Head and Neck Academic Centre

Lead: Professor Mark McGurk

Start date: 2024

End date: recurrent meetings

Current status: open

The management of recurrent pleomorphic adenoma remains a significant clinical challenge, with considerable variation in presentation, therapeutic approach, and long-term outcome. To support the development of shared expertise and to encourage dissemination of best practice, UCL clinicians led by Professor McGurk host the Recurrent Pleomorphic Adenoma National Focus Group.

The purpose of this initiative is to provide a structured forum for multidisciplinary discussion of complex or unusual cases. The group will facilitate exchange of experience among clinicians with expertise in head and neck oncology and will provide a platform for critical appraisal of surgical and adjuvant strategies, as well as exploration of current evidence and emerging research.

Aims of the focus group include:

• Establishing a national forum for case-based discussion of recurrent pleomorphic adenoma
• Encouraging collaboration between centres managing advanced and difficult cases
• Promoting consistent, evidence-based approaches to diagnosis, treatment, and follow-up
• Identifying areas of clinical uncertainty to inform future research priorities

Participation
The group is open to ENT surgeons, oral and maxillofacial surgeons, oncologists, radiologists, pathologists, and other clinicians directly involved in the management of salivary gland neoplasms.

Format
Meetings will be held virtually at regular intervals and will be structured around case presentations, with invited commentary from subject specialists. Clinicians are encouraged to submit cases in advance for consideration.

Further information

Clinicians interested in contributing or attending can get in touch with Contact.HNAC@ucl.ac.uk

Lead: Clare Schilling (UCL), Lucy Collinson (The Francis Crick Institute)

Start date: Jan 2024

End date: Jan 2026

Current status: Open to recruitment

This pilot study aims to develop novel methods of processing and analysis of human lymph node and bone tissue in order to reduce the time to obtain pathology results. This study will use surplus tissue which is removed as part of common reconstructive procedures undertaken simultaneously with head and neck cancer resection. We plan to analyse excised lymph nodes by contrast-enhanced whole node micro-computed tomography (microCT) imaging. Bone tissue will be processed by a rapid microwave decalcification procedure and imaged by microCT. 

These novel methods have not been tested for reliability and compatibility with current clinical histopathological gold standards and thus we seek to obtain a small number of samples to develop optimum parameters to process and image the specimens whilst reducing the time taken to achieve a reliable result. 

In this study, we will not use diagnostic tissue (cancer specimens) but if we are successful in developing a reliable and time-saving protocol, we would seek further resources and approvals to translate this into the clinical pathway.

Sponsor for this study is UCL/UCLH JRO, and funding is via the UCLH Cancer charity, ethics approval - REC reference: 24/NI/0106

Development of a toolkit to improve poSt-operative feeding practices and nUtritional intake in patientS wiTh hEad and Neck cANCer undergoing surgEry with flap tissue reconstruction.

Lead: Florence Cook (PhD student)

Start date: September 2024

End date: August 2027

Current status: Open

This is a mixed-methods NIHR doctoral project which aims to investigate postoperative feeding practices and nutritional adequacy of patients undergoing surgery for head and neck cancer. There are five workstreams:

1. Scoping review of the literature 2. Survey of UK staff practices 3. Prospective cohort study of patients undergoing surgery at UCLH 4. Qualitative enquiries of patient experiences and staff practices 5. Development of a toolkit with stakeholder consultation.

Plain English Summary can be found on the NIHR website.

Study assessing the impact of socioeconomic factors on Head and Neck cancer patients undergoing surgery in North Central and North East London.

Lead: Clare Schilling

Start date: September 2024

End date: September 2026

Current status: Retrospective study completed Sept 2025; prospective study opens to recruit late 2025

Researchers combined data from 1,820 patients recruited from the Scottish Audit of Head and Neck Cancer (SAHNC) between 1999- 2001 with mortality data to study the association of socioeconomic factors on survival outcomes. Data showed that health inequality observed in H&N cancer patients is multifactorial and that further research is needed into the impact of patient, tumour and treatment factors. 

Our study is both retro- and prospective in nature, combining UK national audit outcomes from surgical treatment of oral and maxillofacial cancer and the socioeconomic status of patients treated with surgery in north east and north central London. Our aim is to highlight any health disparities in this network (the largest in the UK) and use these data to ensure resources are allocated to areas of most need.

Ethical approval granted REC reference: 24/NI/0106, retrospective project funded by the North Thames Cancer Alliance

A multi-centre validation study to evaluate whether a new imaging and surgical protocol would work as well as the current gold standard in identifying sentinel nodes in patients with oropharyngeal cancer. This study aims to give doctors more accurate information on which side(s) of the neck to treat following the discovery of cancer in the lymph glands.

