National Cancer Institute®
Last Modified: May 1, 2002
UI - 11914947
AU - Fischer M; Stuben G; Stuschke M; Jahnke K
TI - [Brachytherapy with (192)Iridium in the treatment of recurrent nasopharyngeal carcinoma]
SO - Laryngorhinootologie 2002 Feb;81(2):106-10
AD - Universitats-Hals-Nasen-Ohren-Klinik, Essen. firstname.lastname@example.org
BACKGROUND: Local recurrence of nasopharyngeal carcinomas can be treated in different ways. One option is re-irradiation e. g. as stereotactically guided convergent beam. An operative approach is possible in small recurrent tumours. Brachytherapy is a good alternative because of the steep dose gradient in the pre-irradiated area. METHODS: First step is the creation of a wide approach to the nasopharynx. This leads to a tumour mass reduction and gives space for the applicator. The radioactive substance will be brought into contact with the tumour by an afterloading procedure. The advantage of this therapy is the possibility to protect the surrounding tissue whereas the tumour receives a relatively high dosage. Between 2/90 and 12/96 10 men and 3 women were treated according to this protocol. RESULTS: The median age was 56 years (37- 66 years), the average follow-up period was 49,7 months (8 -123 months). 2 non keratinising and 11 undifferentiated carcinomas were treated. 5 of 13 patients were still alive at the end of the follow-up period. The 5 year over all survival rate was 46 %. 3 patients are free of disease for 5 years or longer. The patients were treated 2 to 6 times with 7 Gy in 5 mm depth. CONCLUSIONS: The results show that good palliation can be achieved by the applied method but larger studies are required to give a definite statement.
UI - 11771007
AU - Freeman JL; Robinson A; Irish J
TI - Brush biopsy for detection of nasopharyngeal cancer.
SO - J Otolaryngol 2001 Dec;30(6):355-6
AD - Department of Otolaryngology, Mount Sinai Hospital, University of Toronto, Ontario.
The technique described above for sampling the nasopharynx requires minimal equipment, instruction, and expertise and causes minimal morbidity. Hence, it may be a valuable tool in a widespread screening program for a far too common and debilitating cancer in certain parts of the world.
UI - 11859706
AU - Li H; Han W; Zhang L
TI - [cDNA expression array in the differential expression profiles of p53 regulated genes in nasopharyngeal carcinoma and the human normal nasopharynx]
SO - Zhonghua Zhong Liu Za Zhi 2001 Nov;23(6):448-50
AD - Carcinogenesis Key Laboratory of Ministry of Public Health, Cancer Institute, Central Southern University, Changsha 410078, China.
OBJECTIVE: To compare the gene expression map of nasopharyngeal carcinoma (NPC) tissue with that of the control tissue by cDNA array and to discuss possible reasons of TP53 accumulation in NPC tissue. METHODS: After the hybridization of Atlas human cancer cDNA expression array 7742-1, analysis of Atlas arrays by means of AtlasImage 1.01a was carried out. Then, the results of array were verified by reverse transcription-polymerase chain reaction (RT-PCR). Gene expression alteration on the protein level was verified by immunohistochemistry. RESULTS: 134 of 588 tumor-related genes were upregulated and 88 downregulated. Thirteen of 32 p53-regulated genes showed differential expression with 11 upregulated and 2 downregulated. CONCLUSION: (1) p53 dysfunction exists in NPC tissues, (2) MDM2, p21 and Bax may be involved in the regulation of nasopharyngeal carcinoma cell growth.
UI - 11859210
AU - Jeng YM; Sung MT; Fang CL; Huang HY; Mao TL; Cheng W; Hsiao CH
TI - Sinonasal undifferentiated carcinoma and nasopharyngeal-type undifferentiated carcinoma: two clinically, biologically, and histopathologically distinct entities.
SO - Am J Surg Pathol 2002 Mar;26(3):371-6
AD - Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.
Sinonasal undifferentiated carcinoma (SNUC) is a rare aggressive neoplasm arising in the nasal cavity and paranasal sinuses. Primary sinonasal nasopharyngeal-type undifferentiated carcinoma (PSNPC) is an even rarer tumor that has not been adequately reported. Both tumors have been reported to be associated with Epstein-Barr virus (EBV). We studied the clinicopathologic features and EBV status of 36 SNUC and 13 PSNPC patients from Taiwan, an EBV endemic area. The median age of SNUC patients was 53 years (range 20-76 years), with a male/female ratio of approximately 2:1. Five patients had histories of previous nasopharyngeal carcinoma treated with irradiation 6-26 years earlier. The most common locations were nasal cavity and ethmoid sinus. Orbital and intracranial invasion and distant metastasis were frequent findings. The median survival was 10 months. All 36 tumors were negative for EBER-1 by in situ hybridization. The median age of PSNPC patients was 58 years (range 36-75 years), with a male/female ratio of approximately 2:1. The most common location is nasal cavity. Eight patients achieved disease-free survival. Eight tumors had the morphology of lymphoepithelioma, whereas significant inflammatory infiltrate was not detected in the other five tumors. All 13 tumors were positive for EBER-1 by in situ hybridization. Because of the difference in the relation with EBV, prognosis, and response to radiotherapy, SNUC and PSNPC should be considered as two entirely different entities. The most important criteria for PSNPC are vesicular nuclei, syncytial pattern, spindle cells, and absence of necrosis.
