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NCI CANCERLIT® Search: Pharyngeal Cancer - June 2002
National Cancer Institute®
Last Modified: June 1, 2002
- Oral squamous cell carcinoma; from an hypothesis about a virus, to concern about possible sexual transmission.
- 10-minute consultation: rhinitis. Article is unhelpful.
- [Diagnostic evaluation of nasopharyngeal carcinoma: role of Epstein-Barr virus]
- Epstein Barr virus associated pediatric nasopharyngeal carcinoma: its correlation with p53 and bcl-2 expression.
- [Transmaxillary approach for surgical removal of the invasive skull base tumors]
- [Visceral voice training for laryngectomy after hypopharyngectomy and visceral transplant]
- [Endoscopic nasal surgery in treatment of nasopharyngeal angiofibroma]
- [Mandibular swing procedure for resection of pharyngeal and skull base tumors]
- A survey of researches on synergy and toxicity abatement of traditional Chinese medicine in radiotherapy of nasopharyngeal carcinoma.
- A prospective, randomized trial comparing neoadjuvant chemotherapy with radiotherapy alone in patients with advanced nasopharyngeal carcinoma.
- Squamous cell carcinoma of the nasopharynx--an analysis of treatment results in 149 consecutive patients.
- Analysis of EBV latency by EBER in situ hybridization in nasopharyngeal carcinoma Spanish patients.
- Peripheral gamma delta T-cell deficit in nasopharyngeal carcinoma.
- Nasopharyngeal carcinoma: treatments and outcomes in the 20th century.
- The use of stereotactic navigation guidance in minimally invasive transnasal nasopharyngectomy: a comparison with the conventional open
- Concomitant chemoirradiation for stage III-IV nasopharyngeal carcinoma in Chinese patients: results of a matched cohort analysis.
- Improvement of local control of T3 and T4 nasopharyngeal carcinoma by hyperfractionated radiotherapy and concomitant chemotherapy.
- [Treatment of nasopharyngeal cancer: literature review]
- [Jejunal free flap for reconstruction of the hypopharynx]
- Clinical profile and multimodality approach in the management of juvenile nasopharyngeal angiofibroma.
- [Induction chemotherapy and larynx preservation: is such practice useful?]
- [Lip, oral cavity and pharynx cancers in France: incidence, mortality and trends (period 1975-1995)]
- The prepuce free flap in 10 patients: modifications in flap design and surgical technique.
- [Commentary on the letter: "Azathioprine and cavum carcinoma in a male patient with autoimmune hepatitis and Crohn's disease"]
- [Collagenase 3 mRNA expression in squamous epithelial carcinomas of the oropharynx]
- [Study on the mechanism of basic fibroblast growth factor (bFGF) release induced by phorbol ester PMA]
- Combined chemoradiation versus radiation therapy alone in locally advanced nasopharyngeal carcinoma: results of a meta-analysis of 1,528
- [Parapharyngeal space-occupying lesions. Differential diagnosis based on case examples]
- [Current status of radiation therapy--evidence-based medicine (EBM) of radiation therapy. Radiotherapy for pharyngeal and laryngeal cancer]
Table of Contents
1
UI - 11978544
AU - Scully C
TI -
Oral squamous cell carcinoma; from an hypothesis about a virus, to
concern about possible sexual transmission.
SO - Oral Oncol 2002 Apr;38(3):227-34
AD - International Centres for Excellence in Dentistry, and Eastman Dental
Institute for Oral Health Care Sciences UCL, University of London, 256
Gray's Inn Road, WC1X 8LD, London, UK. c.scully@eastman.ucl.ac.uk
Nearly two decades ago, we produced the first evidence for the presence
of viral nucleic acids in oral squamous cell carcinoma (OSCC) tissues,
hypothesising that there may be a viral involvement in at least some
OSCC. Subsequently, human papillomaviruses (HPV) in particular have been
implicated in OSCC. Antibody responses to HPV are seen and HPV-DNA
detected in tumors by us and many others, the virus being mainly HPV-16,
the genotype associated with ano-genital cancer. HPV are seen by in situ
hybridisation only in tumour and premalignant tissue but not in
surrounding normal mucosa suggesting HPV has a causal relationship. HPV
may also be integrated in the host genome, further suggesting a causal
role. Studies of patients with OSCC have suggested possible sexual
transmission of HPV. Recent studies have indicated that HPV may be
aetiologically important particularly in some types of oropharyngeal
cancer, at least in tonsillar carcinogenesis, and may represent an
alternative pathway in carcinogenesis to the established factors of
tobacco and alcohol. We have come a very long way in the two decades
since our first suggestion of a viral aetiopathogenesis was greeted with
incredulity, and data from on-going studies by the International Agency
for Research on Cancer, Johns Hopkins Oncology Center and others are
eagerly awaited.
2
UI - 12018224
AU - McCombe A
TI -
10-minute consultation: rhinitis. Article is unhelpful.
SO - BMJ 2002 May 18;324(7347):1219
3
UI - 11962004
AU - Plaza G; Fogue L; Martinez San Millan J; Martinez Vidal A; Bellas C
TI -
[Diagnostic evaluation of nasopharyngeal carcinoma: role of Epstein-Barr
virus]
SO - An Otorrinolaringol Ibero Am 2002;29(1):71-91
AD - Unidad de Otorrinolaringologia, Fundacion Hospital Alcorcon.
gmayor@ctv.es
We present a retrospective series of 27 nasopharyngeal carcinomas,
selected from those attended at Ramon y Cajal Hospital between 1977 and
1996, with the aim of review the role of the study of Epstein-Barr virus
in the diagnostic process of nasopharyngeal carcinoma. Twenty-seven
patients, ranging from 14 to 81 years, with an average age of 50 years
were selected. Male/female ratio was 1,7. All but one case were
Caucasian. A neck mass was the first symptom in 40% of cases, with a
mean diagnostic delay of 17 months. Only 8 cases (23%) did not exhibit
neck nodes at the moment of diagnosis. CT and MRI were essential to
establish staging: 5 stage I, 7 stage II and 15 stage IV, due to
regional extension and/or bone erosion. Radiotherapy was employed in all
cases, helped by chemotherapy in 20% of them. With a mean follow-up of
62 months, 5-years survival was 32% (IC 14,06-52,09). Of 27 cases of
nasopharyngeal carcinoma 4 were differentiated (type I), 2 moderately
differentiated (type II) and 22 undifferentiated (type III). While LMP-1
was only expressed by 41% of cases, PCR detected Epstein-Barr virus
genome in 26 cases (96%) and in situ hybridization for EBERs was
positive in all cases. Thus, all nasopharyngeal carcinomas were related
to Epstein-Barr virus. Expression of LMP-1 seemed to worse the prognosis
of nasopharyngeal carcinoma.
