Head and Neck Oncology Journal Club

Krishnakumar Thankappan
  • 5.0 (2)
  • Medicine

A weekly podcast breaking down the latest peer-reviewed research in head and neck surgery and oncology. Perfect for busy clinicians.

  1. Sep 26

    Predicting Recurrence After Skull Base Surgery for Malignant Tumours

    After skull base surgery for a malignant tumour, what is the chance of the disease coming back, and where? In this episode, we look at a study that used data from the Second International Collaborative Study on skull base surgery, covering 28 institutions. It built and validated nomograms to predict local, regional and distant recurrence in 2,179 previously untreated patients treated between 1995 and 2015. The models were built on patients from North America and Europe and tested on patients from South America, Australia and Asia. Histology, pT3 or T4 disease, nodal involvement, brain invasion and positive margins were the main predictors of recurrence. Melanoma carried a hazard ratio of 13.0 for distant recurrence. The distant recurrence nomogram performed best on external validation, with a C-index of 0.698, while the regional model was weakest at 0.600. We also discuss the study's limitations and how these tools might help with counselling and planning surveillance. In this episode: Study design and the geographic validation approachHistology risk groupsPredictors of local, regional and distant recurrenceHow the nomograms work and how well they performLimitationsBottom line for clinical practiceSource paper: Valero C, Ganly I, Boe LA, Patel SG, et al. Nomograms Predictive of Recurrence in Malignant Tumors Treated With Skull Base Surgery: An International Collaborative Study. Head & Neck. 2026. https://doi.org/10.1002/hed.70390 Host: Krishnakumar Thankappan Head and Neck Oncology Journal Club

    Predicting Recurrence After Skull Base Surgery for Malignant Tumours

  2. Sep 22

    Does Postoperative Radiation Improve Survival in Salivary Gland Adenoid Cystic Carcinoma?

    After complete resection of a parotid or submandibular adenoid cystic carcinoma, does postoperative radiation help patients live longer? In this episode, we look at an updated National Cancer Database analysis from Memorial Sloan Kettering of 2,384 patients treated between 2004 and 2021. Postoperative radiation was associated with better 8-year overall survival: 76.9 percent against 70.3 percent, with an adjusted hazard ratio of 0.76. The benefit extended to early-stage and margin-negative disease. The exception was pT3 to 4 tumours with positive margins, where radiation was not associated with better survival. This may be a biologically aggressive group that needs more than local treatment. We also discuss what the database cannot tell us, including local control and cancer-specific survival, and what these findings mean for tumour board decisions. In this episode: Study design and patient selectionSurvival by tumour stage and margin statusThe pT3 to 4 margin-positive subgroupLimitations of registry dataBottom line for clinical practiceSource paper: Chadha N, Ashji G, Ramanan S, Dee EC, et al. Adjuvant radiation for major salivary gland adenoid cystic carcinoma in the modern era: updated patterns of care and survival from the National Cancer Database (2004 to 2021). Oral Oncology. 2026;181:108107. https://doi.org/10.1016/j.oraloncology.2026.108107 Host: Krishnakumar Thankappan Head and Neck Oncology Journal Club

    Does Postoperative Radiation Improve Survival in Salivary Gland Adenoid Cystic Carcinoma?

  3. Aug 29

    FDG PET/CT for Restaging and Distant Metastasis Detection in Recurrent Head and Neck Cancer