UI - 11958128
AU - Deng L; Zhao XR; Pan KF; Wang Y; Deng XY; Lu YY; Cao Y
TI - Cyclin D1 polymorphism and the susceptibility to NPC using DHPLC.
SO - Sheng Wu Hua Xue Yu Sheng Wu Wu Li Xue Bao (Shanghai) 2002 Jan;34(1):16-20
AD - Laboratory of Molecular Biology, Cancer Research Institute, Xiang-ya School of Medicine, Central South University, Changsha 410078, China.
Cyclin D1 is a key cell cycle regulator and a candidate proto-oncogene, whose deregulation has been implicated in pathogenesis of several types of cancers, including NPC. A common A/G polymorphism (A870G) in exon 4 of the cyclin D1 gene, CCND1, is associated with the presence of 2 distinct mRNA transcripts for this G1/S regulatory protein, and CCND1 genotype has been related to some phenotypes of several tumors. To investigate the influence of cyclin D1 genotypes on the genetic susceptibility in humans from Southern China to sporadic nasopharyngeal carcinoma, cyclin D1 genotyping was performed by denaturing high performance liquid chromatography (DHPLC) and DNA sequencing analysis of the PCR products from 84 NPC cases and 91 normal controls. Gene frequency distribution was tested by Hardy-Weinberg equilibrium and comparison of cyclin D1 gene frequencies between the patient and control groups was performed by chi 2 test. Results showed that in NPC patients, the AA genotype of CCND1 was significantly lower (20.24%) than in normal controls (38.46%), and the GG and AG genotypes (GG + AG) were significantly higher in NPC group than in the control group (chi 2 = 6.946, P corrected = 0.016, OR = 2.463, 95% CI = 1.249-4.859). These suggest that the A/G polymorphism of CCND1 was associated with the susceptibility to NPC, and the GG and AG genotypes in NPC patients were significantly higher than those in normal controls.
UI - 11955726
AU - Vineberg KA; Eisbruch A; Coselmon MM; McShan DL; Kessler ML; Fraass BA
TI - Is uniform target dose possible in IMRT plans in the head and neck?
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1159-72
AD - Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
PURPOSE: Various published reports involving intensity-modulated radiotherapy (IMRT) plans developed using automated optimization (inverse planning) have demonstrated highly conformal plans. These reported conformal IMRT plans involve significant target dose inhomogeneity, including both overdosage and underdosage within the target volume. In this study, we demonstrate the development of optimized beamlet IMRT plans that satisfy rigorous dose homogeneity requirements for all target volumes (e.g., +/-5%), while also sparing the parotids and other normal structures. METHODS AND MATERIALS: The treatment plans of 15 patients with oropharyngeal cancer who were previously treated with forward-planned multisegmental IMRT were planned again using an automated optimization system developed in-house. The optimization system allows for variable sized beamlets computed using a three-dimensional convolution/superposition dose calculation and flexible cost functions derived from combinations of clinically relevant factors (costlets) that can include dose, dose-volume, and biologic model-based costlets. The current study compared optimized IMRT plans designed to treat the various planning target volumes to doses of 66, 60, and 54 Gy with varying target dose homogeneity while using a flexible optimization cost function to minimize the dose to the parotids, spinal cord, oral cavity, brainstem, submandibular nodes, and other structures. RESULTS: In all cases, target dose uniformity was achieved through steeply varying dose-based costs. Differences in clinical plan evaluation metrics were evaluated for individual cases (eight different target homogeneity costlets), and for the entire cohort of plans. Highly conformal plans were achieved, with significant sparing of both the contralateral and ipsilateral parotid glands. As the homogeneity of the target dose distributions was allowed to decrease, increased sparing of the parotids (and other normal tissues) may be achieved. However, it was shown that relatively few patients would benefit from the use of increased target inhomogeneity, because the range of improvement in the parotid dose is relatively limited. Hot spots in the target volumes are shown to be unnecessary and do not assist in normal tissue sparing. CONCLUSION: Sparing of both parotids in patients receiving bilateral neck radiation can be achieved without compromising strict target dose homogeneity criteria. The geometry of the normal tissue and target anatomy are shown to be the major factor necessary to predict the parotid sparing that will be possible for any particular case.
UI - 11955734
AU - Chi KH; Chang YC; Guo WY; Leung MJ; Shiau CY; Chen SY; Wang LW; Lai YL;
TI - Hsu MM; Lian SL; Chang CH; Liu TW; Chin YH; Yen SH; Perng CH; Chen KY A phase III study of adjuvant chemotherapy in advanced nasopharyngeal carcinoma patients.
