Adenoid cystic carcinoma of the palate with squamous metaplasia or basaloid-squamous carcinoma? Report of a case.
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Carcinoma, Adenoid Cystic↗
Biomedical subjects
A B Karim
Publications and source records attributed to A B Karim.
Carcinoma of the soft palate and anterior tonsillar pillar.
The results after treatment of a total of 52 patients between 1974 and 1990 for squamous cell carcinoma of the soft palate and anterior tonsillar pillar by surgery, radiotherapy, or a combination of the two are reported in the present study. Of the 45 patients who were treated for cure, 38 were treated by surgery, followed by radiotherapy in 19 patients (50%). Five patients received definitive radiotherapy only, and 2 were treated by other modalities such as intra-arterial methotrexate and carbon dioxide (CO2) laser. Absolute and determinant 5-year survival rates were 62% and 77%, respectively. Sixty-four percent of patients survived 5 years recurrence-free, and 27% developed multiple primary tumors in the head and neck. Tumor stages III and IV were shown to decrease survival by half compared to stages I and II. A 42% occult nodal metastases rate was observed, and 3 of 11 patients experienced regional relapse in an untreated neck. From this review it appears that surgery, combined with postoperative radiotherapy when indicated, is an effective form of treatment for carcinoma of the soft palate and anterior tonsillar pillar.
Adult↗
Surgery and postoperative radiotherapy and radiotherapy alone in T3-T4 cancers of the pyriform sinus. Treatment results and patterns of failure.
Fifty-four patients with T3-T4 squamous cell carcinomas of the pyriform sinus were treated between 1976 and 1990. Surgery with postoperative radiotherapy (n = 32) was the treatment of choice. Radical radiotherapy was used in patients with contraindications for surgery or with inoperable tumors and in patients who refused surgery. The local control rate was significantly higher in the combined treatment group (31/32; 97%) than in the group treated with radical radiotherapy (14/22; 64%) which consisted of more advanced cases. In patients who received radical radiotherapy, the highest local control rates were recorded with doses of 70 Gy and above and with the use of 2 fractions per day. There was no significant difference in regional control and survival rates between the treatment groups. New approaches are indicated to improve the prognosis of hypopharyngeal cancer.
Adult↗
[Palliative radiotherapy in non-small cell bronchial carcinoma].
OBJECTIVE: Evaluation of palliative radiotherapy for patients with non-small cell lung cancer. DESIGN: Descriptive study. LOCATION: University hospital Vrije Universiteit, Amsterdam. METHOD: Between 1987 and 1991, 146 patients with stage IIIB or IV non-small cell lung cancer received palliative radiotherapy for symptoms of intrathoracic tumour growth. There were 144 evaluable patients and all of them received three fractions of 800 cGy (1 fraction per week). RESULTS: Median survival was 6.3 months for stage IIIB and 4.2 months for stage IV patients (p < 0.005). Stage IIIB patients with a Karnofsky performance score of 70 and above showed significantly (p < 0.01) longer survival than those with a performance score below 70. Local progression was recorded in 61.1% of patients. However, 68.8% of the patients were free of local progression for at least 75% of their remaining survival time. The toxicity of the treatment was acceptable. CONCLUSION: On the basis of these results and results of other studies, it is concluded that the palliative effect of a small number of sessions with high fraction doses is comparable with that achieved with a more fractionated schedule. A short course of radiotherapy is preferable to minimize inconvenience for the patient as well as for the radiotherapy department.
Adult↗
Hypofractionated radiation therapy in unresectable stage III non-small cell lung cancer.
BACKGROUND: Hypofractionation is the current choice for radiation therapy for patients with unresectable non-small cell lung cancer (NSCLC) at the authors' institute. METHODS: In this nonrandomized study, three hypofractionated radiation schedules (40-Gy split course; 30-32 Gy in 6 fractions and 24 Gy in 3 fractions) are evaluated in 301 patients with unresectable Stage III NSCLC: RESULTS: Patients with Stage IIIA disease treated with a 40-Gy split course had longer survival (P < 0.005) and a lower local relapse rate (P < 0.01), but a higher distant failure rate (P < 0.01) than those receiving 24-32 Gy. Survival for patients with Stage IIIA disease treated with 40 Gy at 1, 2, and 5 years was 47%, 22%, and 7%, respectively. For patients with Stage IIIB disease, the radiation scheme used did not correlate with survival and relapse rates. Survival at 1, 2, and 5 years was 30%, 9%, and 2%, respectively. The hypofractionated radiation schemes were well tolerated, and no severe complications were recorded. CONCLUSIONS: In patients with Stage IIIA disease, 40-Gy split-course radiation therapy yields survival rates comparable to those achieved with conventional radiation therapy. In patients with Stages IIIB and IV NSCLC, 24 Gy in 3 weekly fractions yields survival rates comparable to those achieved with higher total doses given in more fractions.
Adenocarcinoma↗
Total glossectomy with laryngeal preservation.