    Recurrent head and neck cancer forces one binary decision: salvageable, or systemic? The standard workup answers it with a chest CT. A 500-patient series from Tata Memorial suggests that's looking in the wrong place first, bone, not lung, was the commonest site of distant spread, and one patient in ten had metastases a neck and chest CT could not see. Full description Episode 22. Krishnakumar Thankappan reviews Prakash, Purandare and colleagues on FDG PET/CT for restaging recurrent head and neck carcinoma, published ahead of print in the Indian Journal of Nuclear Medicine on 17 August 2026. Five hundred patients with histopathologically proven recurrent HNSCC, restaged with PET/CT between 2010 and 2018. Distant metastases were found in 28.8%. Ninety-eight patients had extrathoracic disease; 54, 10.8% of the cohort, had extrathoracic metastases with nothing in the chest at all, and management changed in every one of them. The episode also takes the reported 100% sensitivity apart. Only 8 of those 54 cases had histopathological confirmation; the rest were adjudicated by follow-up imaging or by an MDT that had the PET in front of it. Plus what actually predicts distant spread on multivariate analysis, why SUVmax is useless for triage, and how a 2018 data cutoff changes what the finding now means. Chapters 0:06 — Opening0:37 — The clinical question1:40 — Study design and cohort2:28 — Results: 28.8%, and bone ahead of lung4:06 — What this does not show5:32 — Who to refer for PET/CT6:53 — Limitations7:35 — Bottom lineNumbers from the episode 144/500 (28.8%) with distant metastases · 54 (10.8%) extrathoracic only · skeletal 34% vs lung 30% · recurrent stage IV, OR 2.06 (1.29–3.29) · shorter DFI, OR 0.92 (0.87–0.98) · optimal DFI cut-off 10 months · SUVmax AUC 0.61 Paper Prakash A, Purandare NC, Shah S, Puranik AD, Agrawal A, Pantvaidya G, et al. Utility of FDG PET/CT in Restaging and Detection of Distant Metastases in Recurrent Head and Neck Carcinoma. Indian J Nucl Med. doi: 10.25259/IJNM_71_2026 Music: "Podcast Intro / Opening Talk Show" by Alex Morgan (Pixabay). Numbers from the episode 144/500 (28.8%) with distant metastases · 54 (10.8%) extrathoracic only · skeletal 34% vs lung 30% · recurrent stage IV, OR 2.06 (1.29–3.29) · shorter DFI, OR 0.92 (0.87–0.98) · optimal DFI cut-off 10 months · SUVmax AUC 0.61 Paper Prakash A, Purandare NC, Shah S, Puranik AD, Agrawal A, Pantvaidya G, et al. Utility of FDG PET/CT in Restaging and Detection of Distant Metastases in Recurrent Head and Neck Carcinoma. Indian J Nucl Med. doi: 10.25259/IJNM_71_2026 Music: "Podcast Intro / Opening Talk Show" by Alex Morgan (Pixabay).

    FDG PET/CT for Restaging and Distant Metastasis Detection in Recurrent Head and Neck Cancer

  4. Aug 1

    Superficial Parotidectomy: Why the Operation Is Built That Way

    Superficial parotidectomy is the removal of parotid tissue lateral to the plane of the facial nerve. That definition sets the terms of the operation: it is not a gland excision that happens to involve a nerve, but a nerve dissection from which the gland is delivered as a consequence. This episode is a companion to the step-by-step surgical video on the Head and Neck Cancers channel. The case is a pleomorphic adenoma of the lower pole of the right parotid. Rather than narrating the steps alone, the episode pauses at each stage to set out why the operation is constructed the way it is. In this episode Why the capsule of a pleomorphic adenoma argues against enucleation, and what recurrent disease looks like when it returnsThe developmental reason the facial nerve lies within the parotid, and why there is no true anatomical superficial lobeThe changing dissection plane across the field, and the subplatysmal-to-sub-SMAS trap in the anterior facePreserving the posterior branch of the great auricular nerve, and why patients notice it years laterTwo landmarks — the tragal pointer through the superior tunnel, the posterior belly of digastric through the inferior tunnel — and the failure mode of eachThe tympanomastoid suture and retrograde dissection as alternativesWhat the nerve stimulator is actually telling you, current spread, and why long-acting neuromuscular blockade removes a safety check before the incisionWorking between the landmarks: tunnelling, testing, nerve fishing, and the patience the stage demandsThe inferior kick, the bifurcation at the pes anserinus, and branching variabilityWhy most postoperative weakness is traction and thermal injury rather than transectionFrey syndrome, first bite syndrome, and what to counselWatch the operation Superficial Parotidectomy — Step by Step: https://youtu.be/c_KYd-g1ZDw?si=lOZMFFygA2eoymCb  Presented by Dr. Krishnakumar Thankappan, Professor and Head, Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Kochi, India. This content is provided solely for professional surgical education. It does not replace supervised operative training, institutional protocols, or individual clinical judgement