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1238-44
AD - Cancer Center, Veterans General Hospital-Taipei, National Yang-Ming University, Taipei, Taiwan, Republic of China. email@example.com
PURPOSE: To evaluate the role of adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma (NPC) patients, we conducted a randomized Phase III trial comparing radiotherapy (RT) followed by adjuvant chemotherapy to RT alone in patients with advanced NPC. METHODS Stage IV, M(0) (UICC/AJCC, 1992) advanced NPC disease were randomized to receive standard radiotherapy, as follows: 35-40 fractions, 1.8-2.0 Gy/fraction/day, 5 days/week, to a total dose 70-72 Gy with or without 9 weekly cycles of 24-h infusional chemotherapy (20 mg/m(2) cisplatin, 2,200 mg/m(2) 5-fluorouracil, and 120 mg/m(2) leucovorin) after RT. Of 157 patients enrolled, 154 (77 radiotherapy, 77 combined therapy) were evaluable for survival and toxicity analysis. RESULTS: With a median follow-up of 49.5 months, the 5-year overall survival and relapse-free survival rates were 60.5% vs. 54.5% (p = 0.5) and 49.5% vs. 54.4% (p = 0.38) for the radiotherapy-alone group and the combined radiotherapy and adjuvant chemotherapy group, respectively. The Cox regression showed that the hazard rates ratio of combined treatment to RT alone was 0.673 (p value = 0.232); the 95% confidence interval was 0.352 and 1.288, respectively. Patients who received combined treatment had a lower systemic relapse rate than radiotherapy-alone patients, according to relapse pattern analysis. The incidence of leukopenia (>or= Grade 3) occurred in 17 out of 819 (2.1%) cycles of weekly chemotherapy. No patient developed moderate to severe mucositis (>or= Grade 3). CONCLUSIONS: We conclude that adjuvant chemotherapy after RT for patients with advanced NPC has no benefit for overall survival or relapse-free survival.
UI - 11734117
AU - Breau RL; Gardner EK; Dornhoffer JL
TI - Cancer of the external auditory canal and temporal bone.
SO - Curr Oncol Rep 2002 Jan;4(1):76-80
AD - Department of Otolaryngology, Beth Israel Medical Center, First Avenue at 16th Street, New York, NY 10003, USA. BreauRandallL@uams.edu
Malignant neoplasms involving the temporal bone are a relatively rare and often misdiagnosed disease. Staging of temporal bone cancer has proven difficult because of the small number of patients with this condition, the various histopathologic and histologic findings reported, and a lack of randomized trials. Of the various staging systems that have been proposed, the Pittsburgh classification appears to be the most widely accepted. A retrospective study of 31 patients with temporal bone malignancy at the University of Arkansas for Medical Sciences has led us to propose a modification of the Pittsburgh classification for early-stage lesions. This modification places more emphasis on the site of disease in the canal and less on the size of the primary tumor or degree of bony invasion. This review discusses this staging system, the management of these tumors in a multidisciplinary team approach, reconstructive options, and auditory rehabilitation.
UI - 11796235
AU - Licitra L; Bernier J; Grandi C; Merlano M; Bruzzi P; Lefebvre JL
TI - Cancer of the oropharynx.
SO - Crit Rev Oncol Hematol 2002 Jan;41(1):107-22
AD - START Project, European School of Oncology, Viale Beatrice d'Este, 37, 20122 Milan, Italy.
Oropharyngeal cancer is a rare tumour. Tobacco use and alcohol consumption are recognised as major risk factors. Several carcinogens, occupational exposures and vitamin deficiencies represent the most significant predisposing factors. A varying host susceptibility to carcinogens can be inferred. Carcinoma of the oropharynx has to be suspected whenever sore throat, odynophagia, and ear-ache are described by the patient. Biopsy is mandatory for the definitive diagnosis. TNM classification is crucial for treatment decision-making, while stage grouping is less important. Prognostic factors are treatment-related. Standard treatment of T1-T2 tumours is radiation therapy, for T3 and T4 tumour treatment options are controversial. More advanced tumours can be treated either with surgery followed by conventional radiotherapy or by combined chemo-radiation. Non-conventional fractionation radiotherapy in combination with chemotherapy may represent a third option. Acute toxicity needs to be managed promptly. Late sequelae are less known. Treatment of such tumours requires a multidisciplinary approach within experienced centres.
UI - 11836588
AU - Tsai MH; Chow KC; Lin TY; Yeh SP; Hsueh CT; Chi KH
TI - Expression of Fas ligand in patients with evident skull base involvement of nasopharyngeal carcinoma.
SO - Oncol Rep 2002 Mar-Apr;9(2):247-51
AD - Department of Otolaryngology, China Medical College Hospital and Institute of Medical Research, Taichung, Taiwan.