4
UI - 11979459
AU - Preciado MV; Chabay PA; De Matteo EN; Gismondi MI; Rey G; Zubizarreta P
TI -
Epstein Barr virus associated pediatric nasopharyngeal carcinoma: its
correlation with p53 and bcl-2 expression.
SO - Med Pediatr Oncol 2002 May;38(5):345-8
AD - Virology Laboratory, Ricardo Gutierrez Children's Hospital, Buenos
Aires, Argentina. preciado@conicet.gov.ar
BACKGROUND: Pediatric nasopharyngeal carcinoma (NPC) is relatively rare.
The Epstein Barr virus (EBV) association with the oncogenesis of NPC is
well established. Apoptosis-related proteins, p53 and bcl-2, have also
been described in adult NPC pathogenesis. PROCEDURE: From 1988 to 1998,
16 patients with NPC were treated at R. Gutierrez Children's Hospital
and the National J.P. Garrahan Pediatric Hospital. Their median age was
12 years (range 8-20), 2 females and 14 males. The presence of p53,
bcl-2 and latent membrane protein-1 (LMP-1) of EBV expression was
studied by immunohistochemistry and Epstein Barr encoded RNAs (EBERs) by
in situ hybridization in tissue sections from formalin-fixed,
paraffin-embedded NPC biopsies RESULTS: EBV presence and LMP-1
expression in epithelial tumor cells were detected in all the biopsies
studied. p53 was expressed in 13/16 NPCs, but the frequency of positive
malignant cells differed from case to case, ranging from less than 25 to
100% with heterogeneous staining intensity. Bcl-2 positive staining in
tumor epithelial cells was detected in 2/16; whereas 10/16 cases showed
bcl-2 positivity in infiltrating lymphocytes. CONCLUSIONS: Although our
series is small, we conclude that the pathogenesis of pediatric NPC as a
multistep process may well involve EBV infection. This leads to LMP-1
expression and p53 overexpression in epithelial tumor cells, whereas
bc-2 seems unrelated to the development of this disorder. Copyright 2002
Wiley-Liss, Inc.
5
UI - 11955386
AU - Guo J; Qi Y; Xu Z; Yin Y; Zhang S; Zuo H
TI -
[Transmaxillary approach for surgical removal of the invasive skull base
tumors]
SO - Zhonghua Wai Ke Za Zhi 2002 Feb;40(2):87-9
AD - Department of Neurosurgery, China-Japan Friendship Hospital, Beijing
100029, China.
OBJECTIVE: To investigate the capable use of transmaxillary approach for
surgical removal of invasive skull base tumors, the indications and the
27 consecutive patients with skull base tumor were operated through
transmaxillary approach, including 6 patients with nasopharyngeal
carcinoma, 5 with nasopharyngeal angiofibroma, 5 with nasopharyngeal
cystadenocarcinoma, 2 with olfactory neuroblastoma, 2 with poorly
differentiated carcinoma, 2 with sarcoma, 1 with maxillary carcinoma, 2
with schwannoma, and 2 with chordoma. Most of them (18/27) were
recurrent tumor and 17/27 tumors involved important intracranial
structures. All patients were followed up 2 - 33 months (average 16
months) and the clinical data was reviewed. RESULTS: The tumors could be
totally removed in all patients. There were no operative mortality and
morbidity. After operation, 2 patients died of cancer recurrence in 5
and 8 months separately. One patient had metastasis to the lungs 11
months after operation. Two patients had local recurrence in 7 and 12
months postoperation seperately and live with the tumor now. The rest
patients are back to their routine life. CONCLUSIONS: Transmaxillary
approach facilitates the surgical removal of invasive skull base tumors.
The exposure is wide. The lesion as well as the important anatomy
structures can be viewed directly and clearly. The tumor removal could
be done more thoroughly and safely. This approach is suitable for the
patients in whom tumor involves the skull base extensively and may be
difficult to deal with by other approaches.
6
UI - 11938839
AU - Lu C; Tu G; Tang P
TI -
[Visceral voice training for laryngectomy after hypopharyngectomy and
visceral transplant]
SO - Zhonghua Er Bi Yan Hou Ke Za Zhi 1998 Dec;33(6):325-7
AD - Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Peking
Union Medical Collage, Beijing 100021.
OBJECTIVE: To establish a way to visceral voice after stomach or colon
transplantation for patients with hypopharyngeal or cervical esophageal
cancer. METHODS: Esophageal voice training was used and modified
according to the compliance of the patients. Twenty laryngectomies with
replacement of the hypopharynx and esophagus by stomach(13 cases),
colon(6 cases) and jejunum (1 case) were trained for voice
rehabilitation at the Department of Head and Neck Surgery. RESULTS: The
patients with an artificial esophagus from vicera were easy to gain an
influx of certain volume of gas into their artificial esophagus (stomach
or colon) and to learn to speak. But on the whole the quality of voice
was not so satisfactory. In this series nineteen out of 20 patients
(95%) could express their idea by speech after a training course of
three weeks. CONCLUSION: The literature has emphasized role of
cricopharyngeus muscle in the training of esophageal voice. Owing to the
fact that this series of patients who had had their cricopharyngeus
removed, could easily get their voice rehabilitated, it seems this
muscle played no major role in the voice rehabilitation.
7
UI - 11938850
AU - Han D; Chen X; Wang J
TI -
[Endoscopic nasal surgery in treatment of nasopharyngeal angiofibroma]
SO - Zhonghua Er Bi Yan Hou Ke Za Zhi 1998 Dec;33(6):358-60
AD - Beijing Tongren Hospital, Capital University of Medical Sciences,
Beijing, 100730.
