eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Malignant Nasopharyngeal Tumors: Follow-up

Author: Ho-Sheng Lin, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Faculty, Sleep Fellowship Program, Divison of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine; Chief, Section of Otolaryngology, Department of Surgery, John D Dingell Veterans Affairs Medical Center
Coauthor(s): Willard E Fee Jr, MD, Edward C and Amy H Sewall Professor, Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center
Contributor Information and Disclosures

Updated: Oct 16, 2009

Outcome and Prognosis

The prognostic factors for patients with nasopharyngeal carcinoma (NPC) include the extent of the primary tumor (ie, skull base invasion, cranial nerve involvement, parapharyngeal infiltration), the level of the disease in the neck, the histologic subtype, the age and the sex of the patient, and the type and technique of radiotherapy. Survival rates are generally better in females than in males.

Some of the largest studies have reported a 5-year disease-free survival rate of 40-60% with primary radiation treatment. The 5-year overall survival (OS) rate is 85-95% for stage I NPC and 70-80% for stage II NPC treated with radiation alone. For stages III and IV NPC treated with radiation alone, the 5-year OS rate ranges from 24-80%, with better results generally occurring in patients from Southeast Asia. The Intergroup Study 0099 demonstrated that North American patients with advanced NPC benefited from concurrent chemotherapy with an improved 5-year OS rate of 67% compared with the 5-year OS rate of 37% for patients treated with radiation alone.

WHO type 3 NPC or undifferentiated carcinoma has the most favorable prognosis because of its high degree of radiosensitivity. The 5-year OS rate is 60-80%. In contrast, WHO type 1 NPC has the worst prognosis, with a 5-year OS rate of 20-40% because of its low radiosensitivity.

Unlike other head and neck carcinomas, some NPCs have a long, protracted course. Some patients can live with their recurrent disease for many years before succumbing to the disease.

Future and Controversies

Several areas continue to be debated regarding the management of nasopharyngeal carcinoma (NPC).

The role of chemotherapy in advanced nasopharyngeal carcinoma

Unfortunately, the literature is conflicting regarding the role of chemotherapy in the management of advanced NPC. This discrepancy in the literature may result from differences in the proportion of NPC WHO types, the types of chemotherapeutic agents, and delivery schedules in these various clinical trials. The significant improvement in survival with the addition of chemotherapy reported from the Intergroup Study may be because of the large proportion of patients with type 1 NPC in this study and the concurrent use of chemotherapy. Other large clinical trials, most notably from Asia, include a large proportion of patients with type 2 or 3 NPC who received chemotherapy in the neoadjuvant or adjuvant fashion. These trials failed to demonstrate improvement in overall survival (OS) with the addition of chemotherapy.

Several clinical trials from Asia that incorporated the use of concurrent chemoradiotherapy for locoregionally advanced NPC did show statistically significant improvement in OS. However, results are still conflicting. Using the same regimen as the one used in Intergroup Study 0099, Lee et al reported no statistically significant difference in 3-year OS in patients treated with chemoradiotherapy (76%) versus patients treated with radiation alone (77%). Nonetheless, the locoregional control rate in the chemoradiation group (93%) is statistically significantly better than the radiation alone group (82%).

Most recently, a report from the Meta-Analysis of Chemotherapy in Nasopharyngeal Carcinoma (MAC-NPC) reviewed individual patient data from 8 well-designed, randomized trials comparing chemotherapy plus radiotherapy with radiotherapy alone in locally advanced NPC. A total of 1753 patients were included in this review. The authors found that the addition of chemotherapy improved 5-year OS from 56% to 62% (absolute survival benefit, 6%) and improved EFS from 42% to 52% (absolute benefit, 10%). The authors concluded that the addition of chemotherapy to standard radiotherapy provides a small but significant survival benefit in patients with nasopharyngeal carcinoma. This benefit is essentially observed when chemotherapy is administered concomitantly with radiotherapy. The role of induction chemotherapy and adjuvant chemotherapy is more questionable.