We investigated whether skull base involvement in patients with nasopharyngeal carcinoma (NPC) is correlated with expression of Fas ligand (FasL) in NPC cells. A prospective assessment of FasL expression was determined by immunohistochemistry and in situ hybridization in 98 patients with newly diagnosed NPC. Among these patients, 21 had evident skull base involvement. Expressions of human apoptosis-related genes and FasL were confirmed by reverse transcription-polymerase chain reaction. Relation between the frequency of skull base involvement and FasL expression was analyzed by Chi-square and multivariate analyses. FasL expression was detected in 32 (32.6%) of 98 pathological sections. Compared to patients with low FasL expression in tumors, patients with notable FasL expression had higher incidence of skull base involvement (28.6 vs. 71.4%, p<0.005). Expression of FasL in tumor cells was correlated with the higher frequency of skull base involvement in patients with NPC.
UI - 11885435
AU - Norval EJ; Thompson IO
TI - Non-Hodgkin's lymphomas of Waldeyer's ring: a clinicopathological and immunological study of 64 cases in the western Cape.
SO - SADJ 2001 Nov;56(11):545-8
AD - Dept of Diagnostic Sciences, Division of Maxillofacial Radiology, University of Stellenbosch, Tygerberg. firstname.lastname@example.org
The clinicopathological and immunological features of 64 cases of primary extranodal non-Hodgkin's lymphoma (NHLs) that occurred in Waldeyer's ring (WR) were examined. The objective was to compare the findings of this study with those of previous studies. The age at presentation, sex ratio, and site of occurrence of these tumours within WR concurred with that of other studies. Diffuse large cell lymphomas were the most prevalent in this study. Most T-cell NHLs occurred in the nasopharynx where they constituted 28% of all NHLs in that site. This indicates a higher incidence of nasopharyngeal T-cell NHLs in South Africa as compared with other Western countries.
UI - 11952316
AU - Yabuuchi H; Fukuya T; Murayama S; Sakai S; Okamura J; Fukuda T; Tomita
TI - K; Ro T; Masuda K CT and MR features of nasopharyngeal carcinoma in children and young adults.
SO - Clin Radiol 2002 Mar;57(3):205-10
AD - Department of Radiology, National Kyushu Cancer Centre, Fukuoka, Japan. email@example.com
AIM: To clarify CT and MR features of nasopharyngeal carcinoma (NPC) in children and young adults. METHOD: CT and MR findings of 13 patients (30 years old or younger) with a histopathologic diagnosis of NPC were reviewed. RESULTS: Skull base invasion (12/13), lymphadenopathy (10/13), and infiltrative growth (8/8) were common findings. The signal intensity of tumours was slightly higher than that of muscles in six cases and isointense to that of muscles in two cases on T1-weighted images; it was higher than that of muscle and lower than that of cerebellar grey matter on T2-weighted images in all cases. Internal signals were homogeneous in both pre- and post-Gd-enhanced MR images in all cases. CONCLUSIONS: Despite its rarity in this age group, NPC should be included in a differential diagnosis when CT and MR imaging reveal these features. Copyright 2002 The Royal College of Radiologists.
UI - 11330465
AU - Tavani A; Gallus S; La Vecchia C; Talamini R; Barbone F; Herrero R;
TI - Franceschi S Diet and risk of oral and pharyngeal cancer. An Italian case-control study.
SO - Eur J Cancer Prev 2001 Apr;10(2):191-5
AD - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. firstname.lastname@example.org
The relation between diet and risk of oral and pharyngeal cancer was analysed in a case-control study conducted in North-East Italy between 1996 and 1999. Cases were 132 patients (including 33 women), with incident, histologically confirmed cancer of the oral cavity or pharynx, and controls were 148 subjects (including 45 women) admitted to hospitals for acute conditions unrelated to smoking or alcohol drinking. After allowance for tobacco, alcohol and several other potential confounding factors, significant inverse association with the risk of oral and pharyngeal cancer was found for consumption of total green vegetables (OR 0.37) and total fruit (OR 0.34) with significant trends in risk Compared with alcohol drinkers of < 20 drinks/week and eating > 13 portions/week of total green vegetables, the OR for drinkers of > or = 20 drinks/week and eating < 7 portions/week of green vegetables was 15.44. Our study provides further support to the beneficial effect of high intake of vegetables and fruit, particularly in heavy smokers and alcohol drinkers.
UI - 11839660
AU - Wong TS; Chang HW; Tang KC; Wei WI; Kwong DL; Sham JS; Yuen AP; Kwong YL
TI - High frequency of promoter hypermethylation of the death-associated protein-kinase gene in nasopharyngeal carcinoma and its detection in the peripheral blood of patients.
SO - Clin Cancer Res 2002 Feb;8(2):433-7
AD - Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, SAR China.
