Karim Botros

Background: Pretreatment neutrophil to lymphocyte ratio (NLR) is a negative prognostic marker for survival in head and neck cancer (HNC). Its association with treatment toxicity and intolerance in patients undergoing curative‐intent surgery is unknown. Methods: Ambispective study of patients with operable stage II–IV, HPV‐negative HNC treated at two academic hospitals. Multiple logistic regression was performed to evaluate the association between pretreatment NLR and short‐term treatment outcomes including treatment toxicity and intolerance. Results: Among 456 patients, 194 experienced treatment‐related toxicity, defined as grade ≥ 3 adverse events, and 200 exhibited treatment intolerance, defined as treatment discontinuation or delay due to poor tolerance. High pretreatment NLR was significantly associated with an increased risk of toxicity (OR 1.04; 95% CI: 1.00–1.09) and intolerance (OR 1.06; 95% CI: 1.01–1.12). Patients with an NLR < 2.5 had significantly lower odds of experiencing toxicity (OR 0.50; 95% CI: 0.26–0.96) and intolerance (OR 0.57; 95% CI: 0.33–0.99) after adjusting for multiple confounders. Conclusions: Low pretreatment NLR was associated with reduced treatment toxicity and lower rates of intolerance in patients undergoing curative‐intent surgery for HNC.

Background: Airway obstruction secondary to chyle leak is an exceptionally rare phenomenon. Here, we describe this complication in a patient with anaplastic thyroid carcinoma (ATC) undergoing consolidative surgery after BRAF‐targeted therapy. Methods: A 55‐year‐old man presented with a rapidly enlarging neck mass. Work‐up was consistent with metastatic unresectable BRAF ^V600E ‐mutant ATC. After a remarkable response to neoadjuvant dabrafenib and trametinib, he underwent curative‐intent surgery with a right hemithyroidectomy and bilateral neck dissection. Within 48 h, he developed an expanding left neck mass with laryngeal obstruction due to a chyle leak. Results: Despite surgical repair and maximal medical therapy, the leak persisted necessitating thoracoscopic ligation of the thoracic duct. Final pathology showed a completely excised residual tumor. The patient remains disease‐free on long‐term dabrafenib and trametinib. Conclusions: BRAF‐directed therapy has transformed the care of patients with mutated ATC. As more patients undergo consolidative surgery, increased vigilance is paramount in minimizing complications and their associated morbidity.