Treatment recommendations for type and schedule of chemotherapeutic agents

Even if the decision is made to add chemotherapy to the treatment, the type and the schedule of chemotherapeutic agents must be determined. The goal is to determine the optimal timing and regimen, thereby maximizing the effectiveness of the treatment while minimizing the adverse effects. Numerous clinical trials to address this issue are ongoing.

Conventional versus altered fractionation, stereotactic radiation boost, and brachytherapy

The goal of these therapies is to find the optimal radiation regimen, thereby maximizing the effectiveness of this treatment while minimizing the adverse effects. The general recommendation for treatment of a primary tumor is a radiation dosage of at least 66 Gy. Stereotactic radiotherapy and brachytherapy may be used to boost dosage as well as to minimize surrounding tissue damage. Various clinical trials that involve different radiation regimens have been reported, and many more clinical trials are ongoing.

Salvage nasopharyngectomy or re-irradiation for local recurrence

The choice of therapy for local recurrence is another area of ongoing controversy. Fee concluded that the results of surgical resection are probably only slightly better than retreatment with radiotherapy. However, Fee believes that surgery is associated with fewer long-term complications when compared with re-irradiation. With the continued improvement in radiation delivery techniques such as intensity-modulated radiation therapy (IMRT) and stereotactic boost, complications associated with re-irradiation may decrease.

The best approach for performing nasopharyngectomy

None of the surgical approaches for resection of recurrent NPC is ideal. Because of the nature of the disease process, which involves an extremely complex anatomical region, the surgeon needs to be familiar with all of the surgical approaches. The operation must be tailored to the areas involved by the tumor and may involve a combination of approaches, thus allowing maximal exposure while minimizing associated morbidity.

 


More on Malignant Nasopharyngeal Tumors

Overview: Malignant Nasopharyngeal Tumors
Workup: Malignant Nasopharyngeal Tumors
Treatment: Malignant Nasopharyngeal Tumors
Follow-up: Malignant Nasopharyngeal Tumors
Multimedia: Malignant Nasopharyngeal Tumors
References
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References

  1. Fee WE Jr, Gilmer PA, Goffinet DR. Surgical management of recurrent nasopharyngeal carcinoma after radiation failure at the primary site. Laryngoscope. Nov 1988;98(11):1220-6. [Medline].

  2. Tu GY, Hu YH, Xu GZ, Ye M. Salvage surgery for nasopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. Mar 1988;114(3):328-9. [Medline].

  3. Teo PM, Tsao SY, Ho JH, Yu P. A proposed modification of the Ho stage-classification for nasopharyngeal carcinoma. Radiother Oncol. May 1991;21(1):11-23. [Medline].

  4. Low WK, Leong JL, Goh YH, Fong KW. Diagnostic value of Epstein-Barr viral serology in nasopharyngeal carcinoma. Otolaryngol Head Neck Surg. Oct 2000;123(4):505-7. [Medline].

  5. Ng SH, Chan SC, Yen TC, et al. Pretreatment evaluation of distant-site status in patients with nasopharyngeal carcinoma: accuracy of whole-body MRI at 3-Tesla and FDG-PET-CT. Eur Radiol. Jul 9 2009;[Medline].

  6. Chua ML, Ong SC, Wee JT, et al. Comparison of 4 modalities for distant metastasis staging in endemic nasopharyngeal carcinoma. Head Neck. Mar 2009;31(3):346-54. [Medline].

  7. Liu T, Xu W, Yan WL, Ye M, Bai YR, Huang G. FDG-PET, CT, MRI for diagnosis of local residual or recurrent nasopharyngeal carcinoma, which one is the best? A systematic review. Radiother Oncol. Dec 2007;85(3):327-35. [Medline].

  8. Waxman AD. Use of thallium 201 in tumor evaluation. West J Med. Jul 1992;157(1):60. [Medline].

  9. Yen RF, Ting LL, Cheng MF, Wu YW, Tzen KY, Hong RL. Usefulness of 201TL SPECT/CT relative to 18F-FDG PET/CT in detecting recurrent skull base nasopharyngeal carcinoma. Head Neck. Jun 2009;31(6):717-24. [Medline].

