Oncology being a young specialty, and the FHNO being a young organization most of our membership is actively participating in our meetings. The vigour and enthusiasm at every CME activity is palpable. It does seem that the FHNO with its multi-specialty ethos is at the cusp of greater things. It was conceptualized 14 years ago, and perhaps this was an idea which has now come of age. Dr. Alok Thakar

FHNO Activities 13th Annual Meeting of the FHNO- Jaipur , September 2013  

The Annual meeting at Jaipur in September 2013 proved a great success with traditional Rajasthani hospitality and an immensely engaging and multispeciality academic program. The conference was preceeded by a preconference surgical CME and attended by about 400 delegates. The FHNO acknowledges the contributions by the local organising team and particularly Dr. Prakash Mishra, Dr. Man Prakash and Dr. Pawan Singhal. Some of the academic discussions at the meeting are reproduced later in this Newsletter.

FHNO Session at the Annual Meeting of the Association of Otolaryngologists of India (Mysore, January 2014) The Annual Meeting of the Association of Otolaryngologists of India invited the FHNO to put together a “FHNO Session” at their Annual meeting at Mysore this January. The symposium put up by us was on the theme of “Is less than radical surgery possible in head and neck cancer?” Keeping to the theme Dr Ashok Shenoy spoke on Near-total Laryngectomy. Dr. Dabholkar spoke on Conservation in thyroid malignancy and also on the evolution from Radical to Selective Neck Dissection. Dr Subramania Iyer spoke on reconstruction in Head –Neck and Dr. Prathmesh Pai spoke on the pattern of spread in PNS tumors. The session was well attended by over 200 delegates and evoked significant interest and participation.

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13th Thyroid Surgical Camp - Chikaldhara / Nagpur- January 2014 The 13th Thyroid Surgical Camp organized as an FHNO zonal event by the Nagpur Thyroid Registry and Rotary Nagpur South was held at the beautiful Chikhaldara Hills (Rural Hospital) and at Nagpur from 13th-15th January 2014. This ever popular Annual event at the Chikaldhara Rural Hospital in the midst of a thick forest serves the twin objectives of providing specialized care to the local tribal population and also a forum for informal discussion and education to surgeons. The brainchild of Dr Madan Kapre and Dr. Devendra Mohare, the organizational challenges of this meeting have been smoothed out over the years with the very enthusiastic participation of members from the Rotary club. This year was special as the camp was augmented by an International faculty and also the addition of an additional formal focused academic day at Nagpur. The camp attracted surgeons from all over the country and Dubai. The facilitators were Dr Gregory W. Randolph (Harvard Medical School), Dr Paul Konowitz, Dr Dipti Kamni, Dr Dunia Abdul-Aziz, Dr Jyoti Dhabolkar, Dr Alok Thakar, Dr Lala Murad, Dr. Jayakumar Menon, Dr Vikram Kekatpure and Dr Ashish Varghese. The academic programme covered surgical anatomy, physiology of thyroid gland, workup of a thyroid nodule, tips on how to do a safe total thyroidectomy and management of medical & surgical complications. The Hands on participants got a chance to assist the surgeon. This current year the focus of discussions often centered on the similarities and differences in practice among surgeons in India and the US. Nerve monitoring during thyroid surgery was demonstrated by Dr Randolph and his team from Harvard and created great interest. It gave a glimpse to the various options available to monitor the RLN and EBSLN. The exact indications, techniques and benefits of nerve monitoring were keenly discussed. The talk by Dr Jayakumar Menon on tips and techniques of thyroidectomy in professional singers with a clear message to preserve the strap muscles and treat each thyroid as being done on a singer was appreciated for its lucid presentation. On 15th Jan, Thyroid CME was organized at Nagpur which was attended by Surgeons from the nearby towns and also the registered participants of the workshop. In addition to the Facilitators at Chikhaldara Dr Anil D’Cruz, Dr Devendra Chaukar , Dr Prathamesh Pai and Dr Deepak Abraham (Endocrine Surgeon) enhanced the academic milieu of the CME. The Management of Medullary Thyroid Carcinoma by Dr Deepak Abraham, which had parts taken from “The Physical Lincoln Complete” by John G. Sotos, kept the attention of the participants glued. Genetic testing mandatory for all new cases was reiterated by all. The panel on case based discussion was held by Dr Madan Kapre with active participation from the panelists and participants. Year after year this meeting provides a friendly atmosphere between the faculty and participants to discuss surgical thyroid with an opportunity for hands on. The visit to Chikhandara ends with a visit to the thick jungle to appreciate nature and wild life!! Report by Dr. Ashish Varghese