PURPOSE: Death-associated protein (DAP)-kinase gene is frequently inactivated by promoter hypermethylation in cancer. The aim of this study was to evaluate the promoter methylation status of the DAP-kinase gene in nasopharyngeal carcinoma (NPC). EXPERIMENTAL DESIGN: The methylation status was evaluated by methylation-specific PCR (MSP). Thirty-two NPC biopsy specimens, plasma and buffy coat of 12 patients, 5 NPC cell lines, 3 normal nasopharyngeal biopsy tissues, and 2 normal nasopharyngeal epithelial primary cultures were included in this study. RESULTS: There was no promoter hypermethylation in all 3 normal nasopharyngeal tissues and 2 normal nasopharyngeal primary cultures. Hypermethylation was found in 24 (75%) NPC primary tumor biopsies and 4 (80%) NPC cell lines. Of the 24 patients with hypermethylation of DAP-kinase promoter in the primary tumors, 12 patients had their plasma and buffy coat DNA available for MSP study. Hypermethylated DAP-kinase promoter was detectable in 5 patients in the plasma but not in the buffy coat, 2 patients in the buffy coat but not in the plasma, and 1 patient in both plasma and buffy coat. Four patients had no detectable hypermethylated DAP-kinase promoter in both plasma and buffy coat. Hypermethylation of DAP-kinase promoter was found in both early- and late-stage NPC. CONCLUSIONS: Our results show that hypermethylation of the DAP-kinase promoter is a common early event in NPC. The high frequency of identification of hypermethylated DAP-kinase promoter in plasma and buffy coat of NPC patients illustrates its potential clinical application as tumor marker for the diagnosis and monitoring of treatment result.
UI - 11941590
AU - Huang T; Liu Q; Huang H; Cao S
TI - [Study on genetic epidemiology of nasopharyngeal carcinoma in Guangdong, China]
SO - Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2002 Apr;19(2):134-7
AD - Cancer Center, Sun Yat-sen University of Medical Sciences, Guangzhou, Guangdong, 510060 P. R. China.
OBJECTIVE: To explore the characteristic of genetic epidemiology of nasopharyngeal carcinoma (NPC) in a high risk area Guangdong province, China. METHODS: Population investigation was made on the nuclear pedigrees of the first patient with NPC and his/her spouse, and then complex segregation analysis was performed using regressive Logistic model. RESULTS: The risk of suffering from NPC is 9.31 times higher in the first degree relatives of patient with NPC than in the first degree relatives of spouse. The separation ratio and heritability are 0.0588 (0.0182, 0.0994) and 68.08% respectively. The result of complex segregation analysis shows that model D is better than model A. CONCLUSION: The genetic trend and familial clustering of NPC are more significant and powerful in Guangdong. The risk of suffering from NPC is related with parent's state and senior sibling's state. Nasopharyngeal carcinoma is a multi-gene hereditary disease, but a single gene that decides the susceptibility to NPC may be present.
UI - 11956538
AU - Tan G; Xiao J; Tian Y; Dong L; Jiang N; Zhan F; Li G
TI - Microsatellite analyses of loci at 7q31.3-q36 reveal a minimum of two common regions of deletion in nasopharyngeal carcinoma.
SO - Otolaryngol Head Neck Surg 2002 Mar;126(3):296-300
AD - Department of Otolaryngology, Third Affiliated Hospital, Hunan Medical University, Hunan, Changsha, China. email@example.com
OBJECTIVE: Our goal was to better define the extent and specificity of deletion in the 7q32-qter chromosomal region in nasopharyngeal carcinoma (NPC). DESIGN AND SETTING: Polymerase chain reaction-based deletion analysis was performed on DNA samples from 24 paired NPCs and corresponding germlines using 13 microsatellite markers mapped to chromosome subbands 7q31.3-q36. RESULTS: Loss of heterozygosity of at least 1 marker in this interval was found in 18 (75%) of 24 tumor specimens. Particularly frequent allelic losses were identified at 5 loci: D7S495 (46%), D7S509 (42%), D7S500 (45%), D7S631 (30%), and D7S514 (35%). Two shortest regions of overlap could be identified in this interval, although the most common shortest region of overlap appeared to lie around D7S500 between but not including D7S631 and D7S495, on chromosome subband 7q32. CONCLUSION: These results suggest that at least 2 putative tumor suppressor genes important in the pathogenesis of NPC are present in the examined interval, an interval that has also been found to harbor deletions in breast and prostate carcinomas.
UI - 11956539
AU - Blackwell KE; Azizzadeh B; Ayala C; Rawnsley JD
TI - Octogenarian free flap reconstruction: complications and cost of therapy.