OBJECTIVE: To avoid complications of the routine surgeries for
nasopharyngeal angiofibroma. METHODS: Endoscopic nasal surgery and other
new techniques including controlled-hypotension anesthesia and
nasopharyngeal angiofibroma were treated by endoscopic sinus surgery.
The average age was 16.6 years old. Six accepted preoperative embolism,
seven accepted hypotension anesthesia. RESULTS: No complications had
occurred. Average intraoperative blood loss was 900 ml. All cases were
followed for 1 to 20 months(mean 8 months). Recurrence was found in only
one patient three months after operation. The recurrent rate was 12.5%.
CONCLUSION: The lesions limited to nasal and nasopharyngeal cavities and
with sphnoid and ethmoid invasions can be removed by endoscopic nasal
surgery. Endoscopic surgery has advantages in reducing complications and
obtaining better post operative functions. Transnasal endoscopic
examination is also necessary in the follow-up period. Other techniques
such as CT, digital subtract angiography, preoperative feeding artery
embolism and controlled-hypotension technique during anesthesia are
beneficial.
8
UI - 11938854
AU - Wang T; Li M; Xu A
TI -
[Mandibular swing procedure for resection of pharyngeal and skull base
tumors]
SO - Zhonghua Er Bi Yan Hou Ke Za Zhi 1998 Dec;33(6):371-4
AD - First Affiliated Hospital, Shandong Medical University, Jinan 250012.
OBJECTIVE: To seek for a better approach for the resection of pharyngeal
and skull base tumors. METHODS: The overall tumor distribution for the
entire group was nasopharyngeal 2 cases, oropharyngeal 4, parapharyngeal
space 5 and parapharyngeal infratemporal area 2 cases. All 13 cases of
pharyngeal and skull base tumors had their tumors thoroughly resected
via mandibular swing approaches. Five cases had retropharyngeal node
dissections, 2 cases had unilateral modified radical neck dissections, 5
cases with defect oropharynx were reconstructed with the pectoralis
major myocutaneous flap, 10 cases with malignant tumors had received
adjutant radiotherapy after surgical procedures. RESULTS: Of the 13
cases, 10 were malignant, 3 were benign. The incision in 12 cases healed
primarily, one case with malignant fibrocystic tumor got infective
necrosis of pectoralis major myocutaneous flap, this case healed
completely after more than two months. One case developed dysphagia
postoperatively and was recovered by swallow training. One case had
minimal occlusion disorder. All patients were followed up from 15 months
to 3 years. Three cases with benign tumors achieved good clinical
results and are living well. In the malignant group, one died of
recurrence at 6 months postoperatively, one died of lung metastasis, 2
cases survived for 3 years, 2 for two years, 4 for one year. CONCLUSION:
This procedure provides good exposure of the base of the skull, the
pharynx and the parapharyngeal space as well as the clivus and upper
cervical vertebrae; it allows dissection along the internal carotid
artery and facilitates resection of the tumor en bloc. It provides
operative safety and minimal morbidity.
9
UI - 12014137
AU - Liu C; Liu L; Li P
TI -
A survey of researches on synergy and toxicity abatement of traditional
Chinese medicine in radiotherapy of nasopharyngeal carcinoma.
SO - J Tradit Chin Med 2001 Dec;21(4):303-11
AD - Municipal Hospital of Traditional Chinese Medicine, Zhaoqing, Guangdong
526020.
10
UI - 12001120
AU - Hareyama M; Sakata K; Shirato H; Nishioka T; Nishio M; Suzuki K; Saitoh
TI -
A; Oouchi A; Fukuda S; Himi T
A prospective, randomized trial comparing neoadjuvant chemotherapy with
radiotherapy alone in patients with advanced nasopharyngeal carcinoma.
SO - Cancer 2002 Apr 15;94(8):2217-23
AD - Department of Radiology, School of Medicine, Sapporo Medical University,
Sapporo, Japan. hareyama@sapmed.ac.jp
BACKGROUND: A prospective, randomized study was performed to determine
the efficacy of neoadjuvant chemotherapy over radiotherapy alone in
patients with locally advanced nasopharyngeal carcinoma. METHODS: From
Patients with locoregional carcinoma of the nasopharynx were randomized
to receive two courses of chemotherapy, consisting of cisplatin and
5-fluorouracil (CDDP-5FU), that were administered before radiation
therapy (CT arm) or radiotherapy alone. The patients who received
neoadjuvant chemotherapy were treated with radiation therapy, which was
scheduled to commence 2 weeks after the second course chemotherapy.
RESULTS: With a median follow-up of 49 months, a trend toward improved
overall survival or disease free survival favoring the CT arm was
observed (5-year overall survival rate, 60% vs. 48%; 5-year disease free
survival rate, 55% vs. 43%), although this difference was not
significant. There were no differences in locoregional failure free
survival between the two arms. However, metastasis free survival favored
the CT arm, although this difference was not significant. The results
also demonstrated that most patients in the CT arm who experienced
recurrent disease developed locoregional recurrences before distant
metastases, suggesting that improvements in locoregional control may
lead to improved disease free survival. CONCLUSIONS: The use of CDDP-5FU
chemotherapy prior to radiotherapy in patients with nasopharyngeal
carcinoma did not result in a significant improvement in disease free
survival or overall survival. However, there was a positive tendency in
favor of the CT arm for distant metastasis free survival, although there
was no improvement in the locoregional recurrence free survival rate.
Copyright 2002 American Cancer Society.
11
UI - 11859978
AU - Johansen LV; Grau C; Overgaard J
TI -
Squamous cell carcinoma of the nasopharynx--an analysis of treatment
results in 149 consecutive patients.
SO - Acta Oncol 2001;40(7):801-9
AD - Department of Experimental Clinical Oncology, Danish Cancer Society,
Aarhus University Hospital. larsvendelbo@dadlnet.dk
The purpose of this study was to evaluate the outcome of primary
treatment and treatment of recurrences in patients with nasopharyngeal
carcinoma. The material included 149 consecutive patients seen at the
Aarhus University Hospital from 1963 to 1991 (49 females and 100 males).
The stage distribution was: Stage I-9%, II-3%, III-28%, and IV-60%.
