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In this issue of JAMA Otolaryngology-Head & Neck Surgery, Saraswathula and colleagues used the Surveillance, Epidemiology, and End Results Program (SEER)–Medicare outcomes and claims database to compare the value of 3 different radiotherapy (RT) regimens (ie, RT alone, RT plus cisplatin, or RT plus cetuximab) administered to patients older than 65 years with locally advanced head and neck cancer (HNC) of the oral cavity, oropharynx, larynx, and hypopharynx.
To the Editor We read with interest the article by Qian et al, who reported thyroid cancer incidence among children in the United States. On the basis of similar trends between tumor sizes (0.1-2.0 and >2 cm) and between extent of diseases (localized and regional), they suggested 2 causes of the increase: overdiagnosis, associated with a 2006 recommendation for a similar diagnostic and therapeutic approach in children as in adults by the American Thyroid Association; and environmental risk factors, such as increased exposure to medical radiation. The increase in large-tumor (>2 cm) thyroid cancer is not evidence of a true increase, as ultrasonographic screening of young patients with limited radiation exposure within 3 years after the Fukus.
Every surgical oncologist bristles when considering whether to offer an operation of questionable benefit. Patient, oncologic, and clinician factors all influence whether a surgery is indicated and how to effectively navigate the necessary preoperative counseling and preparation. The inherent risks and rewards of cancer surgery are magnified when the underlying physical fitness of the patient is in question. Even when dealing with technically feasible operations for potentially curable malignant tumors, a patient’s ability to recover and survive long enough to realize the benefit of surgery is critical.
In Reply In our study, we reported that the incidence rate of pediatric thyroid cancer increased more rapidly during 2006 to 2013 than during 1973 to 2006. We proposed that this is likely owing to a combination of enhanced detection and a concurrent true increase in pediatric thyroid cancer incidence based on increased incidences of large tumors and regionally advanced disease. We have read the comments of Murakami et al and wish to address their concerns regarding the interpretation of the later finding.
This issue of JAMA Otolaryngology presents “Complications, Mortality, and Functional Decline in Patients 80 Years and Older Undergoing Major Head and Neck Ablation and Reconstruction” by Fancy et al. This work represents a major contribution to the head and neck reconstructive literature in a group that many have long held the speculative opinion do worse with surgery: the oldest of the old. This is a growing population, thus presenting a pressing research topic.

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