 

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CME Head and Neck Surgery on 18th – 19th Jan 2014 , THE MEDICITY, Gurgaon The CME on “ Head and Neck Surgery – Current concepts” organised by the Medicity on the 18 – 19th January 2014 was an academic delight . The event was brought forth as extension of the AOI Delhi monthly meet. The organizing group lead by Dr Deepak Sarin and his enthusiastic team members had put in a lot of hard work in designing the scientific schedule which was short and crisp. The programme enjoyed the participation of in-house and national faculty that included Dr.Jyoti Dhabolkar, Dr. Madan Kapre , Dr Alok Thakar, Dr. Imre Gerlinger, Dr.. Naresh Panda, Dr. Prathamesh Pai, Dr. Shamit Chopra and Dr.Umanath Nayak. The video sessions focused on Thyroidectomy, Parotidectomy, Neck dissections, Laser cordectomies, Free flaps and Parathroidectomy were of interest to both ENT as well as Head and Neck practitioners. Each session was applauded and witnessed lively one-to-one interaction with the speaker. The post-lunch session on Day One focused on Thyroid that gave an overview of handling thyroid lesion. The latter part of the session had a stimulating panel discussion that saw the audience participating actively. The evening session had a series of talks pertaining to Laryngeal carcinoma. Day One of the event ended on a beautiful note with a Karaoke musical evening with enthusiastic participation from all delegates and the FHNO President ( see picture!). The second day of the CME kicked off with an informal breakfast session .This was followed by talks pertaining to oral cavity carcinomas. The last academic event had thought-provoking sessions pertaining to Paranasal sinus carcinoma, Stomal stenosis, Cyberknife and Ear malignancies. The CME concluded on a high note, evident in the atmosphere of bonhomie between the delegates and the faculty. Report by Dr. Tapaswini Sharma

Interactive Session with Dr. Jatin Shah , Mumbai 24 Nov 2013

A one day Head-Neck CME was organized by KEM Hospital Mumbai on 24 Nov 2013 and featured wide participation from many of the leading Head-Neck Surgeons of Mumbai.

        

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2nd Head, Neck and Thyroid Cancer Forum, Patel Hospital, Jalandhar, February 2014 The meeting at Jalandhar was organized on a scale so as to be almost mistaken for a mid-term meeting! A truly multispecialty meeting with organizational inputs from Head-Neck Surgery (Shamit Chopra), Radiation Oncology (Harpreet Singh, Shikha Chawla), Medical Oncology (Anubha Barthuar) and Nuclear Medicine (Vishu Chauhan). The meeting witnessed a very enthusiastic participation from all specialties, a very large faculty drawn from all over India and the neighbouring SAARC nations, concurrent academic sessions, opportunities for resident participation by free papers and posters and also a very large trade exhibition. It generated immense interest in the local press and has set very high standards. Much continues to be expected from this young team at Patel Hospital, Jalandhar.

Shireen Gazdar FHNO Travel Fellowships 2013 24 applications were received for Shireen Gazdar- FHNO travel fellowship for 2013 - 14. Following scrutiny by a panel of 3 reviewers the following candidates were declared successful :

3 Months Fellowship Mudit Mittal, Ujjain

 

1 Month Fellowship

Photograph not  Available 

       

  

Amit Dhawan, Amiritsar

 

         

    

Rajendra Bothra, Bikaner

     

Shawn Joseph, Cochin

             

Aseem Mishra, Mumbai

The candidates are to avail of their fellowship at any national centre of excellence of their choice. The fellowship has to be availed prior to the next Annual Conference. The time and effort put in by Dr. Rajiv Sharan (Co-ordinator, FHNO Fellowships) and Dr. Pilloo Hakim (Chairman Fellowship Committee) in administering this fellowship is acknowledged.  

  FHNO Website The FHNO website has been revamped. Dr. Daxesh Patel has been particularly active on this front and his regular involvement is acknowledged. Do visit the website at www.fhno.org. Comments, criticisms and suggestions for improvement are welcome.