Primary treatment was delivered with curative intent in 145 patients
(97%). Persistent or recurrent disease after primary radical treatment
was observed in 82 of the patients; 54% at the T-level, 40% at the
N-level, and 33% at the M-level. A curative salvage attempt was carried
out in 14 patients only, all with nodal recurrence: surgery in 8
patients (4 controlled) and radiotherapy in 6 patients (2 controlled).
The 5-year local tumour control, locoregional tumour control,
disease-specific survival rate and the overall survival rate for the
patients treated with curative intent were 66%, 53%, 50% and 43%,
respectively. Most of the patients (88%) had poorly differentiated
tumours and these patients had the best prognosis. A major complication
in three patients was radiation-induced myelopathy due to high-dose
radiation delivered to the brain stem. Significant positive prognostic
factors for treatment outcome in univariate analyses were early
T-classification, small clinical stage, poor differentiation and low
age. The Cox multivariate analysis showed that early T-categories, low
N-categories and poor differentiation were independent, positive
prognostic factors. Nasopharyngeal carcinoma is curable with primary
radiotherapy; patients with poorly differentiated tumours have the best
prognosis. Only a few patients were salvaged after recurrence. The
factor most essential for success is primary control of the disease at
the T- and N-levels.
12
UI - 11911270
AU - Burgos JS; Vera-Sempere FJ
TI -
Analysis of EBV latency by EBER in situ hybridization in nasopharyngeal
carcinoma Spanish patients.
SO - Anticancer Res 2001 Nov-Dec;21(6A):3921-4
AD - Centro de Biologia Molecular Severo Ochoa-C.S.I.C., Facultad de
Ciencias, Universidad Autonoma de Madrid, Cantoblanco, Spain.
jburgos@cbm.uam.es
BACKGROUND: The aim of this study was to analyse the Epstein-Barr virus
(EBV) latency by detecting the EBV-associated latent small nuclear RNAs
(EBER), in a group of biopsies from Spanish patients with diagnosed
nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: NPC paraffin
samples with the presence of EBV demonstrated by non-isotopic in situ
hybridization (NISH) and nested-PCR, were analysed for EBV latency using
EBER in situ hybridization (EBER-ISH). RESULTS: We detected EBER in
83.3% of samples (10 out of 12 cases), demonstrating the relationships
between EBV genome presence with the latent viral infection. We
correlated these results of EBV-DNA and -RNA presence with the
immunoexpression of latent membrane protein-1 (LMP-1), a viral oncogenic
protein (8 out of 12 cases or 66.6%). CONCLUSION: These results indicate
that all the types of NPC are variants of an EBV-associated malignancy
and that viral latency is a critical phenomenon in the development of
this neoplasia.
13
UI - 11979436
AU - Zheng BJ; Ng SP; Chua DT; Sham JS; Kwong DL; Lam CK; Ng MH
TI -
Peripheral gamma delta T-cell deficit in nasopharyngeal carcinoma.
SO - Int J Cancer 2002 May 10;99(2):213-7
AD - Department of Microbiology, The University of Hong Kong, Queen Mary
Hospital, Hong Kong SAR, People's Republic of China.
Previous studies identified CD56(+) and CD56(-) subsets of peripheral
gamma delta T cells from healthy donors. Both subsets responded to
stimulation by a myeloma cell line, XG-7 and undergo vigorous ex vivo
expansion in the presence of exogenous IL-2. They are cytotoxic for
different tumor targets including nasopharyngeal carcinoma, but they
differ from one another in that the CD56(-) subset has an additional
growth requirement for IL-7 and exhibited greater cytotoxicity against
nasopharyngeal carcinoma (NPC) targets. These immune cells were further
shown to retard tumor growth in a nude mice NPC model. To assess if
these immune cells might contribute to host defense against NPC, we
compared gamma delta T-cell status of NPC patients with healthy donors
and survivors who had been in clinical remission of the cancer. It was
found that peripheral gamma delta T cells of patients were impaired in
their response to the stimulatory effects of XG-7 and exhibited weak or
essentially no cytotoxicity for the NPC targets. The deficits were
present in early and advanced stages of the cancer but were restored
among survivors after successful treatment of the cancer. These findings
support a role for peripheral gamma delta T cells in host defense
against NPC. It was noted that these immune cells comprise less than 5%
of peripheral blood monocytic cells and hence it was not surprising that
this component of host defense was breached early in the development of
the cancer. Copyright 2002 Wiley-Liss, Inc.
14
UI - 12000691
AU - Mould RF; Tai TH
TI -
Nasopharyngeal carcinoma: treatments and outcomes in the 20th century.
SO - Br J Radiol 2002 Apr;75(892):307-39
AD - Department of Radiation Oncology, Allan Blair Cancer Centre, 4101
Dewdney Avenue, Regina, Saskatchewan, S4T 7T1 Canada.
Nasopharyngeal carcinoma (NPC), although rare in Europe and North
America, is not uncommon in parts of Asia such as southern China and
Hong Kong. Consequently, very few oncologists in the Western world have
extensive experience in treating this neoplasm. Treatment using external
beam therapy and/or brachytherapy evolved greatly during the 20th
century and is still evolving, particularly with the use of adjunctive
chemotherapy regimes. Diagnosis of NPC has also improved with the
availability of CT and MRI. This worldwide review is divided into
historical, transitional and modern eras, with the latter concerning
1971-2000. Currently, the most controversial aspects of NPC are
recommendations for treatment of recurrent disease and the role of
chemotherapy in the overall framework of treatment. Comparison of
results from different centres is not possible without an understanding
of the various staging systems that are, and have been, used; a
comparison is given in this review. In the future, early diagnosis,
adequate radiation dose to the primary with boost to bulky disease, and
regular follow-up with biopsy of any suspicious residual or recurrent
disease, are likely to become key issues to improve outcome. Also, apart
from direct/indirect nasopharyngoscopy, the role of follow-up CT needs
to be studied for early detection of residual or recurrent disease. More
clinical trials on chemo-radiation are also required, in order to study
optimum doses and agents.
15
UI - 12000693
AU - To EW; Yuen EH; Tsang WM; Lai EC; Wong GK; Sun DT; Chan DT; Lam JM;
TI -
Ahuja A; Poon WS
The use of stereotactic navigation guidance in minimally invasive
transnasal nasopharyngectomy: a comparison with the conventional open
transfacial approach.