SO - Otolaryngol Head Neck Surg 2002 Mar;126(3):301-6
AD - Division of Head and Neck Surgery, Department of Surgery, University of California Los Angeles School of Medicine, USA. firstname.lastname@example.org
OBJECTIVE: The study goal was to document the reliability, incidence of complications, and cost of therapy for patients older than 80 years who undergo microvascular head and neck reconstruction. PATIENTS AND METHODS: Thirteen octogenarians underwent free flap reconstruction of defects resulting from the treatment of head and neck cancer at an academic tertiary care medical center. The incidence of medical and reconstructive complications and the cost of hospitalization were compared with those for 99 younger patients who were treated during the same time period. RESULTS: There were no cases of free flap failure or significant reconstructive complications in the octogenarians. The incidence of medical complications was 62% in the octogenarians and 15% in the younger patients. The average cost of therapy was $54,702 per octogenarian patient compared with $30,397 per younger patient. The increased incidence of medical complications and increased cost arose primarily from an increased severity of preoperative systemic illness in the octogenarians. However, controlling for comorbidity did not eliminate the discrepancy in medical complications between the octogenarians and the younger patients. CONCLUSIONS: Although microvascular head and neck reconstruction in the elderly is very reliable, the incidence of medical complications and the cost of therapy are significantly increased in octogenarians.
UI - 10543650
AU - Groell R; Willfurth P; Schaffler GJ; Mayer R; Schmidt F; Uggowitzer MM;
TI - Tillich M; Genser B Contrast-enhanced spiral CT of the head and neck: comparison of contrast material injection rates.
SO - AJNR Am J Neuroradiol 1999 Oct;20(9):1732-6
AD - Department of Radiology, University Hospital Graz, Austria.
BACKGROUND AND PURPOSE: Contrast-enhanced spiral CT studies of the head and neck are performed frequently using contrast material volumes of approximately 30 g iodine and a scan delay of 30-45 seconds. Because little is known about the effects of contrast material injection rates on tissue enhancement, this was prospectively investigated in our study. METHODS: Ninety-seven patients underwent spiral CT of the head and neck. Each patient was assigned randomly to one of four groups who received 100 mL of nonionic contrast material (300 mg I/mL) at different monophasic injection flow rates with 1.5, 2, 3, and 4 mL/s. Scanning started after a constant delay of 35 seconds. The attenuation of the carotid artery, jugular vein, and sternocleidomastoid muscle was measured over time and the attenuation of the submandibular and thyroid gland was evaluated. Vascular attenuation of at least 150 HU was considered to be sufficient. RESULTS: The mean scan time was 33+/-5 seconds. The study, using an injection rate of 2 mL/s, showed the longest time of sufficient overall (arterial and venous) vessel attenuation (27+/-4 seconds, P< or =.008). The injection flow rate did not influence significantly muscular attenuation (mean enhancement during scan time: 9+/-7 HU). The 1.5 mL/s protocol showed the lowest attenuation values of the submandibular gland (81+/-12 HU) and the highest attenuation values of the thyroid gland (164+/-22 HU), but the attenuation of the thyroid gland was not statistically different from that revealed by the 2 mL/s protocol. CONCLUSION: Using 100 mL of intravenous contrast material with 300 mg I/mL for spiral CT studies of the entire head and neck, the optimal injection flow is 2 mL/s, whereas lower flow rates resulted in insufficient venous enhancement.
UI - 12007936
AU - Lee N; Xia P; Quivey JM; Sultanem K; Poon I; Akazawa C; Akazawa P;
TI - Weinberg V; Fu KK Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience.
SO - Int J Radiat Oncol Biol Phys 2002 May 1;53(1):12-22
AD - Department of Radiation Oncology, University of California-San Francisco, 505 Parnassus Avenue, L-08, San Francisco, CA 94143, USA. email@example.com
PURPOSE: To update our experience with intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma (NPC). METHODS AND IMRT for NPC at the University of California-San Francisco (UCSF). There were 20 females and 47 males, with a mean age of 49 (range 17-82). The disease was Stage I in 8 (12%), Stage II in 12 (18%), Stage III in 22 (33%), and Stage IV in 25 (37%). IMRT was delivered using three different techniques: 1) manually cut partial transmission blocks, 2) computer-controlled auto-sequencing segmental multileaf collimator (SMLC), and 3) sequential tomotherapy using a dynamic multivane intensity modulating collimator (MIMiC). Fifty patients received concomitant cisplatinum and adjuvant cisplatinum and 5-FU chemotherapy according to the Intergroup 0099 trial. Twenty-six patients had fractionated high-dose-rate intracavitary brachytherapy boost and 1 patient had gamma knife radiosurgery boost after external beam radiotherapy.The prescribed dose was 65-70 Gy to the gross tumor volume (GTV) and positive neck nodes, 60 Gy to the clinical target volume (CTV), 50-60 Gy to the clinically negative neck, and 5-7 Gy in 2 fractions for the intracavitary brachytherapy boost. Acute and late normal tissue effects were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria. The local progression-free, local-regional progression-free, distant metastasis-free rates, and the overall survival were calculated using the Kaplan-Meier method. RESULTS: With a median follow-up of 31 months (range 7 to 72 months), there has been one local recurrence at the primary site. One patient failed in the neck. Seventeen patients developed distant metastases; 5 of these patients have died. The 4-year estimates of local progression-free, local-regional progression-free, and distant metastases-free rates were 97%, 98%, and 66% respectively. The 4-year estimate of overall survival was 88%. The worst acute toxicity documented was as follows: Grade 1 or 2 in 51 patients, Grade 3 in 15 patients, and Grade 4 in 1 patient. The worst late toxicity was Grade 1 in 20 patients, Grade 2 in 15 patients, Grade 3 in 7 patients, and Grade 4 in 1 patient. At 3 months after IMRT, 64% of the patients had Grade 2, 28% had Grade 1, and 8% had Grade 0 xerostomia. Xerostomia decreased with time. At 24 months, only one of the 41 evaluable patients had Grade 2, 32% had Grade 1, and 66% had Grade 0 or no xerostomia. Analysis of the dose-volume histograms (DVHs) showed that the average maximum, mean, and minimum dose delivered were 79.3 Gy, 74.5 Gy, and 49.4 Gy to the GTV, and 78.9 Gy, 68.7 Gy, and 36.8 Gy to the CTV. An average of only 3% of the GTV and 3% of the CTV received less than 95% of the prescribed dose. CONCLUSION: Excellent local-regional control for NPC was achieved with IMRT. IMRT provided excellent tumor target coverage and allowed the delivery of a high dose to the target with significant sparing of the salivary glands and other nearby critical normal tissues.