  10. Shanmugaratnam K, Chan SH, de-The G, et al. Histopathology of nasopharyngeal carcinoma: correlations with epidemiology, survival rates and other biological characteristics. Cancer. Sep 1979;44(3):1029-44. [Medline].

  11. Fee WE Jr. Nasopharynx. In: Close LG, Larson DL, Shah JP. Essentials of Head and Neck Oncology. New York, NY: Thieme; 1998:205-210.

  12. Chen CL, Wen WN, Chen JY, Hsu MM, Hsu HC. Detection of Epstein-Barr virus genome in nasopharyngeal carcinoma by in situ DNA hybridization. Intervirology. 1993;36(2):91-8. [Medline].

  13. Hao SP, Tsang NM, Chang KP. Differentiation of recurrent nasopharyngeal carcinoma and skull base osteoradionecrosis by Epstein-Barr virus-derived latent membrane protein-1 gene. Laryngoscope. Apr 2001;111(4 Pt 1):650-2. [Medline].

  14. Kwong DL, Nicholls J, Wei WI, et al. The time course of histologic remission after treatment of patients with nasopharyngeal carcinoma. Cancer. Apr 1 1999;85(7):1446-53. [Medline].

  15. Tsai ST, Jin YT, Mann RB, Ambinder RF. Epstein-Barr virus detection in nasopharyngeal tissues of patients with suspected nasopharyngeal carcinoma. Cancer. Apr 15 1998;82(8):1449-53. [Medline].

  16. Dictor M, Siven M, Tennvall J, Rambech E. Determination of nonendemic nasopharyngeal carcinoma by in situ hybridization for Epstein-Barr virus EBER1 RNA: sensitivity and specificity in cervical node metastases. Laryngoscope. Apr 1995;105(4 Pt 1):407-12. [Medline].

  17. Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. Apr 1998;16(4):1310-7. [Medline].

  18. Lu H, Peng L, Yuan X, et al. Concurrent chemoradiotherapy in locally advanced nasopharyngeal carcinoma: a treatment paradigm also applicable to patients in Southeast Asia. Cancer Treat Rev. Jun 2009;35(4):345-53. [Medline].

  19. Al-Sarraf M. Treatment of locally advanced head and neck cancer: historical and critical review. Cancer Control. Sep-Oct 2002;9(5):387-99. [Medline].

  20. Chi KH, Chang YC, Guo WY, et al. A phase III study of adjuvant chemotherapy in advanced nasopharyngeal carcinoma patients. Int J Radiat Oncol Biol Phys. Apr 1 2002;52(5):1238-44. [Medline].

  21. Chua DT, Sham JS, Choy D, et al. Preliminary report of the Asian-Oceanian Clinical Oncology Association randomized trial comparing cisplatin and epirubicin followed by radiotherapy versus radiotherapy alone in the treatment of patients with locoregionally advanced nasopharyngeal carcinoma. Asian-Oceanian Clinical Oncology Association Nasopharynx Cancer Study Group. Cancer. Dec 1 1998;83(11):2270-83. [Medline].

  22. Ma BB, Chan AT. Recent perspectives in the role of chemotherapy in the management of advanced nasopharyngeal carcinoma. Cancer. Jan 1 2005;103(1):22-31. [Medline].

  23. Chan AT, Leung SF, Ngan RK, et al. Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. Apr 6 2005;97(7):536-9. [Medline].

  24. Lin JC, Jan JS, Hsu CY, Liang WM, Jiang RS, Wang WY. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol. Feb 15 2003;21(4):631-7. [Medline].

  25. Wee J, Tan EH, Tai BC, et al. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol. Sep 20 2005;23(27):6730-8. [Medline].

  26. Wee J, Tan EH, Tai BC. Final report of SQNP01-a phase III randomized trial comparing RT with chemoRT for locally advanced nasopharyngeal cancer. JInt J Radiat Oncol Biol Phys. 2006;66:S16.

  27. Lee AW, Tung S, Chua D. Prospective randomized study on therapeutic gain achieved by addition of chemotherapy for T1-4N2-3M0 nasopharyngeal carcinoma (NPC) [abstract 5506]. Proc Am Soc Clin Oncol. 2004;23.