SO - Br J Radiol 2002 Apr;75(892):345-50
AD - Division of Head and Neck-Plastic and Reconstructive Surgery, Department
of Surgery, The Chinese University of Hong Kong, Prince of Wales
Hospital, Shatin, Hong Kong.
The purpose of this paper is to study the efficacy of applying
stereotactic navigation guidance to nasopharyngectomy via a minimally
invasive transnasal approach as compared with the conventional open
transfacial approaches. The nasopharynx is the centre of the anterior
skull base, which is remote from the surface of the facial skeleton. It
is well known that there are several surgical approaches for access to
resect tumours from the nasopharynx. However, the open techniques have
been associated with much morbidity and only provide access to, and
identification of, the ipsilateral internal carotid artery that forms
the lateral boundary and resection limit of the nasopharynx. The
coupling of stereotactic navigation guidance and a minimally invasive
transnasal approach for nasopharyngectomy allows the surgeon to identify
and protect the internal carotid artery bilaterally at the nasopharynx.
This technique reduces operating time and morbidity to a minimum and yet
is oncologically sound for resecting nasopharyngeal lesions. We compare
15 patients who underwent the stereotactic navigation guidance approach
with 20 patients who received a conventional open transfacial approach.
16
UI - 12023137
AU - Chua DT; Sham JS; Au GK; Choy D
TI -
Concomitant chemoirradiation for stage III-IV nasopharyngeal carcinoma
in Chinese patients: results of a matched cohort analysis.
SO - Int J Radiat Oncol Biol Phys 2002 Jun 1;53(2):334-43
AD - Department of Clinical Oncology, University of Hong Kong, Queen Mary
Hospital, Pokfulam, Hong Kong SAR, China. dttchua@hkucc.hku.hk
PURPOSE: To evaluate the toxicity and efficacy of concomitant
chemoirradiation (CRT) followed by adjuvant chemotherapy compared with
radiotherapy (RT) alone in Chinese patients with locoregionally advanced
nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: Between March
and IV (n = 38, 81%) NPC were treated with by CRT using cisplatin 100
mg/m(2) on Days 1, 22, and 43 of RT, plus adjuvant chemotherapy using
cisplatin 80 mg/m(2) for 1 day and 5-fluorouracil 1 g/m(2) for 4 days on
Days 71, 99, and 127. These patients were then compared with a cohort of
47 patients treated between 1990 and 1993 with RT alone, who were
matched with respect to T stage, N stage, nodal bilaterality, nodal
level, and nodal size. The RT techniques were similar in the two groups
but different dose and fractionation schemes were used. The median
biologic equivalent dose to 2 Gy per fraction delivered to the
nasopharynx was 68 Gy in the CRT group and 65.3 Gy in the RT-alone
group. RESULTS: The compliance rates were 62% for concomitant
chemotherapy and 40% for adjuvant chemotherapy. No treatment-related
deaths occurred. At the end of treatment, 96% of the CRT group and 79%
of the RT-alone group achieved a complete response (p = 0.013). With a
median follow-up of 26 months, the 3-year relapse-free survival,
disease-specific survival, overall survival, local relapse-free
survival, nodal relapse-free survival, and distant metastasis-free
survival rate for the CRT group and the RT-alone group was 62% vs. 44%
(p = 0.048), 67% vs. 71% (p = 0.88), 65% vs. 69% (p = 0.93), 87% vs. 75%
(p = 0.059), 95% vs. 80% (p = 0.026), and 75% vs. 70% (p = 0.84),
respectively. CONCLUSION: Our experience indicates that concomitant CRT
improves locoregional control in Chinese patients with locoregionally
advanced NPC, but our analyses failed to detect any impact on distant
failure and survival. The failure to reduce distant metastasis and
improve survival may have related in part to the more advanced disease
stage in our patients and the relatively low compliance rate of adjuvant
chemotherapy. Our findings suggest caution should be exercised in
extrapolating the findings of the Intergroup Study 0099 to Chinese
patients, and confirmatory results from prospective randomized studies
in the endemic population are needed.
17
UI - 12023138
AU - Jian JJ; Cheng SH; Tsai SY; Yen KC; Chu NM; Chan KY; Tan TD; Cheng JC;
TI -
Lin YC; Leu SY; Hsieh CI; Tsou MH; Lin CY; Huang AT
Improvement of local control of T3 and T4 nasopharyngeal carcinoma by
hyperfractionated radiotherapy and concomitant chemotherapy.
SO - Int J Radiat Oncol Biol Phys 2002 Jun 1;53(2):344-52
AD - Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer
Center, Pei-Tou, Taipei, Taiwan. jamesjian@mail.kfcc.org.tw
PURPOSE: When the primary tumor of nasopharyngeal carcinoma (NPC) is
treated at the base of skull and intracranium with conventional
radiotherapy, the result is generally poor. In this report, we
investigated whether hyperfractionated radiotherapy (HFRT) and
concomitant chemotherapy (CCT) could achieve better local control and
survival in NPC patients with T3 and T4 lesions. PATIENTS AND METHODS:
Forty-eight patients (11 T3 and 37 T4 NPC) were treated with HFRT and
CCT. HFRT was administered at 1.2 Gy per fraction, two fractions per
day, Monday-Friday for 62 fractions for a total dose of 74.4 Gy.
Concomitant chemotherapy consisting of cis-diamino-dichloroplatinum
(CDDP) alone or CDDP and 5-fluorouracil was delivered simultaneously
with radiotherapy during Weeks 1 and 6. Adjuvant chemotherapy consisted
of CDDP and 5-fluorouracil for 2 to 3 cycles and was given monthly
beginning 1 month after completion of radiation. RESULTS: With a median
follow-up of 57 months (range: 28-94 months), the 3-year locoregional
control rate was 93%, the disease-free survival rate was 71%, and the
overall survival rate was 72%. For T4 patients, the 3-year locoregional
control rate was 91%, disease-free survival was 62%, and overall
survival was 63%. The major acute toxicity was Grade 3 mucositis in 73%
and Grade 2 weight loss in 31% of patients. Fifty percent of patients
were tube fed. Most patients tolerated the combined modality treatments
relatively well; 88% of patients completed their radiation treatment
within 8 weeks. CONCLUSION: HFRT and CCT for T3 and T4 NPC were
associated with excellent local control and improved survival. The
treatment-related toxicity was acceptable and reversible. We would
recommend using HFRT with CCT for advanced T-stage NPC if the
three-dimensional conformal radiation planning shows a significant
portion of the brainstem to be inside the treatment field.
