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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.
In Reply We appreciate the response from Ropers and colleagues to our commentary, and welcome the news that they do not dismiss imaging for children with unilateral sensorineural hearing loss. We agree that there is insufficient strong evidence to help guide the use of imaging for prognosis at this time, and we support the strong recommendation that future studies should address the research questions of prognostic value, comorbid conditions, and effective interventions in this population of children. Furthermore, we share the concern that most of the imaging currently performed is not easily accessible for research studies that we posit will derive benefit for this population.
To the Editor We would like to respond to the invited commentary to our meta-analysis and literature review on the benefit of imaging in children with unilateral sensorineural hearing loss (USNHL). The authors suggest that our review (1) dismisses imaging for USNHL as useless in most children, and (2) frames imaging in a way that discourages patients and parents from imaging. However, we would like to emphasize that this is neither our message nor what we practice.
In this issue of JAMA Otolaryngology–Head & Neck Surgery, Bray and colleagues shine a light on the increasing incidence of head and neck melanoma among pediatric and young adult patients (defined as ages 0-39 years). By using a large North American cancer epidemiological database that included 26 US states and 6 Canadian provinces, the authors found that the incidence of head and neck melanoma among pediatric and young adult patients increased by 51% over the 20-year period between 1995 and 2014.
Mission Statement:JAMA Otolaryngology–Head & Neck Surgery provides timely information for physicians and scientists concerned with diseases of the head and neck. Given the diversity of structure and function based in this anatomic region, JAMA Otolaryngology–Head & Neck Surgery publishes clinical, translational, and population health research from an array of disciplines. We place a high priority on strong study designs that accurately identify etiologies, evaluate diagnostic strategies, and distinguish among treatment options and outcomes. Our objectives are to (1) publish original contributions that will enhance the clinician’s understanding of otolaryngologic disorders, benefit the care of our patients, and stimulate research in our fiel.

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