 

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Minutes of the FHNO General Body Meeting 28th September 2013 Venue: Hotel Clarke’s Amer, Main Conference Hall Welcome address: Madan Kapre: The Dr. Kapre welcomed the members, called the meeting to order and outlined the agenda for the meeting. Condolence message for Late LH Hiranandani: The Dr. Kapre requested the members to observe one minute silence for the departed soul of Late LH Hiranandani. A special LH Hiranandani memorial session was held during the scientific program. Drs. Tiwari, Dabholkar, Hakim, and Kapre spoke in that session. Approval of minutes of 2012: Minutes of 2012 General Body meeting was circulated by e-mail to all the members one month before the meeting. The members were requested for any feedback about the decision made at the previous meeting, in particular changes in by- laws outlined in the prior General Body meeting. The minutes was seconded by Dr. Shenoy and unanimously approved by the members. Welcome message from incoming office bearers: Jyoti Dabholkar: On behalf of the incoming FHNO office bearers: Dr. Dabholkar (President), Dr. Thakar (Secretary) and Dr. Kekatpure (Treasurer), Dr. Dabholkar addressed the members. She outlined the plan for the new team. The focus would be to increase membership of FHNO and make it a true multi-disciplinary organization catering for head and neck oncology. She also emphasized the need for better communication in the form of newsletters and improvement in the website visibility. Secretary report: Moni Kuriakose To avoid repetition of the activities of FHNO during the past year outlined at the inaugural meeting, this matter was not discussed. Members were given opportunity to ask questions or clarifications of the previous years activities. Treasurer report: Vikram Kekatpure: Dr. Kekatpure outlined the current status of FHNO finances and auditing of account. Members were informed regarding the progress of audit being done by Goutam and associates. All necessary documents for audit submitted till March 2013. Audit work was pending due to non availability of FHNO bye-laws. Members were informed that total income for FY 2012-13 was Rs 612,989 and a expenditure of Rs 659,376. The savings account had a closing balance of Rs 804,378 on 31st March 2013. Total value of FD account with Canara bank as of 31st March 2013 Rs 46,46,010. A generous donation of Rs 500,000 received from FHNO organizing committee, Ahmedabad was acknowledged and greatly appreciated by all members. Fellowship program report: Rajeev Sharan: Dr. Rajeev Sharan outlined the process involved in announcing and selection of candidates for the Shireen-Gazdar Travel Fellowship. E-mail announcements about the Travel Fellowship were made three months preceding the selection. The criteria for selection of candidates were predefined, three eminent head and neck oncologists of the country were included in the selection panel in addition to the chair of the FHNO Fellowship program. The shortlisted names were vetted by Dr. Piloo Hakim. Twenty four candidates applied for the five travel fellowship positions. Since there were no candidates expressing interest for the one year fellowship, it was decided to give five short term travel fellowship of 1 to 3 months duration. Four candidates were selected for 1 month and one candidate was selected for 3 months travel fellowship. Twenty thousand will be given for one month and Rs 50000 will be given for 3 months travel fellowship. During the ensuing discussion, Dr. Hakim inquired the funds available for the travel fellowship. Dr. Kekatpure explained that funds allocated to the Travel fellowships were utilized only for this purpose and not used for any other activities of the FHNO.

 

Dr. Kuriakose acknowledged the omission of informing the donor previous years utilization of funds to the donor.

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Dr. Dabolkhar agreed to correct this error and inform the donor the utilization of funds. Update on 2014 Meeting to be held in Chandigarh Program outline for the 2014 meeting was outlined by Dr. Sushmita Ghoshal. The dates of the meeting is scheduled as 26-28 September, 2014 Proposals for 2015 Meeting: Dr. Jai Kumar proposed for Chennai. During his presentation he informed the members that Chennai is one of the metropolis which has not had FHNO conference in the past. He outlined that Chennai has a strong oncology presence as will rich cultural tradition making the city not only scientifically appealing but culturally too. Dr. Iyer proposed for New Delhi on behalf of Dr. Alok Thakar. He mentioned that in 2015, the IFHNOS world tour will be held in New Delhi and it would be logistically easier to organize it together with FHNO meeting in Delhi The Governing Council will discuss the two nominations and make the formal announcement in the next six months time. HN-COG UPDATE: Dr. Iyer gave summary of activities of HN-COG, in particularly highlighting the proposed HPV study. The HPV study will be open for accrual in the next two months. He has requested members to provide plans for future studies. Dr. Arun from Kolkota will coordinate these efforts. The financial status of HN-COG was listed by Dr. Iyer. The opening balance was 500,000. The expenditure was about 50,000, Closing Balance is 4,50,000 Approval of new members / executive committee •