• Start Date: 01 Sept 2020
• End Date: 31 July 2024    
• Current Status: Recruitment
• LOOC Clinical Trial Protocol

Background

Cancer at the back of the mouth and throat is usually only discovered after it has spread to lymph glands in the neck. This means that both the original tumour and the cancer that has spread need to be treated.

Doctors need to decide whether to treat just one side of the neck or to treat both, as the cancer may have spread to both sides or may be likely to spread to another side in the future. They base this decision on things such as how aggressive the cancer is, whether the patient smokes and whether the HPV virus is present. This difficult decision can mean some patients get treatment on both sides of the neck that they may not need, which can result in lasting problems with swallowing. Others can receive treatment on one side only to have the cancer return on the other.

This study hopes to give doctors more accurate information on whether to treat one side or two. This will be done using a procedure called Sentinel Node Biopsy (SNB) to see whether the cancer has spread to the other side of the neck. If this study is successful, we will have found a way to give doctors much better, more accurate information on what treatment to give and speed up the time that it takes for patients to go through the treatment process.

Sponsors

• UCL
• NIHR Clinical Research Network

Lead: Professor Mark McGurk, Dr Vin Patel

An open invitation multidisciplinary UK collaborative project to discuss and shape the current management of odontogenic tumours.  Odontogenic tumours are extremely rare meaning sharing knowledge and experience is key to improving outcomes. Recent studies suggest drug treatment, such as BRAF-inhibitors, can reduce the morbidity of conventional surgical treatment. This forum aims to provide practical expert advice as well as supporting access to novel therapies through clinical trials.

• Start Date: 06 Mar 2024
• End Date: TBC   
• Current Status: Data Collection

Lead: Dr Roganie Govender

SIP SMART2 is a multi-centre pilot cluster-randomised trial of a tailored swallowing prehabilitation intervention for people newly diagnosed with head and neck cancer. The main aims are:

1) Assess the feasibility and acceptability of the intervention to those receiving and delivering SIP SMART

2) Identify any process and implementation issues related to delivery

3) Determine whether it meets the apriori criteria to proceed to a larger definitive trial.

• Start Date: 03 Aug 2022
• End Date: 30 Sep 2023   
• Current Status: Closed to recruitment, in follow-up.

Lead: Mr Nicholas Hamilton

A UK multidisciplinary collaborative project to evaluate the outcomes of tracheostomy in COVID-19 patients. It also examines the implementation of national guidance in COVID-19 tracheostomies and the incidence of COVID-19 infections amongst those healthcare workers involved in the procedure.

• Start Date: 01 Apr 2020
• End Date: 30 Sep 2021    
• Current Status: BMJ Publication / PDF
• COVIDTrach Clinical Trial Protocol

Background

When COVID-19 leads to a severe infection in the lungs, patients need to be placed on a ventilator. Before the pandemic, clinical practice was for patients expected to be on a ventilator for over 7 days to undergo a tracheostomy, a surgical procedure to put a breathing tube through the neck into the airway. It is uncertain whether patients with COVID-19 also benefit from this operation due to the severity of their respiratory illness and high death rate. Furthermore, there is concern that opening the airway through the tracheostomy puts healthcare professionals performing the procedure at risk of being infected by the coronavirus.

COVIDTrach is a collaborative project by surgeons and intensive care doctors that looks at the outcomes of ventilated COVID-19 patients undergoing tracheostomy and evaluates the use of personal protective equipment and the rate of COVID-19 infection amongst operators. So far, data on 800 patients have been entered into an online database; this proposal focuses on expanding and completing this database to answer the fundamental questions of the safety and effectiveness of tracheostomy in COVID-19.

Sponsors

• UCL Rapid Response COVID-19 Fund / Wellcome Trust
• NIHR Clinical Research Network
• The Federation of Surgical Specialty Associations
• Intensive Care Society
• Difficult Airway Society

Contributer (Sites)