UI - 12007938
AU - Clippe S; Pommier P; Poupart M; Ceruse P; Rosenbusch T; Ramade A;
TI - Montbarbon X; Gerard JP; Carrie C; Ardiet JM Role of brachytherapy in treatment of epidermoid carcinomas of the vallecula after conservative supraglottic laryngectomy followed by irradiation.
SO - Int J Radiat Oncol Biol Phys 2002 May 1;53(1):29-35
AD - Department of Radiotherapy, Centre Leon Berard, 28 rue Laennec, Lyon 69008, France. firstname.lastname@example.org
PURPOSE: To evaluate survival and functional results of the treatment of carcinomas of the vallecula using surgery, irradiation, and interstitial brachytherapy. METHODS AND MATERIALS: Between 1990 and 1998, 36 patients with squamous cell carcinoma of the vallecula were treated with horizontal supraglottic functional laryngectomy, external beam radiotherapy (median dose 54 Gy), and additional interstitial brachytherapy (median dose 16 Gy). Results were compared with a previous series of 22 patients treated without brachytherapy. RESULTS: The median follow-up was 44 months. The 5-year actuarial overall survival rate was 61.3%. The 5-year specific survival rate was 86%, with 2 local failures (local control rate 94.4%) and 4 isolated distant metastases. Ten patients developed a second primary. The overall survival was 34% for 22 patients previously treated without brachytherapy. Severe toxicities occurred in 9 patients: death (related to larynx edema or inhalation, n = 1), soft tissue necrosis (n = 1), aspiration pneumonia (n = 1), mandibular necrosis (n = 2), pharyngocutaneous fistula (n = 2), and laryngeal edema (n = 2). All the patients fed orally with no definitive gastrostomy or tracheotomy. CONCLUSION: Additional brachytherapy for vallecula carcinoma seems to improve locoregional control and overall survival dramatically. Functional results were also excellent. To our knowledge, this original therapeutic schedule has never been previously described.
UI - 12007944
AU - Lee AW; Kwong DL; Leung SF; Tung SY; Sze WM; Sham JS; Teo PM; Leung TW;
TI - Wu PM; Chappell R; Peters LJ; Fowler JF Factors affecting risk of symptomatic temporal lobe necrosis: significance of fractional dose and treatment time.
SO - Int J Radiat Oncol Biol Phys 2002 May 1;53(1):75-85
AD - Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, SAR, China. email@example.com
PURPOSE: To study the factors affecting the risk of symptomatic temporal lobe necrosis after different fractionation schedules. METHODS AND MATERIALS: One thousand thirty-two patients with T1-2 nasopharyngeal carcinoma treated with radical radiotherapy in Hong Kong during 1990-1995 were studied. They were treated at four different centers with similar techniques but different fractionation schedules: 984 patients were given 1 fraction daily throughout (q.d.), and 48 patients were irradiated twice daily (b.i.d.) for part of the course. The median total dose was 62.5 Gy (range 50.4-71.2), dose per fraction was 2.5 Gy (range 1.6-4.2), and overall treatment time (OTT) was 44 days (range 29-70). In addition, 500 patients received supplementary doses for parapharyngeal extension, 113 received booster doses by brachytherapy, and 114 received sequential chemotherapy using cisplatin-based regimes. RESULTS: Altogether, 24 patients developed symptomatic temporal lobe necrosis: 18 from the q.d. group and 6 from the b.i.d. group. The 5-year actuarial incidence ranged from 0% (after 66 Gy in 33 fractions within 44 days) to 14% (after 71.2 Gy in 40 fractions within 35 days). Multivariate analyses showed that the risk was significantly affected by the fractional effect of the product of total dose and dose per fraction (hazard ratio [HR] = 1.04, 95% confidence interval [CI] 1.02-1.05), OTT (HR 0.88, 95% CI 0.80-0.97), and b.i.d. scheduling (HR 13, 95% CI 3-54). Repeating the analyses for patients treated with the q.d. schedules confirmed the independent significance of OTT in addition to the product of total dose and dose per fraction. CONCLUSION: The tentative results suggest that in addition to fractional dose, the OTT also had significant impact on the risk of temporal lobe necrosis, and b.i.d. scheduling increased the hazard further.