  28. Chen Y, Liu MZ, Liang SB, et al. Preliminary results of a prospective randomized trial comparing concurrent chemoradiotherapy plus adjuvant chemotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma in endemic regions of china. Int J Radiat Oncol Biol Phys. Aug 1 2008;71(5):1356-64. [Medline].

  29. Baujat B. Chemotherapy as an adjunct to radiotherapy in locally advanced nasopharyngeal carcinoma. Cochrane Database Syst Rev [serial online]. Oct 18, 2006;4:[Medline]. Available at http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004329/frame.html.

  30. Preliminary results of a randomized trial comparing neoadjuvant chemotherapy (cisplatin, epirubicin, bleomycin) plus radiotherapy vs. radiotherapy alone in stage IV(> or = N2, M0) undifferentiated nasopharyngeal carcinoma: a positive effect on progression-free survival. International Nasopharynx Cancer Study Group. VUMCA I trial. Int J Radiat Oncol Biol Phys. Jun 1 1996;35(3):463-9. [Medline].

  31. Hareyama M, Sakata K, Shirato H, et al. A prospective, randomized trial comparing neoadjuvant chemotherapy with radiotherapy alone in patients with advanced nasopharyngeal carcinoma. Cancer. Apr 15 2002;94(8):2217-23. [Medline].

  32. Rossi A, Molinari R, Boracchi P, et al. Adjuvant chemotherapy with vincristine, cyclophosphamide, and doxorubicin after radiotherapy in local-regional nasopharyngeal cancer: results of a 4-year multicenter randomized study. J Clin Oncol. Sep 1988;6(9):1401-10. [Medline].

  33. Hsu MM, Tu SM. Nasopharyngeal carcinoma in Taiwan. Clinical manifestations and results of therapy. Cancer. Jul 15 1983;52(2):362-8. [Medline].

  34. Chua DT, Sham JS, Choy D, et al. Patterns of failure after induction chemotherapy and radiotherapy for locoregionally advanced nasopharyngeal carcinoma: the Queen Mary Hospital experience. Int J Radiat Oncol Biol Phys. Apr 1 2001;49(5):1219-28. [Medline].

  35. Kwong DL, Sham JS, Au GK, et al. Concurrent and adjuvant chemotherapy for nasopharyngeal carcinoma: a factorial study. J Clin Oncol. Jul 1 2004;22(13):2643-53. [Medline].

  36. Leung TW, Tung SY, Sze WK, et al. Treatment results of 1070 patients with nasopharyngeal carcinoma: an analysis of survival and failure patterns. Head Neck. Jul 2005;27(7):555-65. [Medline].

  37. Lee AW, Poon YF, Foo W, et al. Retrospective analysis of 5037 patients with nasopharyngeal carcinoma treated during 1976-1985: overall survival and patterns of failure. Int J Radiat Oncol Biol Phys. 1992;23(2):261-70. [Medline].

  38. Sham JS, Choy D. Prognostic factors of nasopharyngeal carcinoma: a review of 759 patients. Br J Radiol. Jan 1990;63(745):51-8. [Medline].

  39. Fu KK, Newman H, Phillips TL. Treatment of locally recurrent carcinoma of the nasopharynx. Radiology. Nov 1975;117(2):425-31. [Medline].

  40. Yan JH, Hu YH, Gu XZ. Radiation therapy of recurrent nasopharyngeal carcinoma. Report on 219 patients. Acta Radiol Oncol. 1983;22(1):23-8. [Medline].

  41. Zhang EP, Lian PG, Cai KL, et al. Radiation therapy of nasopharyngeal carcinoma: prognostic factors based on a 10-year follow-up of 1302 patients. Int J Radiat Oncol Biol Phys. Feb 1989;16(2):301-5. [Medline].

  42. Wei WI, Ho CM, Wong MP, Ng WF, Lau SK, Lam KH. Pathological basis of surgery in the management of postradiotherapy cervical metastasis in nasopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. Sep 1992;118(9):923-9; discussion 930. [Medline].