18
UI - 12035485
AU - Noel G; Dessard-Diana B; Vignot S; Mazeron JJ
TI -
[Treatment of nasopharyngeal cancer: literature review]
SO - Cancer Radiother 2002 Apr;6(2):59-84
AD - Centre de protontherapie d'Orsay, BP 65, 91402 Orsay, France.
noel@ipno.in2p3.fr
The conventional radiotherapy and the associated treatments improved the
prognostic of nasopharyngeal cancer. A better selection of the patients
who must have a more aggressive treatment also probably contributed to
this improvement. Even if a relation could be found between the
locoregional relapse rate and the distant relapse rate, these two events
remain often independent. It results from it that the improvement of
local control rate necessarily does not result in a better control of
the disease. The patients with a locally advanced tumor, with or not an
invasion of the base of the skull and/or neurological symptoms, must
have an aggressive locally treatment. This probably includes the
increase in dose delivered to the tumor via a more conformational
radiotherapy, a brachytherapy, radiotherapy in stereotaxic conditions or
other techniques. Dose within the tumor must be at least 70 Gy and the
prophylactic nodal dose, at least 50 Gy. CT scan and MRI are essential
for delineating the volumes of interest. The protocols of
hyperfractionated radiotherapy did not give convincing results.
Association with chemotherapy allowed, on the other hand, an improvement
of the prognostic locally advanced cancers. Neoadjuvant or adjuvant
chemotherapy was largely used to attempt to limit the risks of systemic
dissemination, but an improvement of results was not clearly
demonstrated. An improvement of the rates of survival and control of the
disease, on the other hand, was observed in a certain number of studies
with the chemoradiotherapy. In the event of locoregional relapse, an
aggressive attitude can allow the control of the disease in the absence
of systemic dissemination. Salvage treatments are, however,
disappointing for when distant relapse occurs which suggests a
difference in chemosensitivity between primary tumor and metastasis.
19
UI - 12017885
AU - Oestreicher-Kedem Y; Ad-el D; Gore E; Feinmesser R; Spitzer T
TI -
[Jejunal free flap for reconstruction of the hypopharynx]
SO - Harefuah 2002 Apr;141(4):340-3, 411, 410
AD - Department of Otolaryngology, Rabin Medical Center, Petach-Tikva.
Squamous cell carcinoma of the hypopharynx is an aggressive tumor with a
bad prognosis. When the tumor is resected it is necessary to reconstruct
the hypopharynx and the esophagus. Today, reconstruction with a jejunal
free flap is considered to be the preferred option. We present a series
of five patients with squamous cell carcinoma of the hypopharynx
operated on at the Department of Otolaryngology in the Rabin Medical
Center. All underwent total laryngopharyngectomy and reconstruction with
a jejunal free flap. Three patients resumed total enteral nutrition
about two weeks post surgery. One patient suffered from a
pharyngocutaneous fistula and continued parenteral nutrition via a
jejunostomy. One patient suffered from necrosis of the flap, which
necessitated its resection. Despite the morbidity which follows surgery
of the hypopharynx and despite the low cure rates, a successful
reconstruction with jejunal free flap enables the resumption of oral
nutrition and improvement in the patients quality of life.
20
UI - 12018564
AU - Rao BN; Shewalkar BK
TI -
Clinical profile and multimodality approach in the management of
juvenile nasopharyngeal angiofibroma.
SO - Indian J Cancer 2000 Dec;37(4):133-9
AD - Department of Radiotherapy, Government Medical College and Hospital,
Aurangabad, Maharashtra, India.
Our experience with 19 cases of juvenile nasopharyngeal angiofibroma
(JNA) over a period of 10 years is discussed. All cases are managed with
combined modalities which include pre-operative hormonal therapy,
radiotherapy and/or surgical resection via transpalatal approach. All
patients became asymptomatic with these treatment modalities. The use of
combined modalities of treatment is advocated so as to achieve decreased
intraoperative blood loss and cure, a reality.
21
UI - 12016041
AU - Sarini J; Bocciolini C; Fournier C; Penel N; Kara A; Van JT; Lefebvre JL
TI -
[Induction chemotherapy and larynx preservation: is such practice
useful?]
SO - Bull Cancer 2002 Apr;89(4):411-7
AD - Departement de cancerologie cervico-faciale, Centre Oscar-Lambret, 3,
rue Frederic-Combemale, 59020 Lille Cedex.
BACKGROUND: Surgery followed by irradiation is considered to be the
standard treatment but require frequently a total laryngectomy.
Chemotherapy followed by irradiation is available in larynx and
hypopharynx squamous cell carcinoma (SCC) treatment. Are results
obtained in daily induction chemotherapy usefulness identical to results
obtained in larynx preservation studies? PATIENTS AND METHOD: We
conducted a retrospective study on patients treated at centre
Oscar-Lambret, Lille, from 1986 to 1995, by chemotherapy followed by
definitive radiotherapy or by surgery and radiotherapy for laryngeal or
hypopharyngeal cancer treatment. All patients were naive of previous
head and neck SCC and a surgical treatment, requiring total
laryngectomy, should be proposed with curative intent. Induction
chemotherapy associated cisplatin (100 mg/m2) on day 1 and
5-fluorouracil (5FU)(1,000 mg/m2) on days 1-4 or 1-5. Irradiation was
performed for responders (complete or partial > 50%). If case of
non-responder, patients underwent surgical treatment followed by
irradiation. We compared results obtained with patients enrolled in
clinical trial and with patients whom benefited from this protocol out
of trial. RESULTS: Hundred-eight patients were evaluable for purposes of
this study. Fifty-two patients were included in clinical trial (group 1)
while 56 patients (group 2) were not. There was no statistical
difference as regard neither to sex nor to node (palpable or not
palpable) and metastasis status between the groups. We found a higher
frequency of laryngeal tumour in group 2 (31 vs 17; p =.03). We observed
more stage III and less stage IV in group 1. For chemotherapy-related
toxic reactions, the exclusive statistical difference observed was
haematological toxicity grade III and IV after the second cycle (0 pt in
group 1 vs 8 pts in group 2; p =.02). After initial treatment, complete
response was achieved without statistical difference between the groups
(88.2% vs 78%; p =.27). A surgical procedure was performed in 46 cases
without difference according to the reference group and functional
larynx preservation was 55.8% (29/52) in group 1 and 53.6% (30/56) in
group 2. Whatever the group, causes of death were similarly distributed.
