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Abramson Cancer CenterNCI CANCERLIT® Search: Pharyngeal Cancer - May 2002
National Cancer Institute®
Last Modified: May 1, 2002
Table of Contents
1
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. markus.fischer@uni-essen.de
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.
2
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.
3
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.
4
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.
5
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.
6
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.
7
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. khchi@vghtpe.gov.tw
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.
8
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.
9
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.
10
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.
11
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. ejgn@sun.ac.za
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.
12
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.
hyabuu@nk-cc.go.jp
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.
13
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.
tavani@marionegri.it
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.
14
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.
15
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.
16
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. tangl@public.cs.hn.cn
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.
17
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. kblackwe@ucla.edu
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.
18
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.
19
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.
leen@radonc17.ucsf.edu
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.
20
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. clippe@lyon.fnclcc.fr
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.
21
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.
awmlee@ha.org.hk
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.
22
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.
23
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. b677750@mailserv.cuhk.edu.hk
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%).
24
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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