Executive Committee Members

Surgeons Radiation Oncology Medical Oncology Allied services •

: Rajendra Toprani, Pranay Gaekwad, Devendra Chaukar, Deepak Sarin : JP Agarwal, Indraneel (Tata, Kolkota) : Bharath Rangarajan, Atul Sharma : Kane

Basic Sciences: Amritha Suresh

Ex-officio members to executive committee: These members are to be selected by the President and secretary to the EC to assist in various activities of the association. The existing members will continue their activities until new members are proposed by the incoming office bearers. Knowledge cell: Arun P Online communication, discussion forum and web management: Daxesh Patel, Sudhir VR, Prathmesh Pai Publicity and outreach: Ravi Deo, JK Sigh, Anil D’Cruz Membership cell: Jyoti Dabholkhar, Gopinath, Mathan Mohan Journal: PSN murthy Cancer prevention: Pankaj Chaturvedi, Sathish Rao Guidelines committee: Krishna Kumar Travel fellowship committee: Rajiv Sharan FHNO Tour: Vikram Kekatpure

 

FHNO Conference free paper/poster award committee: Alok Thakar, Arun P. FHNO Conference representative: Naresh Panda.

• New member: Thirty eight people applied for membership. After scrutinizing their eligibility their applications were approved to become members of FHNO. Any other issues: The Governing council requested general body to members to nominate names for life-time achievement award for 2014. M A Kuraiakose (Hony. Secretary, 2011-2013)  

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Academic Snippets from the 13th Annual Meeting of the FHNO

HEMI VS TOTAL THYROIDECTOMY FOR WELL DIFFERENTIATED THYROID CANCER (FHNO ANNUAL CONFERENCE, JAIPUR 2013)

The panel discussion on Hemi vs Total Thyroidectomy was moderated by Dr Madan Kapre and the panelists were Daxesh Patel, Rajesh Kantharia, Rajnikanth Venkataraman, Karun Sethi, Jyoti Dabholkar, Kaustubh Patel, Prakash Mishra and Sourabh Arora. The panel discussion was a little different as it was not about showing cases, but it was about questioning the logic and philosophy of treatment. The panellists discussed how to translate the Western guidelines to the Indian scenario, as all the panellists agreed that we tend to see more advanced cases. It was generally agreed upon that extrathyroidal spread and the location of the thyroid carcinoma within the thyroid lobe had far reaching implications than just the size of the tumour. Regarding the multicentricity of the Well Differentiated Thyroid Cancers, the panellists seemed to be more favourable towards Total thyroidectomy on this issue. On the issue of extrathyroidal extension: it was further agreed that USG, CT and MRI were preferred choice in this order. In the opinion of the panelists, minor extrathyroidal extension did not upstage the tumour or the treatment. Nodal status: N1 status was discussed and although the panelists agreed that the literature indicated to that it does not impact survival, the panelists also noted that it does affect the extent of surgical treatment. The panelists seemed to be more in favour of conservative clearance than for radical neck clearance for obvious fear of increased morbidity. They all agreed that bilateral central compartment clearance should best be avoided. On the issue of follow up and surveillance; the economic issues, patients’ informed choices and their rural/urban background was discussed at length. The surveillance strategy, as discussed on the panel, stressed upon USG for the neck and Thyroglobulin assays for the distant non palpable metastatic disease. In conclusion, the panellists agreed upon the following statement: “Compelled not by a survival advantage but by a 7 fold reduction in local recurrence , the optimal extent of surgical resection in low risk PTC patients is Bilateral Lobar Resection ( Total Thyroidectomy “ [Hay et al Surgery. Dec 1998.vol 124(6)]. It was also agreed upon and concluded that the key decision makers; the surgeon, the endocrinologist and nuclear medicine physicist should be involved in the process to improve upon the results and evolve individual centres’ strategy.

