Gaining Much Needed Insight Into Treating Head and Neck Cancer Among Pediatric Patients

One of the biggest challenges that Mount Sinai pediatric otolaryngologist Aldo V. Londino, MD, faces in his practice is how best to treat patients who present with head and neck cancers. The low incidence rate among this population means there is less research to consult for additional guidance on optimal approaches.

“That contrasts with the adult realm, where there are significantly more cases of head and neck cancer and thus more research to inform care,” says Dr. Londino, Chief, Pediatric Otolaryngology, Mount Sinai Kravis Children’s Hospital, and Assistant Professor, Pediatric Otolaryngology, Icahn School of Medicine at Mount Sinai.

“However,” he continues, “database information on pediatric patients has grown over the years to the point that it has become a resource for us. This creates a unique opportunity to look at the data for insights that can guide us in making treatment decisions in ways that were not previously possible.”

Sourcing Data and Identifying Trends

Working with his colleagues at Mount Sinai, Dr. Londino is leading efforts to gain those insights. He is sourcing data from national databases to identify trends in the types of head and neck cancers that are being diagnosed among pediatric patients, approaches to treatment, and outcomes. He is also interested in comparing these data with those from adult patients who have been diagnosed with thyroid cancer, salivary gland tumors, and head and neck lymphomas.

“Some of the differences are obvious,” he explains. “For example, overall head and neck cancer is less common in children, children often do better than adult patients, or they may experience a delay in diagnosis because cancer is not the first thing on our minds when we see a pediatric patient. Thus, highlighting such delays or other trends will ensure that physicians have these factors in the back of their minds during diagnosis and treatment.”

Although Dr. Londino’s investigations are in their early stages, he and his colleagues have already noted an interesting phenomenon. Using data collected by the American College of Surgeons’ National Cancer Database from 3,600 pediatric patients and 334,400 adult patients between 2004 and 2020, they found that pediatric differentiated thyroid cancer might be associated with worse pathologic and short-term outcomes than those among adults.

“That is striking, but at this point, we do not have the context and cannot speculate as to why we saw this phenomenon,” Dr. Londino says. “Even so, this is a vital insight in that we really need to think about how we personalize a treatment plan for our pediatric patients to ensure we achieve the best possible outcomes for them through surgery.”

Growing the Database of Pediatric Patients

Dr. Londino is planning further studies that will explore and compare head and neck cancers among adult and pediatric patients. He believes these efforts will result in additional findings that give pediatric otolaryngologists more guidance and confidence in the diagnosis and treatment of these diseases while revealing new avenues for exploration. He also believes the continued growth of the national databases through the addition of more patients will result in a more robust resource to fuel his research and its applicability.

“Every time we enter a new battle for a patient, we gain more information about the characteristics of their disease, the pathway, the response to treatment, and recurrence,” he says. “These well-rounded data are very useful for us because they will enable us to really dig into these diseases and uncover insights that help us achieve better results among pediatric patients.”