Robert Hodge

Royal Brisbane Hospital, Brisbane, Queensland, Australia

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Publications (5)11.96 Total impact

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    ABSTRACT: Background Swallowing and nutrition guidelines for patients with head and neck cancer are available for identification of proactive gastrostomy placement in patients with high nutritional risk. The purpose of this study was to investigate improvements to the validity of these guidelines.MethodsA multivariate analysis was fitted to the original dataset (n = 501) to examine the variables that may predict gastrostomy placement (eg, tumor site, treatment, sex, and age). Using these factors, the high risk category was modified and retrospectively validated in the same cohort to provide new measures of sensitivity and specificity.ResultsThe following were positive predictors of gastrostomy placement: T3 (p = .01), T4 (p < .001), and chemoradiotherapy (p < .001). Laryngeal (p = .02) and skin cancer (p < .001) were negative predictors. Modification of the high risk definition improved sensitivity to 58% and maintained specificity at 92%.Conclusion Minor modifications to the high risk definition in the guidelines have improved the guideline sensitivity for future use. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
    Head & Neck 08/2015; DOI:10.1002/hed.24184 · 2.64 Impact Factor
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    ABSTRACT: Background: The purpose of this study was to evaluate combined autofluorescence (AF) and narrow band imaging (NBI) for detection of mucosal lesions additional to known primary head and neck cancers and to determine impact on management. Methods: Patients with head and neck cancer requiring preoperative screening or posttreatment surveillance had white light (WL), AF and NBI inspection of the head and neck and bronchus. Known primary cancers were not analyzed, only additional lesions. Moderate dysplasia or worse was considered significant. Results: In all, 73 patients were recruited. Respectively, there were 24 and 18 additional lesions in the head and neck and bronchus that had significant histopathology. In both regions, AF and NBI were more sensitive than WL for detecting significant dysplasia with NBI demonstrating better specificity than AF (p = .003); 11 of 73 patients (15.1%) had additional findings detected by AF and NBI, which had an impact on management. Conclusion: Combined AF and NBI inspection is highly specific at panendoscopy and can influence management.
    Head & Neck 05/2013; 35(5). DOI:10.1002/hed.22999 · 2.64 Impact Factor
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    ABSTRACT: Evidence-based nutritional and swallowing guidelines were developed to identify patients at high risk of developing malnutrition during chemoradiation for head and neck cancer. These guidelines recommended a prophylactic gastrostomy and were actively implemented at our institution in January 2007. This study assesses the effect of this policy change on patient outcomes. This retrospective cohort study was carried out for the years before (2005) and after (2007) implementation of these guidelines. In all, 165 patients were treated with radical chemoradiation for head and neck cancer at our institution in the years 2005 and 2007. Gastrostomy tube complications were low. Patients in 2007 had significantly fewer hospital admissions, unexpected admissions, and a shorter mean duration of hospital stay in comparison with those in 2005. Prophylactic gastrostomy tubes in patients with high-risk head and neck cancer resulted in a significant decrease in hospital admissions and length of stay, and led to increased bed availability. © 2012 Wiley Periodicals, Inc. Head Neck, 2013
    Head & Neck 03/2013; 35(3). DOI:10.1002/hed.22992 · 2.64 Impact Factor
  • David Fielding · Julienne Agnew · David Wright · Robert Hodge ·
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    ABSTRACT: Panendoscopy is used in selected patients with head and neck cancer to detect second primary disease. We hypothesized that adding autofluorescence to the bronchoscopy and laryngoscopy part of this procedure could add to the detection of clinically meaningful dysplasias and carcinomas in both the head and neck and bronchus, with resultant change in management. Prospective observational study on consecutive patients with head and neck cancer who had panendoscopy prior to surgery. Teaching hospital, tertiary referral center. All patients had white-light inspection observed by ENT surgeons, followed by autofluorescence inspection of the head and neck tumor and surrounding area as well as the bronchus. Extra biopsies were taken from regions of abnormal fluorescence where there was no white-light abnormality. Sixty-six patients were studied; mean age 64.9 +/- 11 years. As a result of autofluorescence, 33 mucosal biopsies were taken from the head and neck and 37 from the bronchus. Histology included three carcinoma in situ lesions and four severe dysplasias. As a result of these autofluorescence biopsies, change of management occurred in four patients (6% of the total patients). Standard panendoscopy changed management in five patients. Therefore, standard panendoscopy led to change in management in only 55 percent of cases (CI 21%-86%, P = 0.02), with the rest detected by autofluorescence. Adding autofluorescence to panendoscopy in patients with head and neck cancer changed management in a clinically significant number of patients.
    Otolaryngology Head and Neck Surgery 03/2010; 142(3 Suppl 1):S20-6. DOI:10.1016/j.otohns.2009.12.021 · 2.02 Impact Factor
  • David Fielding · Julie Agnew · David Wright · Robert Hodge ·
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    ABSTRACT: Head and neck (H&N) cancer patients have a high incidence of local field change as well as second primary lung tumours. We have applied the Wolf Diagnostic Autofluorescence Endoscopy (DAFE) system in a novel way, combining autofluorescence evaluation of both H&N region and bronchial. New H&N cases as well as “old” cases with symptoms were included. The DAFE procedure was done separate to panendoscopy. The H&N region was examined first; images were recorded of the known primary with reference to subsequent resection margins, as well as of adjacent mucosa inspecting for additional abnormal sites. Then autofluorescence bronchoscopy was performed. Changes in management were only on the basis of histology taken because of abnormal autofluorescence. One hundred and seven cases were referred, including 96 new cases and 11 old cases. Autofluorescence examination of H&N detected sites which led to change of management in 11 patients. This included additional sites in nine patients (which then either had extra surgery or radiotherapy as a result) and wider resection margins were made possible in two patients. In the bronchus there were 21 significant lesions in 16 patients. Immediate management change occurred in one invasive cancer, two microinvasive carcinomas and three carcinomas in situ (in four patients). There were 15 sites of severe and moderate dysplasia in 12 patients. None of these bronchoscopic lesions were detectable on CT chest. Therefore, overall an immediate change in management occurred in 15 of 107 patients (14% of patients). This combined procedure yielded a significant number of lesions particularly as a simple addition to preoperative work-up in new H&N cancer cases.
    Photodiagnosis and Photodynamic Therapy 12/2006; 3(4):259–265. DOI:10.1016/j.pdpdt.2006.07.004 · 2.01 Impact Factor