 

As the jury may not soon return on this issue, it was finally agreed upon that surgical philosophy should seriously consider the safety of the RLNs and Parathyroid glands and the policy should be resource based.

Madan Kapre

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DEBATE : PAROTID TUMORS SHOULD BE MANAGED BY TOTAL PAROTIDECTOMY ? This lively debate was moderated by Col Ajith Nilakantan. The speakers and panelists included Devendra Chaukar, Krishna Kumar, Shamit Chopra, Elizbeth Iype, Kuddush Ahmed, Pranay Gaikwad, Azhar Jan Battoo, Shubha Gupta and Pawan Singhal. Salivary gland tumors have a diverse histopathology. They are relatively uncommon and constitute about 3-4% of head and neck neoplasm. Most common gland to be involved is parotid gland which constitute about 80% of salivary gland tumors, of which approximately 80% are benign. PAROTID TUMOURS SHOULD BE MANAGED BY TOTAL PAROTIDECTOMY ? The surgical options include Enucleation, extra capsular parotidectomy, superficial parotidectomy, adequate parotidectomy, total conservative parotidectomy, total parotidectomy with facial nerve excision and radical parotidectomy depending on the indication. Superficial parotidectomy is the minimal standard surgical procedure accepted and is the bench mark for other procedures. It is indicated in tumors limited to superficial lobe of the parotid gland i.e. part lying above the facial nerve. In the surgical procedure the facial nerve is identified and all its branches are preserved. Adequate parotidectomy is indicated in benign tumors limited to the tail of the parotid in which the tumour is removed with margins of normal parotid tissue. It is considered to be a safe procedure with less morbidity. In extracapsular parotidectomy the plane of dissection is within a compartment of loose areolar tissue which is approximately 2-3 mm from the tumour. Unlike enucleation in which the capsule is breached and the tumour within is removed. In a study by Dell’Aversana et al and M Mc Gurk et al, extra capsular dissection showed similar effectiveness and fewer side effects than superficial parotidectomy in benign tumours. It can be considered as an alternative to superficial parotidectomy for tumors located in the superficial portion of the parotid gland and especially so for tumors in the tail of the parotid. Total parotidectomy involves removing both the superficial and deep lobe of the parotid gland. A greater degree of iatrogenic facial nerve injury and subsequent post surgical morbidity is to be expected in comparison to superficial parotidectomy alone. It is indicated in deep lobe involvement with preserved facial n. function, high grade tumours, involvement of intraglandular nodes and positive margin following superficial parotidectomy. Deep lobe Tumors with significant involvement of the parapharyngeal space may require formal exploration of the parapharyngeal space by a transcervical approach or a paramedian mandibulotomy approach for tumour excision. Total parotidectomy with facial nerve excision is done when the facial nerve is found to be involved by the tumour. PRESURGICAL EVALUATION The role of presurgical diagnostic imaging and FNAC were discussed. Imaging is useful to detect involvement of the deep lobe of parotid gland, extension and fixity to adjacent bony structures, to differentiate between parapharyngeal space lesions and deep lobe tumours, and for the assessment of the neck nodes. CT Scan is found to be better when bony infiltration at skull base or involvement of the mandible is suspected. However MRI gives better soft tissue delineation and is useful in involvement of the deep lobe of the parotid gland or parapharyngeal space involvement or facial nerve involvement. It is also useful in case of intracranial extension is suspected and in case of recurrent tumours. In a study by Koyuncu M, Sesen T, Akan H et al comparing CT and MRI both were noted to be morphologically equivalent studies and have same diagnostic potential in parotid tumors. However MRI is 3 times more expensive than CT. The study also reported that MRI is better at determining perineural spread than CT and the criteria for identifying perineural spread includes replacement of nerve with tumor, enhancement of gadolinium and increase in size of nerve.

 

The sensitivity and specificity of FNAC in parotid tumours is 80% and 97 % respectively. The advantages are that it differentiates salivary tumours from non salivary pathology and also differentiates benign from malignant pathology. This has role in preoperative counselling as it helps in planning the extent of surgery, determining management of facial nerve and the neck.