  43. Fisch U. The infratemporal fossa approach for nasopharyngeal tumors. Laryngoscope. Jan 1983;93(1):36-44. [Medline].

  44. Panje WR, Gross CE. Treatment of tumor of the nasopharynx: surgical therapy. In: Thawley SE, Panje WR. Comprehensive Management of Head and Neck Tumors. 1. Philadelphia, Pa: WH Sauders Co; 1987:662-683.

  45. Wei WI, Ho CM, Yuen PW, Fung CF, Sham JS, Lam KH. Maxillary swing approach for resection of tumors in and around the nasopharynx. Arch Otolaryngol Head Neck Surg. Jun 1995;121(6):638-42. [Medline].

  46. Morton RP, Liavaag PG, McLean M, Freeman JL. Transcervico-mandibulo-palatal approach for surgical salvage of recurrent nasopharyngeal cancer. Head Neck. Jul-Aug 1996;18(4):352-8. [Medline].

  47. King WW, Ku PK, Mok CO, Teo PM. Nasopharyngectomy in the treatment of recurrent nasopharyngeal carcinoma: a twelve-year experience. Head Neck. May 2000;22(3):215-22. [Medline].

  48. Cheng SW, Ting AC, Lam LK, Wei WI. Carotid stenosis after radiotherapy for nasopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. Apr 2000;126(4):517-21. [Medline].

  49. Agulnik M, Siu LL. State-of-the-art management of nasopharyngeal carcinoma: current and future directions. Br J Cancer. Mar 14 2005;92(5):799-806. [Medline].

  50. Al-Sarraf M, LeBlanc M, Giri PG. Superiority of 5-year survival with chemoradiotherapy vs. radiotherapy in patients with locally advanced nasopharyngeal cancer. Intergroup 0099 phase III study: final report abstract. Proc Am Soc Clin Oncol. 2001;20:227a.

  51. Bailet JW, Mark RJ, Abemayor E, et al. Nasopharyngeal carcinoma: treatment results with primary radiation therapy. Laryngoscope. Sep 1992;102(9):965-72. [Medline].

  52. Brown JJ, Berry GJ, Moretto J, Keating WF, Fee WE Jr. Validity of clinic biopsy specimens in classifying histopathologic characteristics of recurrent nasopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. Sep 1997;123(9):950-5. [Medline].

  53. Brown JJ, Fee WE Jr. Management of the neck in nasopharyngeal carcinoma (NPC). Otolaryngol Clin North Am. Oct 1998;31(5):785-802. [Medline].

  54. Chen MK, Lai JC, Chang CC, Liu MT. Minimally invasive endoscopic nasopharyngectomy in the treatment of recurrent T1-2a nasopharyngeal carcinoma. The Laryngoscope [serial online]. May 2007;117:894-896. [Medline]. Available at http://www.laryngoscope.com/pt/re/laryngoscope/abstract.00005537-200705000-00027.htm;jsessionid=Gc8TMp3PRsB32mmQYSXQ0C2zD69kJ0qH5Jn11y0VGC0ygthpfB7T!-1740698184!181195629!8091!-1.

  55. Chien G, Yuen PW, Kwong D, Kwong YL. Comparative genomic hybridization analysis of nasopharygeal carcinoma: consistent patterns of genetic aberrations and clinicopathological correlations. Cancer Genet Cytogenet. Apr 1 2001;126(1):63-7. [Medline].

  56. Chong VF, Rumpel H, Fan YF, Mukherji SK. Temporal lobe changes following radiation therapy: imaging and proton MR spectroscopic findings. Eur Radiol. 2001;11(2):317-24. [Medline].

  57. Fee WE Jr, Roberson JB Jr, Goffinet DR. Long-term survival after surgical resection for recurrent nasopharyngeal cancer after radiotherapy failure. Arch Otolaryngol Head Neck Surg. Nov 1991;117(11):1233-6. [Medline].