UI - 11731428
AU - Starr JR; Daling JR; Fitzgibbons ED; Madeleine MM; Ashley R; Galloway
TI - DA; Schwartz SM Serologic evidence of herpes simplex virus 1 infection and oropharyngeal cancer risk.
SO - Cancer Res 2001 Dec 1;61(23):8459-64
AD - Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195, USA.
In vitro and animal models suggest that the herpes simplex virus 1 (HSV1) may contribute to the development of oropharyngeal squamous cell carcinoma (OSCC). To determine whether the risk of OSCC is related to infection with HSV1 in humans, we recruited 260 patients from 18 to 65 years old who were newly diagnosed with OSCC between 1990-1995 while residing in three western Washington State counties. For comparison, we recruited at random 445 controls frequency matched to cases on age and sex. Participants completed in-person interviews and provided serum samples that were tested for antibody response to HSV1. After adjusting for sex, cigarette smoking, alcohol consumption, age, and income, HSV1 antibody positivity was associated with a slightly increased risk of OSCC [adjusted odds ratio (OR), 1.3; 95% confidence interval (CI), 0.9-2.0]. The adjusted association between HSV1 antibody positivity and OSCC risk among those who were current cigarette smokers (OR, 4.2; CI, 2.4-7.1) was stronger than would be predicted based on the additive combination of smoking alone (OR, 2.3; CI, 1.2-4.2) and HSV1 seropositivity alone (OR, 1.0; CI, 0.6-1.7). There was suggestive evidence that the association between HSV1 infection and OSCC was similarly modified by evidence of HPV infection but no evidence of effect modification with alcohol consumption. This population-based study suggests that HSV1 may enhance the development of OSCC in individuals who are already at increased risk of the disease because of cigarette smoking or HPV infection.
UI - 11836556
AU - Hui AB; Lo KW; Teo PM; To KF; Huang DP
TI - Genome wide detection of oncogene amplifications in nasopharyngeal carcinoma by array based comparative genomic hybridization.
SO - Int J Oncol 2002 Mar;20(3):467-73
AD - Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong, P.R. China. firstname.lastname@example.org
We have applied the method of genomic microarray to investigate amplification of oncogenes throughout the genome of nasopharyngeal carcinoma (NPC). Array based comparative genomic hybridization (array CGH) allows simultaneous examination of 58 oncogenes commonly amplified in various human cancers. In the present study, we have examined 15 NPC samples including five cell lines, two xenografts and eight primary tumours with array CGH to reveal the particular oncogenes associated with this cancer. This is the first genome wide survey of multiple oncogene amplifications involved in the development of NPC. Non-random gene amplifications were identified for the first time in NPC on MYCL1 in 1p34.3 and on TERC and PIK3CA at 3q26.3. Other high level amplified oncogenes included NRAS, RAF1, MYB, EGFR, FGF4, EMS1, and D17S167. Highest frequencies of gain of novel oncogenes were detected on MYCL1 (66.7%), TERC (46.7%), ESR (46.7%), PIK3CA (40%), LAMC2 (33.3%), and CSE1L (33.3%).
UI - 11876609
AU - Dhar PK; Rao TR; Sreekumaran Nair N; Mohan S; Chandra S; Bhat KR; Rao K
TI - Identification of risk factors for specific subsites within the oral and oropharyngeal region--a study of 647 cancer patients.
SO - Indian J Cancer 2000 Jun-Sep;37(2-3):114-22
AD - Department of Anatomy, (Human Genetics Section), Kasturba Medical College, Manipal, Karnataka, India.
Studies on site specific risks for oral cancers are few. Present investigation explores the possible role of human sociodemographic factors in causing oral cancer. Majority of patients had poor oral hygiene (85.5%) and belonged to 51-60 years age group (35.7%). Most of the subjects were agriculture workers (30.3%). Tongue and floor of mouth included majority of the affected sites (77.2%). Male to female ratio was highest for tonsil (32.3%) but differed marginally for other subsites. Majority of females used tobacco (81%) while males users of tobacco, alcohol and smoking reported in nearly equal proportions. Tobacco and smoking were found as primary risk factors for several intraoral subsites. However, for tongue, palate and lip no risk factor could be identified from given patients' characteristics. In general, tobacco posed high risk for buccal mucosa and alveolus in comparison to other subsites. Smoking affected tonsil and floor of mouth more than other sites. Alcohol posed more risk for buccal mucosa and floor of mouth than tongue.
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