    Superficial Parotidectomy: Why the Operation Is Built That Way

  5. Jul 28

    Weekly or 3-Weekly Cisplatin? JCOG1008 at Five Years

    Most units moved to weekly cisplatin years before the randomised evidence caught up. JCOG1008 gave us the interim answer in 2022. This month brings the five-year data — and a number that is easy to misread. In this episode: Why the trial was designed as a noninferiority study, and what the 1.32 margin was chosen to preserveThe five-year efficacy results across overall survival, relapse-free survival and local controlWhy "not worse" and "better" are different claims — and why the confidence intervals matter more than the gap between the curvesThe baseline imbalances that randomisation did not stratify forDose intensity as the likely explanation for why this trial and the Indian phase III trial disagreeLate toxicity, nutrition support–free survival, and the two treatment-related deathsKey numbers: 261 patients randomised, 132 to 3-weekly cisplatin 100 mg/m² and 129 to weekly 40 mg/m². At a median follow-up of 5.6 years, five-year overall survival was 58.7% versus 71.2%, stratified HR 0.76 (95% CI 0.52–1.12) — noninferiority confirmed. Five-year relapse-free survival 53.0% versus 64.3% (HR 0.81), local relapse-free survival 57.2% versus 68.8% (HR 0.79). Adjusting for T stage, N stage and primary site moved the hazard ratio to 0.88 (95% CI 0.60–1.29). Estimated dose intensity was 33.6 versus 29.3 mg/m² per week. No late adverse event differed by 10% or more between the arms. Paper discussed: Tahara M, Kiyota N, Kodaira T, et al. Long-Term Follow-Up of JCOG1008, a Randomized Phase II/III Trial of Chemoradiotherapy Comparing 3-Weekly Cisplatin With Weekly Cisplatin in Postoperative Head and Neck Cancer. J Clin Oncol. Published online June 26, 2026. doi:10.1200/JCO-25-01708 Trial registration: jRCTs031180135 Links: Summary: hnoncology-journalclub.netlify.appVideo channel: youtube.com/@headandneckcancers

    Weekly or 3-Weekly Cisplatin? JCOG1008 at Five Years

  6. Jul 17

    Dabrafenib plus trametinib in BRAF V600E RAI-refractory thyroid cancer

    The first phase 3 trial of BRAF/MEK inhibition in radioactive iodine-refractory, BRAF V600E-positive differentiated thyroid cancer, and the results are decisive. In this global, double-blind trial (153 patients, 42 sites, 11 countries), previously treated patients who had progressed on one or two VEGFR-targeted therapies were randomised 2:1 to dabrafenib plus trametinib or placebo. Dabrafenib plus trametinib more than tripled median progression-free survival , 12.8 vs 3.7 months (HR 0.38, 95% CI 0.25–0.57; p0.0001), and produced a 57% response rate against 4% on placebo. Interim overall survival favoured the combination but was not yet significant (HR 0.66; p=0.083), immature and confounded by crossover. Pyrexia (48%) and anaemia (45%) were the most common adverse events, with no new safety signals. We work through what this means for second-line practice, why BRAF genotyping now carries a clear therapeutic consequence, and the limitations, half the cohort from mainland China, and no head-to-head against cabozantinib. Paper: Gao M, Park YJ, et al. Efficacy and safety of dabrafenib plus trametinib in adults with differentiated thyroid cancer: a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet Oncology, 13 July 2026.  https://doi.org/10.1016/S1470-2045(26)00133-6

    Dabrafenib plus trametinib in BRAF V600E RAI-refractory thyroid cancer

  7. Jul 4

    The METRO PLUS Trial: Metronomic Chemotherapy Added to Paclitaxel-Carboplatin in Advanced HNSCC

    Can a $180-a-year regimen close the access gap in advanced head and neck cancer? In this episode we cover METRO PLUS (Kapoor et al., JCO Global Oncology 2026), a single-center, open-label, phase III trial from Varanasi testing whether adding triple oral metronomic chemotherapy — erlotinib, celecoxib, and weekly methotrexate — to paclitaxel-carboplatin improves survival in platinum-sensitive, unresectable advanced HNSCC. 238 patients, randomized 1:1, in a young, oral-cavity-predominant cohort. The combination doubled median overall survival (10 v 5 months; HR 0.54) and progression-free survival (6 v 2 months; HR 0.38), lifted the 6-month OS rate to 68.6% versus 36.5%, and did all of this without increasing grade 3-5 toxicity. Quality of life favored the combination across multiple domains. Paper: https://doi.org/10.1200/GO-25-00721

    The METRO PLUS Trial: Metronomic Chemotherapy Added to Paclitaxel-Carboplatin in Advanced HNSCC

  8. Jun 28

    Thyroglossal Duct Cyst Excision: Sistrunk Procedure

    Audio companion to our surgical video on the Sistrunk procedure for thyroglossal duct cyst. Embryology, why simple excision recurs, and a concise step-by-step of the operation — incision, subplatysmal flaps, strap separation, central hyoid skeletonisation and resection, en bloc specimen delivery, and layered closure. Watch the dissection: https://www.youtube.com/watch?v=cki1r1fIAw8

    Thyroglossal Duct Cyst Excision: Sistrunk Procedure
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About

A weekly podcast breaking down the latest peer-reviewed research in head and neck surgery and oncology. Perfect for busy clinicians.

Information

  • Creator
    Krishnakumar Thankappan
  • Years Active
    2025 - 2026
  • Episodes
    27
  • Rating
    Clean
  • Copyright
    © 2026 Krishnakumar Thankappan

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