Cancer was the first cause of death in both groups. The overall survival
of the population (108 patients) was 81.5% at one year, 49.6% at 3 years
and 35.3% at 5 years with a median survival of 3 years. There was no
statistical difference between both groups. Some parameters influenced
the overall survival like T (p =.04), response to chemotherapy (p=.006),
extra capsular spread (p = 0.03) and response after completion
treatment. CONCLUSION: Induction chemotherapy is available for larynx
preservation but cannot be considered as a standard treatment.
Nevertheless, results should be reproduced in daily practice with
experimented teams as found with non included patient's results. The
long-term side effects of such protocols should be evaluated. Recent
publication, on increase postoperative infection after chemotherapy,
should be evaluated in clinical trial. If confirmed, cost effectiveness
of such complication must be integrated in larynx preservation
protocols. Larynx preservation remains an interesting point of view for
patients but stay an optional procedure and not a reference.
22
UI - 12016042
AU - Menegoz F; Lesec'H JM; Rame JP; Reyt E; Bauvin E; Arveux P; Buemi A;
TI -
Raverdy N; Schaffer P
[Lip, oral cavity and pharynx cancers in France: incidence, mortality
and trends (period 1975-1995)]
SO - Bull Cancer 2002 Apr;89(4):419-29
AD - Registre du cancer de l'Isere, 21, chemin des Sources, 38240 Meylan.
registre.cancer.isere@wanadoo.fr
With 10,882 estimated new cases in 1995 in France, lip, oral cavity and
pharynx tumours rank 4th, representing 8.1% of all cancers in men. They
are less frequent in women, with a sex ratio of 7. Based on the French
cancer registries data which cover 13% of the metropolitan territory in
2000, both incidence and mortality increased until early 1980s to
decrease thereafter. The main hypothesis proposed to explain the French
leadership world-wide for these tumours deals with alcohol and tobacco
consumption. Important differences observed between several areas within
Europe, for some subsites, in connection with age or sex, are pointing
toward the need of new studies about environment and/or genetics. Until
now, comparisons between countries were made at the level of lip, oral
cavity and pharynx category as a whole or by large subgroups. In this
work we attempt to establish more accurate statistics, in order to
comply with the situation of this cancer in France. Present results
should encourage the scientific community to conduct site specific
epidemiological studies.
23
UI - 12045559
AU - Werker PM
TI -
The prepuce free flap in 10 patients: modifications in flap design and
surgical technique.
SO - Plast Reconstr Surg 2002 Jun;109(7):2330-5; discussion 2336-7
AD - Centre for Plastic, Reconstructive and Hand Surgery, Isala Klinieken,
Locatie Sophia, 8000 GK Zwolle, The Netherlands. pwerker@worldonline.nl
The prepuce free flap was used in 10 oral and oropharyngeal
reconstructions. During the course of this study, various modifications
took place. Residual penile skin necrosis and skin island necrosis early
in the series led to modification of flap design. This solved the
donor-site problem by placing the skin island more proximally, to
consist of the outer layer of the prepuce and an equidimensional area of
penile skin proximal to the prepuce. Identification of the vascular
pedicle was greatly facilitated by changing to retrograde dissection,
making skin incision in the mons veneris superfluous. Incongruence
between donor and recipient artery, together with microsurgical
arrogance, resulted in (resolvable) inflow problems in four patients.
One flap was lost. After modification, marginal necrosis still occurred
in one flap, most likely because of an episode of venous congestion.
Although much care was taken to not harvest more skin than in a regular
circumcision, penile skin shortage, especially during erection, appeared
to be the major long-term shortcoming of this flap. Flap thinness and
pliability, both expected strongholds of the flap, were evident during
flap inset, but less apparent during follow-up because of postoperative
radiotherapy in the majority of the cases. The best indications for this
flap include defects in the tonsillar area extending into the soft
palate, tongue, lateral oropharynx, retromolar trigonum, gums, and
vallecula.
24
UI - 11481076
AU - Cara Terribas CJ; Lopez Garcia A
TI -
[Commentary on the letter: "Azathioprine and cavum carcinoma in a male
patient with autoimmune hepatitis and Crohn's disease"]
SO - Gastroenterol Hepatol 2001 Aug-Sep;24(7):366-7
25
UI - 11963786
AU - Gottschlich S; Koch R; Gorogh T; Holtmeyer C; Hoffmann M; Rudert H;
TI -
Maune S
[Collagenase 3 mRNA expression in squamous epithelial carcinomas of the
oropharynx]
SO - HNO 2002 Jan;50(1):43-7
AD - Klinik fur Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie,
Universitatsklinikum Kiel, Arnold-Heller-Strasse 14, 24105 Kiel.
BACKGROUND: Metalloproteinases (MMP) are endopeptidases, which are able
to degrade extracellular matrix. It is assumed that MMP play an
important role in invasion and metastasis of malignomas. The expression
of collagenase-3, also named MMP-13, was already detected in squamous
cell carcinoma of the head and neck, but the significance in the process
of metastasis is still unclear. PATIENTS AND METHODS: 36 tumor biopsies
of oropharyngeal squamous cell carcinoma (10 cases N0, 26 patients N+)
and 12 biopsies of normal oropharyngeal mucosa were analysed with
reverse transcriptase-PCR and Northern Blot for their mRNA-expression of
MMP-13 and TIMP-1, the physiological inhibitor of MMP-13. RESULTS: In 30
of 36 (83.3%) tumor biopsies a MMP-13-mRNA-expression was detected. In 9
of 10 (90%) cases with N0-status and 21 of 26 (80.7%) cases with
N(+)-neck the mRNA-expression could be shown. There was no correlation
between MMP-13-mRNA-expression and N-status. In 34 tumor biopsies
(94.4%) a TIMP-1-expression was detected. MMP-13-mRNA was not detected
in normal oropharyngeal mucosa. CONCLUSIONS: It seems that
MMP-13-mRNA-expression is not a prognostic factor for metastatic
behavior of oropharyngeal cancer and therefore not helpful for further
decisions on the therapy.