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The limitations of PET scan in parotid lesions was discussed and especially its false positive rate of 30% being positive even in inflammatory lesions and Warthin’s tumour and pleomorphic adenoma. USG is a non invasive and inexpensive imaging modality for evaluation. It helps to differentiate a solid lesion from cystic lesion. And an USG guided FNAC increase the accuracy of FNAC. However it is operator dependent and not suited for deep lobe tumours or parapharyngeal space tumours. FROZEN SECTION EXAMINATION The disadvantage of frozen section is that it is fraught with inaccuracies. However it may still be done to clarify a preop diagnosis, check the surgical margins, and to assess for facial nerve involvement or neck node involvement. SINGLE VS MULTIMODALITY TREATMENT and POST OP RADIATION. Multimodality treatment such as combination of surgery and radiotherapy can reduce the morbidity and may even increase the cure rates. The indications for post op radiotherapy include advanced stage disease (T3, T4), positive margins, adverse histopathological report (intermediate and high grade tumours, adenoid cystic carcinoma, lymph node mets), deep lobe tumours, pre op facial nerve paralysis, lymphatic/vascular/perineural involvement and in recurrent tumours. The important factor determining the choice of treatment is the extent and location of lesion. In small lesion just a complete surgical excision would be enough. However large lesion which have invaded adjacent tissue may require extensive resection or post op RT, or may be unresectable. In disseminated lesion no aggressive local or regional therapy is required except in Adenoid Cystic Carcinoma who may survive for years even with pulmonary metastasis. In case of tumour extends to inaccessible areas like the base of skull, a non surgical modality of treatment needs to be considered. In case the of tumour proximity to vital structures, the resection margins needs to be kept close with post op radiotherapy. Histology also has important role in deciding the treatment modality. In case of adenoid cystic carcinoma with the risk of peri neural spread, post op radiotherapy is indicated. Similarly high grade lesion which have got higher incidence of systemic metastasis require systemic therapy. FACIAL NERVE MANAGEMENT An informed written consent should include risk of damage to facial nerve and its implication. It may require to be sacrificed per operatively if it is found to be adherent to the tumour with nerve grafting or preoperatively if there are features of facial nerve involvement. In case of adenoid cystic carcinoma a free proximal facial nerve stump must be confirmed by frozen section. MANAGEMENT OF THE NECK Limited disease in first echelon nodes requires a selective neck dissection but for more extensive nodal disease a comprehensive neck dissection is done. In a N0 neck, prophylactic sampling neck dissection is indicated in large tumours (>4cm), SCC, high grade mucoepidermoid carcinoma, facial nerve paralysis, elderly(>54 years), perilymphatic invasion and extra parotid extension. If level 2 sampling on frozen section is positive then proceed with neck dissection. References:

 

1. Dell'Aversana Orabona G, Bonavolontà P, Iaconetta G, Forte R, Califano L. Surgical management of benign tumors of the parotid gland: extracapsular dissection versus superficial parotidectomy--our experience in 232 cases. J Oral Maxillofac Surg. 2013 ;71(2):410-3 2. M Mc Gurk, BL Thomas. Extracapsular dissection for clinically benign parotid lumps: reduced morbidity without oncological compromise. British journal of cancer, 2003 (89) 1610-1613. 3. Koyuncu M, Seşen T, Akan H, Ismailoglu AA, Tanyeri Y. Comparison of computed tomography and magnetic resonance imaging in the diagnosis of parotid tumors. Otolaryngol Head Neck Surg. 2003;129(6):726-32. 4. Jafari A, Royer B, Lefevre M et al, Value of the cytological diagnosis in the treatment of parotid tumors. Otolaryngol Head Neck Surg , 2009 ;140(3):381-5. 5. Iseli TA, Karnell LH, Preston TW et al. Facial nerve sacrifice and radiotherapy in parotid adenoid cystic carcinoma. Laryngoscope. 2008 Oct; 118(10):1781-6 6. Valstar MH, van den Brekel MW, Smeele LE.Interpretation of treatment outcome in the clinically node negative neck in primary parotid carcinoma: a systematic review of the literature. Head Neck 2010 Oct;32(10):1402-11. 7. Armstrong et al. Indication for elective treatment of neck in cancer of major salivary salivary glands. Cancer 1992;69:615-9.

Col. Ajith Nilakanta

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FHNO - Travel Fellowships / Shireen Gazdar Fellowship 2014  

Travel Fellowships disbursed by the FHNO includes three Annual FHNO Travel Fellowships. and one Annual Shireen Gazdar Training Fellowship in Head-Neck Oncosurgery.

