Publications by authors named "Daniel C Chelius"

7 Publications

  • Page 1 of 1

Diagnosis and management of pediatric epithelial salivary gland malignancy.

Curr Opin Otolaryngol Head Neck Surg 2020 Dec;28(6):443-448

Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine.

Purpose Of Review: Salivary tumors are uncommon among children but are more likely to be malignant compared with adults. A lack of experience makes consensus in treatment elusive. Amidst recent publication of large institutional and national series, this review aims to discuss the epidemiology, diagnosis, investigation, and treatment for pediatric epithelial salivary malignancies.

Recent Findings: Pediatric salivary malignancies are often low grade and carry a favorable prognosis. High-grade tumors portend an increased risk of recurrence and a decreased survival. Surgeons should strive for oncologic resection with clear margins and avoid enucleation and excisional biopsies. Overt nodal metastases require concurrent neck dissection, whereas elective neck dissections may be reserved for cases with high risk of occult disease, such as advanced stage and high-grade neoplasms. Adjuvant radiation should be considered in high-grade tumors.

Summary: The paucity of high-level evidence clouds treatment decisions and further encourages pediatric salivary malignancies to be treated in an experienced center with a multidisciplinary approach.
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December 2020

Integrated DNA and RNA sequencing reveals targetable alterations in metastatic pediatric papillary thyroid carcinoma.

Pediatr Blood Cancer 2021 Jan 3;68(1):e28741. Epub 2020 Oct 3.

Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.

Background: Pediatric papillary thyroid carcinoma (PTC) is clinically and biologically distinct from adult PTC. We sequenced a cohort of clinically annotated pediatric PTC cases enriched for high-risk tumors to identify genetic alterations of relevance for diagnosis and therapy.

Methods: Tumor DNA and RNA were extracted from FFPE tissue and subjected to next-generation sequencing (NGS) library preparation using a custom 124-gene hybridization capture panel and the 75-gene Archer Oncology Research Panel, respectively. NGS libraries were sequenced on an Illumina MiSeq.

Results: Thirty-six pediatric PTC cases were analyzed. Metastases were frequently observed to cervical lymph nodes (29/36, 81%), with pulmonary metastases less commonly found (10/36, 28%). Relapsed or refractory disease occurred in 18 patients (18/36, 50%). DNA sequencing revealed targetable mutations in 8 of 31 tumors tested (26%), most commonly BRAF p.V600E (n = 6). RNA sequencing identified targetable fusions in 13 of 25 tumors tested (52%): RET (n = 8), NTRK3 (n = 4), and BRAF. Mutually exclusive targetable alterations were discovered in 15 of the 20 tumors (75%) with both DNA and RNA analyzed. Fusion-positive PTC was associated with multifocal disease, higher tumor staging, and higher American Thyroid Association risk levels. Both BRAF V600E mutations and gene fusions were correlated with the presence of cervical metastases.

Conclusions: Targetable alterations were identified in 75% of pediatric PTC cases with both DNA and RNA evaluated. Inclusion of RNA sequencing for detection of fusion genes is critical for evaluation of these tumors. Patients with fusion-positive tumors were more likely to have features of high-risk disease.
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January 2021

Assessment and Management of Thyroid Disease in Children.

Otolaryngol Clin North Am 2019 Oct 26;52(5):957-967. Epub 2019 Jul 26.

Department of Otolaryngology-Head and Neck Surgery, Pediatric Thyroid Tumor Program and Pediatric Head and Neck Tumor Program, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite D0420, Houston, TX 77030, USA. Electronic address:

This article summarizes the current management of pediatric thyroid disease, with an emphasis on surgical management. Medical and surgical approaches to hyperthyroidism are reviewed as well as pathways for evaluation of nodules and malignancy. Differences between pediatric and adult thyroid management are highlighted.
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October 2019

Pediatric Craniomaxillofacial Oncologic Reconstruction.

Clin Plast Surg 2019 Apr 30;46(2):261-273. Epub 2019 Jan 30.

Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Street, CC 610.00, Houston, TX 77030, USA. Electronic address:

Reconstruction of defects of the head and face in the pediatric population requires special consideration for future growth, and at times temporization in anticipation for skeletal maturity followed by subsequent reoperation at an appropriate age. Additional challenges include more limited donor sites, smaller anastomoses, and unpredictable postoperative compliance compared with their adult counterparts. Nonetheless, successful composite bony and soft tissue, and isolated soft tissue defects in children are safely reconstructed using existing local tissue and microsurgical techniques.
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April 2019

Bevacizumab as Treatment for Epistaxis in Hereditary Hemorrhagic Telangiectasia: A Literature Review.

Ann Otol Rhinol Laryngol 2019 May 29;128(5):467-471. Epub 2019 Jan 29.

2 Texas Children's Hospital, Houston, Texas, USA.

Background: Severe, recurring epistaxis is the most common symptom of hereditary hemorrhagic telangiectasias (HHT). Current treatment modalities range from noninvasive treatments that frequently fail to achieve even short-term control to surgeries and systemic therapies that carry significant risk of complications. Recently, bevacizumab, a VEGF inhibitor, has been proposed as an alternative option to alleviate epistaxis symptoms in HHT.

Objective: To review the current literature regarding the use of bevacizumab for the treatment of epistaxis in patients with HHT and provide guidance on its usage for this indication.

Methods: A narrative literature review was performed to analyze various methods and dosages of bevacizumab administration for the treatment of HHT-related epistaxis, along with a review of current treatment modalities and their drawbacks.

Results: The current standard of care for HHT-related epistaxis consists of treatments that are largely ineffective or invasive with significant potential complications. Submucosal bevacizumab has demonstrated efficacy in reducing frequency, duration, and severity of epistaxis in those with HHT.

Conclusion: Given the inadequacies and potential drawbacks of current treatments for epistaxis in HHT, there is a need for new therapeutic options. Submucosal bevacizumab has been effective with a limited risk profile in a number of studies and should now be considered as a treatment option for refractory epistaxis. Controlled studies are recommended to quantify optimal dosing, treatment schedule, and specific subpopulations that will respond best to this treatment.
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May 2019

Optimal positioning techniques with fiberoptic laser excision in the treatment of congenital tongue base lesions.

Laryngoscope 2013 Jun 11;123(6):1552-5. Epub 2013 Mar 11.

Department of Otolaryngology-Head and Neck Surgery, Kansas University Medical Center, Kansas City, Kansas 66160, USA.

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June 2013

Postcricoid vascular lesions: histopathological and immunohistochemical diagnosis.

Laryngoscope 2011 Feb 13;121(2):397-403. Epub 2011 Jan 13.

Department of Otolaryngology-Head and Neck Surgery, University of Connecticut, Farmington, Connecticut, USA.

Objectives/hypothesis: Postcricoid vascular lesions are a rare cause of dysphagia and stridor in the pediatric population. Currently, there is no clear consensus on what type of vascular lesions are common in the postcricoid area because adequate histological or immunohistochemistry studies are lacking. This study aimed to describe the histology and immunohistochemistry of postcricoid masses in our institutions' experience, and consolidate available data on the symptoms, management, and histology of these unusual malformations with a comprehensive literature review.

Study Design: Retrospective patient and literature review.

Methods: A retrospective review of patients with postcricoid vascular lesions was performed at two pediatric tertiary care institutions. Histology and immunohistochemistry studies were performed in patients undergoing a lesion biopsy. A complete literature review of the English language was completed for cases involving vascular lesions of the postcricoid area.

Results: Four patients were identified in our study with postcricoid vascular lesions. All patients presented with symptoms of dysphagia and intermittent stridor. Histology and immunohistochemistry studies were performed in three patients. GLUT-1 was negative in all three patients, and CD34 was positive in all patients tested. Lewis Y antigen was performed in one patient and was negative. A description of 19 cases reported in the English literature is included.

Conclusions: Patients with postcricoid vascular lesions usually present with mild to moderate feeding difficulties, and stridor or dyspnea with agitation. Histopathology and immunohistochemistry results suggest that postcricoid vascular lesions may often represent congenital vascular malformations instead of infantile hemangiomas.
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February 2011