26
UI - 12014111
AU - Wang N; Xu YH
TI -
[Study on the mechanism of basic fibroblast growth factor (bFGF) release
induced by phorbol ester PMA]
SO - Shi Yan Sheng Wu Xue Bao 1998 Mar;31(1):41-8
AD - Shanghai Institute of Cell Biology, Academia Sinica, Shanghai 200031,
China.
Basic fibroblast growth factor (bFGF) is a strong mitogenic factor and
inducer of angiogenesis. It may play an important role in the growth of
solid tumors. Whereas bFGF is known to act extracellularly, the protein
lacks a transient signal peptide. No defined mechanism for bFGF
secretion has been characterized besides release from dead or injured
cells. To explore molecular mechanism that modulates bFGF release, we
treated CNE-2 cells with PMA for two days and found that the treatment
increased bFGF gene expression in the cytoplasm and bFGF release
significantly after 48 hours. This result suggests that protein kinase C
is very likely to be involved in the bFGF release regulation. Our
results have also shown that PKC-alpha activated by PMA in CNE-2 cells
can phosphorylate bFGF (18 KDa) in CNE-2 cells. The result suggests that
PKC-alpha translocation and activation can phosphorylate bFGF in CNE-2
cells and increase bFGF release.
27
UI - 12040275
AU - Huncharek M; Kupelnick B
TI -
Combined chemoradiation versus radiation therapy alone in locally
advanced nasopharyngeal carcinoma: results of a meta-analysis of 1,528
patients from six randomized trials.
SO - Am J Clin Oncol 2002 Jun;25(3):219-23
AD - Division of Radiation Oncology, Department of Clinical Oncology,
Marshfield Clinic Cancer Center, Wisconsin, USA.
It is currently unclear whether the addition of chemotherapy to standard
radiation therapy improves clinical outcome in patients with
locoregionally advanced nasopharyngeal cancer. A meta-analysis was
performed to evaluate the impact of integrating chemotherapy with
external beam radiation therapy in this clinical setting. Using
previously described methods, a protocol was developed outlining a
meta-analysis examining the influence of chemoradiation versus radiation
alone (control arm) in locoregionally advanced nasopharyngeal carcinoma.
The outcomes of interest were disease-free/progression-free and overall
survival. Literature search techniques, study inclusion criteria, and
statistical procedures were prospectively defined. Data from all
available randomized controlled trials was pooled using a fixed effects
model (Peto). Results were expressed as summary relative risks.
Statistical tests for heterogeneity were performed. If statistical
heterogeneity was demonstrated, sensitivity analyses were performed to
evaluate possible sources of heterogeneity across the included studies.
The literature search identified six randomized controlled trials
enrolling more than 1,500 patients. All trials compared standard radical
external beam radiation therapy (control arm) with radiation plus
chemotherapy delivered either adjuvantly, neoadjuvantly, or concurrently
with radiation. Pooling all six studies using
disease-free/progression-free survival as the endpoint demonstrated that
the addition of chemotherapy to radiation therapy increased
disease-free/progression-free survival by 37% at 2 years, 40% at 3
years, and 34% at 4 years after treatment. Likewise, the summary
relative risk for overall survival at 2 years after treatment with the
addition of chemotherapy to the treatment regimen was 0.80 (0.63-1.02),
reflecting a 20% increase in 2-year survival. This finding was
marginally non-statistically significant. Three- and 4-year survival was
increased by 19% and 21%, respectively, with the data for 4-year
survival being statistically significant. The addition of chemotherapy
to standard radical radiation therapy for locoregionally advanced
nasopharyngeal cancer increases both disease-free/progression-free and
overall survival by 19 to 40% at 2 to 4 years after treatment, depending
on the endpoint of interest. Future trials are needed to confirm these
results and determine the most effective regimen for integrating
chemotherapy with radiation therapy in this setting.
28
UI - 11975077
AU - Weber A; Tannapfel A; Kosling S; Bootz F
TI -
[Parapharyngeal space-occupying lesions. Differential diagnosis based on
case examples]
SO - HNO 2002 Mar;50(3):223-9
AD - Klinik fur Hals-Nasen-Ohren-Heilkunde, plastische Operationen,
Universitatsklinikum Leipzig, Liebigstrasse 18a, 04103 Leipzig.
INTRODUCTION: Parapharyngeal tumors account for only 0.8% of all head
and neck tumors which often presents the problem of preoperative
diagnosis. Up to 80% of parapharyngeal tumors are benign. PATIENTS:
tumors and 1 retropharyngeal abscess were treated. The median age was 54
years. Only 2 patients demonstrated peripheral nerve lesions
preoperatively. RESULTS: 17 tumors and the retropharyngeal abscess were
excised via transcervical approach, with an extension by parotidectomy
and temporary mandibular split in 1 case. Histological entities were
pleomorphic adenomas in 5 cases, a ganglioneurinoma, neurinoma of the
vagal nerve and metastasis of a squamous cell carcinoma in 2 patients
each, furthermore neuroblastoma, extramedullary plasmocytoma, T-cell
lymphoma, and hemangioma in 1 patient each. CONCLUSIONS: We demonstrate
the differential diagnosis of parapharyngeal tumors as well as their
diagnostic and therapeutic management. The tumors should be excised by a
transcervical approach to protect cervical vessels and nerves, which is
limited by a transoral approach.
29
UI - 12043214
AU - Chatani M
TI -
[Current status of radiation therapy--evidence-based medicine (EBM) of
radiation therapy. Radiotherapy for pharyngeal and laryngeal cancer]
SO - Nippon Igaku Hoshasen Gakkai Zasshi 2002 Mar;62(4):126-31
AD - Department of Radiology, Osaka Rosai Hospital.
Radiation therapy is the first choice of treatment for early pharyngeal
and laryngeal cancers, especially those of the glottic larynx and
nasopharynx. For advanced lesions without distant metastasis, more
intensive treatments, i.e., chemoradiotherapy, multiple fractions per
day, and conformal radiotherapy are introduced to improve local control
and survival. However, the level of evidence-based medicine is different
for each treatment modality
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