The FHNO Travel fellowships are open to all aspects of Head-Neck Oncology but the Shireen Gazdar Fellowship is specifically created for surgical training in Head-Neck Oncology. The Fellowships provide partial support for the successful candidate to travel to and spend time at any national centre of repute to acquire exposure to and skills in Head-Neck Oncology. For further details and to apply- please visit www.fhno.org

Bids for 2016 Annual Meeting Members are invited to bid for the 2016 Annual Meeting. Bids for conference are to be made two years in advance at the general body by writing to the FHNO secretary and by an oral presentation to the general body. This bid should have the names of the core organizing team, organizing secretary / chairman, proposed conference venue and approximate rates. The FHNO executive committee will make the final selection of the location and will get the location ratified by the general body conducted at the annual conference preceding the proposed conference. Members interested in bidding for the 2016 meeting may write to the Hony. Secretary to request a copy of the Annual Conference SOP. Bids for the meeting are to be received by the office of the Secretary by September 15, 2014.

  

 

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Nominations for FHNO Life Time Achievement Award - 2014  

Members of the FHNO may send in nominations of eminent Head-Neck Oncologists for consideration of the FHNO Life Time Achievement Award.

Nominations shall be screened by the Governing Council. Upto two awards may be given in a particular year but it is not essential for the award to be given out every year. The award may be awarded posthumously. The attributes of a potential awardee are deemed as such : Essential attributes 1. Significant contributions to the field of head and neck oncology from prevention, societal awareness, early detection, treatment, education and understanding of the disease process 2. Person of good repute in the community 3. Indian origin Desirable attributes 1. Member of FHNO 2. The contribution by the awardee is sustainable 3. Has held substantial position in an institution or organization Members of the FHNO may send in their nominations to the secretary with a small write up listing the attributes and contributions of the of the nominee. Nominations may be sent by post or by email ([email protected]; [email protected]). Nominations are to be received by July 31, 2014. Update your contact details Members are requested to regularly update us of any change of address/ email id./ contact details.

FHNO General Body meeting – Notice, September 2014, Chandigarh Notice is hereby given for the General Body meeting of the FHNO to be held at Chandigarh concurrent with the 14th Annual Conference of the Association (27 September, 2014) at the conference venue ( JW Marriott Hotel, Chandigarh). The meeting is tentatively scheduled for 1730. The exact date and scheduling of the meeting shall be communicated closer to the time of the meeting by electronic communication. Further members may ascertain the same by communicating with the FHNO office secretary at [email protected] or 09810588319. GBM proposed Agenda : 1. Welcome address: President, Dr. JP Dabholkar 2. Condolences if any 3. Approval of Minutes of 2013 General Body Meeting 4. Secretary report: Dr. A Thakar 5. Treasurer report: Dr. V Kekatpure 6. Travel Fellowship program report 7. 2015 FHNO Annual meeting 8. Proposals for 2016 FHNO Annual meeting 9. HN-COG update: Dr. S. Iyer 10. Approval of new members/executive committee 11. Any other matter with the permission of the chair.

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Name

: _____________________________________________

Age / Date of Birth

: _____________________________________________

 

Professional Qualification  (With year and Institution)  

 

 

: _____________________________________________      _____________________________________________

 

 

  

Address for communication : _____________________________________________ _____________________________________________________________________ _____________________________________________________________________ Tel. No.

Office

_______________________________________

Residence

_______________________________________

Mobile

_______________________________________

E-mail ID : ____________________________________________________________ Present position

: _____________________________________________

Area of interest / expertise : _____________________________________________

Signature Type of Membership : (Please Select) 1. Life member (Rs.3000/-) Open to all medical professionals holding a recognized post graduate degree in the concerned specialty 2. Life Associate Member (Rs.3000/-) Open to all paramedical professionals involved in the specialty

Please make your payment by Demand Draft (payable at Bangalore) / Cheque (MICR Cheque payable at Delhi)to - Foundation for Head & Neck Oncology

Please send the form and payment to the Secretary at this address:  

Dr. Alok Thakar Department of Otolaryngology & Head – Neck Surgery, Room no – 4058, 4th Floor, Teaching block, All India Institute of Medical Sciences, Ansari Nagar, New Delhi –29. Email : [email protected], Ph. : 011-26593492

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