Trained in facial plastic and reconstructive surgery, Rosenthal specializes in the treatment and reconstruction of head and neck cancer. His research interests involve the use of optical imaging techniques to better detect cancer during surgical procedures, and he has initiated multiple clinical trials in improving cancer surgery and assessing drug delivery. A mentor and frequently invited speaker, Rosenthal has authored or co-authored more than 250 peer-reviewed publications.

OHNS and the Vanderbilt Bill Wilkerson Center, which also includes the Department of Hearing and Speech Science, are recognized as international leaders in research for new treatments and cures for voice, cancer, hearing, and other diseases of the head and neck. As a result, OHNS is currently ranked No. 2 in the nation in total National Institutes of Health funding among departments of otolaryngology.


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Purpose:  Positive margins dominate clinical outcomes after surgical resections in most solid cancer types, including head and neck squamous cell carcinoma. Unfortunately, surgeons remove cancer in the same manner they have for a century with complete dependence on subjective tissue changes to identify cancer in the operating room. To effect change, we hypothesize that EGFR can be targeted for safe and specific real-time localization of cancer.

Experimental design:  A dose escalation study of cetuximab conjugated to IRDye800 was performed in patients (n = 12) undergoing surgical resection of squamous cell carcinoma arising in the head and neck. Safety and pharmacokinetic data were obtained out to 30 days after infusion. Multi-instrument fluorescence imaging was performed in the operating room and in surgical pathology.

Although surgical resection has been the primary treatment modality of solid tumors for decades, surgeons still rely on visual cues and palpation to delineate healthy from cancerous tissue. This may contribute to the high rate (up to 30%) of positive margins in head and neck cancer resections. Margin status in these patients is the most important prognostic factor for overall survival. In addition, second primary lesions may be present at the time of surgery. Although often unnoticed by the medical team, these lesions can have significant survival ramifications. We hypothesize that real-time fluorescence imaging can enhance intraoperative decision making by aiding the surgeon in detecting close or positive margins and visualizing unanticipated regions of primary disease. The purpose of this study was to assess the clinical utility of real-time fluorescence imaging for intraoperative decision making. Methods: Head and neck cancer patients (n = 14) scheduled for curative resection were enrolled in a clinical trial evaluating panitumumab-IRDye800CW for surgical guidance (NCT02415881). Open-field fluorescence imaging was performed throughout the surgical procedure. The fluorescence signal was quantified as signal-to-background ratios to characterize the fluorescence contrast of regions of interest relative to background. Results: Fluorescence imaging was able to improve surgical decision making in 3 cases (21.4%): identification of a close margin (n = 1) and unanticipated regions of primary disease (n = 2). Conclusion: This study demonstrates the clinical applications of fluorescence imaging on intraoperative decision making. This information is required for designing phase III clinical trials using this technique. Furthermore, this study is the first to demonstrate this application for intraoperative decision making during resection of primary tumors.

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Byers began taking several doses of Radithor per day, believing it gave him a "toned-up feeling", but stopped in October 1930 (after taking some 1400 doses) when that effect faded. He lost weight and had headaches, and his teeth began to fall out. In 1931, the Federal Trade Commission asked him to testify about his experience, but he was too sick to travel so the commission sent a lawyer to take his statement at his home; the lawyer reported that Byers's "whole upper jaw, excepting two front teeth and most of his lower jaw had been removed" and that "All the remaining bone tissue of his body was disintegrating, and holes were actually forming in his skull."[7]

Typically, as you would expect, a lot of us creatives find it difficult to conform to norms and so forth. I missed a lot of meetings in my first few days, and I had to figure out a way to stay ahead of that. I now have an NFC sticker on my table such that as soon as I get in, and drop my mobile on it, my calendar for the day pops up. This is typically how the day begins for me, a way to ensure I do not miss any other meetings. I use this to plan my to-do and schedule my activities around those meeting times. I do a lot of ideating, of course, and shooting happens almost every day. I came in as we were about to sign a big client, and immediately got to work on that. Initially, I had to also be the project manager for most of the work the video team was doing, but now we have a Project Manager, and because of her, I have some free time now.

In patients with primary squamous cell carcinoma of the head and neck, the presence of lymph node metastasis is considered the most important negative prognostic factor for survival. Despite advanced anatomic and metabolic imaging techniques, in patients staged clinically and radiographically as node-negative (cN0), occult lymph node metastasis are still present in 20-30% of patients. To address this, the current guidelines recommend either elective regional neck dissection or sentinel lymph node biopsy. Compared to a neck dissection, minimally- invasive sentinel lymph node biopsy minimizes surgical morbidity, cosmetic deformity, and duration of surgery. unfortunately, the sentinel lymph node biopsy technique has not been widely adopted in head and neck cancer because the tumors are often inaccessible and patients poorly tolerate direct tumor injections (the current standard of care). To facilitate the adoption of this minimally-invasive technique in routine clinical practice the United States, we propose to overcome these traditional barriers to sentinel lymph node biopsy using a systemically delivered agents to replace locally injected agents. To this end, we propose a pilot study in head and neck cancer patients to determine if the presence of radio- or fluorescence-labeled panitumumab correlates with histological evidence of cancer in surgically obtained lymphadenectomy samples. If successful, our study would be the first trial to evaluate the use of a systemic imaging agent for sentinel lymph node biopsy identification and removal. Successful application of this technique to head and neck cancers could have implications for other tumor types for which lymph node status plays an important role.

The current standard of care for staging regional disease in head and neck cancer requires the removal of all of the lymph nodes in the neck, which is associated with significant morbidity. Although current guidelines recommend sentinel lymph node biopsy as a valid alternative to complete removal of lymph nodes in head and neck cancer, most tumors of this region are not accessible to local injection. We propose the first clinical trial to evaluate the systemic administration of optical and radiotracer contrast agents for sentinel lymph node biopsy.

Objective: To assess the effect of combining a synthetic matrix metalloprotease inhibitor and chemoradiation therapy on tumor growth in a murine model of head and neck squamous-cell carcinoma (SCC). Methods: Athymic, nude mice bearing SCC-1 xenografts were used to comprise 4 treatment groups: (1) control receiving vehicle alone, (2) marimastat alone, (3) cisplatin + radiation in combination and (4) marimastat + cisplatin + radiation in combination. The marimastat was administered at a dose of 8.7 mg/kg/day over a 14-day period via a subcutaneous osmotic pump. The control group received vehicle only via a subcutaneous osmotic pump. Radiotherapy was given in 4 fractions of 8 Gy divided over days 8, 12, 16 and 20 with 4 intraperitoneal doses of cisplatin (3 mg/kg) 1 h before each fraction of radiation. Results: Animals receiving triple treatment had delayed growth, measured as lengthened tumor doubling time, compared to the cisplatin + radiation combination (p = 0.03). Also, compared to control, the triple-treatment group (p = 0.005) had delayed growth in terms of doubling time. Factor VIII immunohistochemistry to assess microvessel density did not demonstrate a reduction in neovascularization between the triple-treatment and cisplatin + radiation combination groups. Statistical analysis failed to demonstrate any significant difference among groups. Conclusions: Chemoradiation + marimastat therapy had delayed tumor growth, compared to the chemoradiation alone. Based on these results, marimastat may work in combination with chemotherapy and radiation to inhibit tumor growth.

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