  58. Ho JH. Stage classification of nasopharyngeal carcinoma: a review. IARC Sci Publ. 1978;99-113. [Medline].

  59. International Nasopharynx Cancer Study Group. Preliminary results of a randomized trial comparing neoadjuvant chemotherapy (cisplatin, epirubicin, bleomycin) plus radiotherapy vs. radiotherapy alone in stage IV(> or = N2, M0) undifferentiated nasopharyngeal carcinoma: a positive effect on progression-free survival. International Nasopharynx Cancer Study Group. VUMCA I trial. Int J Radiat Oncol Biol Phys. Jun 1 1996;35(3):463-9. [Medline].

  60. Lee JT, Ko CY. Has survival improved for nasopharyngeal carcinoma in the United States?. Otolaryngol Head Neck Surg. Feb 2005;132(2):303-8. [Medline].

  61. Ma J, Mai HQ, Hong MH, et al. Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. J Clin Oncol. Mar 1 2001;19(5):1350-7. [Medline].

  62. Neel HB 3rd, Pearson GR, Weiland LH, et al. Application of Epstein-Barr virus serology to the diagnosis and staging of North American patients with nasopharyngeal carcinoma. Otolaryngol Head Neck Surg. Jun 1983;91(3):255-62. [Medline].

  63. Teo PM, Chan AT, Lee WY, Leung TW, Johnson PJ. Enhancement of local control in locally advanced node-positive nasopharyngeal carcinoma by adjunctive chemotherapy. Int J Radiat Oncol Biol Phys. Jan 15 1999;43(2):261-71. [Medline].

  64. Vokes EE, Liebowitz DN, Weichselbaum RR. Nasopharyngeal carcinoma. Lancet. Oct 11 1997;350(9084):1087-91. [Medline].

  65. Wee J, Tai BC, Wong HB. Phase III randomized trial of radiotherapy versus concurrent chemo-radiotherapy followed by adjuvant chemotherapy in patients with AJCC/UICC (1997) stage 3 and 4 nasopharyngeal cancer of the endemic variety [abstract 5500]. Proc Am Soc Clin Oncol. 2004;23:487.

  66. Wee J, Tai BC, Wong HB. Phase III randomized trial of radiotherapy versus concurrent chemo-radiotherapy followed by adjuvant chemotherapy in patients with AJCC/UICC (1997) stage 3 and 4 nasopharyngeal cancer of the endemic variety [abstract 5500]. Proc Am Soc Clin Oncol. 2004;23:487.

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Further Reading

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Keywords

malignant nasopharyngeal tumors, nasopharyngeal carcinoma, NPC, nasopharyngeal cancer, undifferentiated carcinoma, lymphoepithelioma, nasopharyngectomy, salvage nasopharyngectomy, head and neck cancer, head and neck carcinoma, cervical metastasis, EBV

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Contributor Information and Disclosures

Author

Ho-Sheng Lin, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Faculty, Sleep Fellowship Program, Divison of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine; Chief, Section of Otolaryngology, Department of Surgery, John D Dingell Veterans Affairs Medical Center
Ho-Sheng Lin, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Sleep Medicine, American Association of University Professors, American College of Surgeons, American Head and Neck Society, Association of VA Surgeons, Chinese American Medical Society, Southwest Oncology Group, and Triological Society
Disclosure: Nothing to disclose.

Coauthor(s)

Willard E Fee Jr, MD, Edward C and Amy H Sewall Professor, Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center
Willard E Fee Jr, MD is a member of the following medical societies: American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, California Medical Association, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Accuray, Inc Ownership interest Consulting; Health Development Corp. Ownership interest Consulting; IRX Therapeutics Grant/research funds Other; NIH Grant/research funds Other

Medical Editor

Benoit J Gosselin, MD, FRCSC, Associate Professor of Surgery, Dartmouth Medical School; Director, Comprehensive Head and Neck Oncology Program, Norris Cotton Cancer Center; Staff Otolaryngologist, Division of Otolaryngology-Head and Neck Surgery, Dartmouth-Hitchcock Medical Center
Benoit J Gosselin, MD, FRCSC is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Medical Association, American Rhinologic Society, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, College of Physicians and Surgeons of Ontario, New Hampshire Medical Society, North American Skull Base Society, and Ontario Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Division of Otolaryngology, George Washington University
Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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