• Aberdeen Royal Infirmary
• Addebrooke's Hospital
• Aintree University Hospitals NHS Trust
• Ashford St Peter's
• Barking, Havering and Redbridge NHS Trust
• Barnet Hospital
• Basingstoke & North Hampshire Hospital
• Bedford Hospitals NHS Foundation Trust
• Birmingham Queen Elizabeth Hospital
• Birmingham City Hospital
• Birmingham Heartlands & Goodhope Hospital
• Bodelwyddan - Glan Clwyd Hospital
• Bradford Royal Infirmary
• Bristol Royal Infirmary
• Broomfield Hospital
• Chelsea & Westminister
• Colchester Hospital
• Conquest Hospital
• Countess of Chester Hospital
• Coventry and Warwickshire Hospital
• Croydon Hospital
• Doncaster Royal Hospital
• Dumfries and Galloway
• East Surrey Hospital
• Eastbourne District General Hospital
• Forth Valley Royal Hospital
• Glasgow Royal Infirmary
• Gloucestershire Hospitals NHS Trust
• Great Western Hospital
• GSTT
• Harefield Hospital
• Hereford Country Hospital
• Hillingdon Hospital
• Homerton University Hospital
• Imperial NHS Trust
• Inverclyde Royal Infirmary
• Isle of Wight
• James Paget Hospital
• John Radcliffe
• Kent and Canterbury
• King's College Hospital
• Kings Mill Hospital
• Leeds General Infirmary
• Leicester Royal Infirmary
• Lewisham Hospital
• Lister Hospital
• Maidstone and Tunbridge Wells NHS Trust
• Manchester University Foundation Trust
• Medway Maritime Hospital
• Monklands General Hospital
• Morriston
• Musgrove Park Hospital
• Nevill Hall Hospital
• New Cross Hospital
• Newcastle Hospital
• Norfolk and Norwich University Hospital
• North Cumbria Integrated Care
• Northumbria Healthcare NHS Trust
• Northwick Park Hospital
• Peterborough City Hospital
• Pinderfields Hospital
• Prince Charles Hospital Merthyr Tydfil
• Princess Alexandra Hospital
• Queens Alexandra Hospital
• Queen Elizabeth University Hospital
• Queens Medical Centre
• Queen's Hospital (Burton)
• Raigmore Hospital, Inverness
• Royal Albert Edward Hospital
• Royal Alexandra Hospital
• Royal Berkshire NHS Foundation Trust
• Royal Blackburn Hospital
• Royal Bolton Hospital
• Royal Cornwall Hospital
• Royal Derby Hospital
• Royal Free Hospital
• Royal Gwent Hospital
• Royal Liverpool Hospital
• Royal London Hospital (Barts Health)
• Royal Preston Hospital
• Royal Sussex County Hospital
• Russells Hall
• Salisbury District Hospital
• Scarborough Hospital
• Sheffield Teaching Hospital
• Shrewsbury and Telford Hospitals
• Southend University Hospital
• St Georges Hospital
• St Helens & Knowsley Teaching Hospitals NHS Trust
• St John's Hospital at Howden
• Stepping Hill Hospital
• Stoke Mandeville Hospital
• Sunderland Royal Hospital
• Tameside & Glossop Integrated Care NHS Trust
• The James Cook University Hospital
• The Rotherham NHS Foundation Trust
• The Whittington Hospital
• Tunbridge Wells Hospital
• University College London Hospitals
• University Hospital of North Midlands
• University Hospital of Wales
• University Hospital Southampton
• University Hospitals Bristol and Weston NHS Foundation Trust
• University Hospitals Derby & Burton
• University Hospitals Plymouth
• Walsall Manor Hospital
• Watford General Hospital
• West Middlesex Hospital
• West Suffolk Hospital
• Wexham Park Hospital
• Whipps Cross University Hospital (Barts Health)
• Whittington Hospital
• William Harvey Hospital
• Wrexham Maelor Hospital
• Wythenshawe Hospital
• York Hospital

Publications

Preprint report: COVIDTrach collaborative, NJI Hamilton, et al., COVIDTrach; a prospective cohort study of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK. (2020). medRxiv 2020.10.20.20216085.

Interim Report: COVIDTrach; the outcomes of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK. (2020). BJS. 107 (12), e583-e584.

There is an urgent need to understand the outcomes of COVID-19-infected patients who undergo surgery. Capturing real-world data and sharing international experience will inform the management of this complex group of patients who undergo surgery throughout the COVID-19 pandemic, improving their clinical care. CovidSurg has been designed by an international collaborating group of surgeons and anaesthetists which has now reached 69 countries.

• Start Date: 14 July 2020
• End Date: 14 July 2025    
• Current Status: Data Collection
• CovidSurg Clinical Trial Protocol

Criteria

Patients must meet the following two criteria:

• Undergoing any type of surgery in an operating theatre, including obstetrics.
• Either before or after surgery: (i) lab test confirmed SARS-CoV2 infection or (ii) clinical diagnosis of COVID-19 (no test performed).

Any hospital can participate. Some hospitals might currently have few cases while others might have a lot. Every hospital treating or expecting to treat surgical patients with COVID-19 infection is welcome.

The primary outcome is mortality at 30 days after surgery. Secondary outcomes will be other surgical and medical complications. There is no fixed data collection period and patients can be included either prospectively or retrospectively. Data will be stored in a secure online platform (REDCap). Only anonymised data will be collected.

All the collaborators will be recognised as co-authors in any publications resulting from this study. A corporate authorship model will be used under the CovidSurg Collaborative group.

Sponsors

• NIHR Global Health Research Unit