OBJECTIVE: To evaluate the results of a planned combined therapy with surgery and postoperative radiotherapy in the management of large (T3 to T4) squamous cell carcinomas of the tongue-tongue base in properly selected patients. PATIENTS AND METHODS: Twenty-one patients underwent this procedure in a 4-year period. The selection criteria were directed to identify those patients in whom laryngeal preservation was feasible and who were motivated. Five categories of patients were included: those with (1) large primary tumors of the tongue-tongue base; (2) recurrence after initial radiotherapy, brachytherapy, chemotherapy, or a combination of these modalities; (3) recurrence after initial surgery and radiotherapy; (4) double primary tumors; and (5) second or third primary tumors arising in the tongue or base of the tongue. Preoperative investigation included examination under anesthetic and magnetic resonance imaging. Depending on the proximity of the primary tumor to the mandible, a mandibular split, a marginal resection, or a segmental resection was carried out. Soft-tissue replacement was achieved by a myocutaneous or a muscle flap of the pectoralis muscle with split skin. Whenever possible tissues of the contralateral floor of the mouth were also used. Laryngeal suspension was performed in all cases. Postoperative radiotherapy consisted of megavolt therapy, 66 Gy in 6 weeks to the primary site and both sides of the neck. RESULTS: Resumption of swallowing and speech was achieved in all patients. External deformity was slight. Patients were able to return to their families. CONCLUSIONS: Total glossectomy with laryngeal preservation in properly selected patients provides local and regional control and preserves quality of life.
Adult↗
Hypofractionation radiotherapy for a locally recurrent rectal carcinoma as a treatment for an elderly patient.
A very old patient, who had been suffering from rectal carcinoma for many years without achieving a complete response to electrocoagulations, was given palliative radiotherapy by hypofractionation with a total dose of 30 Gy in 3 weeks, 1 fraction a week. A complete response was achieved. No special therapy-related morbidity was noted. After the radiotherapy, an acceptable quality of life was maintained for 12 months without a local recurrence. It is concluded that radiotherapy may be a simple and efficient method of palliation without distressing morbidity compared with electrocoagulation.
Adenocarcinoma↗
Consolidative thoracic radiotherapy and prophylactic cranial irradiation in limited disease small cell lung cancer.
Between 1983 and 1990, 128 patients with limited disease small cell lung cancer (SCLC) received consolidative thoracic irradiation after reaching a complete (CR) or partial response (PR) to combination chemotherapy. Patients in CR (n = 85) received 35-36 Gy in 12-14 fractions and patients in PR (n = 43) 24-30 Gy in 3-6 fractions. Until 1989, prophylactic cranial irradiation (PCI) was given to patients in CR. There was no significant difference in survival between the CR and PR group. However, patients with residual tumor detected by radiology or bronchoscopy or cyto-/histology had significantly longer survival than those with residual tumor demonstrated by more than one of the above methods of investigation. Overall, local progression was observed in 22% and distant dissemination in 63% of patients. The rate of brain metastases was significantly lower in patients treated with methotrexate and nitrosurea containing schedules and PCI, compared to those who were treated with other schedules (irrespective of PCI).
Antineoplastic Combined Chemotherapy Protocols↗
Hypofractionated radiation therapy in the treatment of superior vena cava syndrome.
We retrospectively reviewed 46 patients with superior vena cava syndrome during the period 1986-1992. The common symptoms included congestion of collateral veins of the neck, anterior chest wall, face, eyelids and right arm. Dyspoea and cyanosis occurred less frequently. In all but two patients a histological diagnosis was made by invasive and non-invasive examination without complications. In 82% of all patients a primary lung carcinoma was the cause of the superior vena cava syndrome. For 39 patients radiotherapy was the first treatment of choice. To relieve the distressing symptoms patients received one of two regimens employing hypofractionated radiotherapy. In regimen 3F, 25 patients received three weekly high dose fractions of 8 Gy delivering a total dose of 24 Gy. Regimen 2F, applied to seven patients, consisted of two weekly fractions of 8 Gy, giving a total of 24 Gy. In both regimens a good palliative result was established, however the results of the 3F regimen were superior. Using the 3F regimen a partial response was obtained in 96% of all patients, and 56% achieved a complete response. With the 2F regimen a partial response was achieved in 70% of all patients, and a complete response in only 28%. Minimal side effects were noted. After reviewing our experience, the 3F regimen is recommended for rapid and effective relief of the superior vena cava syndrome.
Adult↗
[Neck lymph node dissection in squamous cell carcinoma originating in the head-and-neck area; the significance for the prognosis].
Neck dissection has a therapeutical as well as a prognostic relevance with respect to regional recurrence and distant metastases. Between January 1973 and July 1986 576 neck dissections in 511 patients (396 men, 115 women, among whom 486 with squamous cell carcinoma of the head and neck, and 14 with neck metastases of an unknown primary tumour) were performed at the department of Otolaryngology-Head and Neck Surgery of the Free University Hospital, Amsterdam. Patients with tumour at the margins were excluded. Recurrence-free curves were calculated according to Kaplan-Meier and the log rank test was used to test the differences. All patients underwent a comprehensive neck dissection and were irradiated postoperatively when three or more tumour-positive nodes or extranodal spread were reported by the pathologist. Endpoint for analysis was occurrence of an ipsilateral neck recurrence or of a distant metastasis. Figures were corrected for a simultaneous recurrence at a higher level. A total of 29 neck recurrences (7.2%; n = 523) and 26 distant metastases (10.7%; n = 281) were demonstrated in the 5-year follow-up period. The number of positive nodes was of prognostic significance for both events (p = 0.039 and p = 0.0027). Extranodal spread was shown only to increase the incidence of distant metastases (p = 0.017), whereas its prognostic value with regard to recurrence in the neck was nullified by the strict institution of postoperative radiotherapy. It is recommended to give radiotherapy to patients with two positive nodes and possibly to every patient with a histopathologically positive neck.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Squamous cell carcinoma of the nasal vestibule.
We reviewed 30 patients with squamous cell carcinoma of the nasal vestibule to present our experience of their management and to evaluate the prognostic factors that may influence their outcome. For T1 lesions radiotherapy remains the treatment of choice, because of the superior cosmetic result. Fifteen (68 per cent) out of 22 patients with T2 lesions were treated with primary radiotherapy. Surgery however, was eventually required in 16 (72 per cent) out of 22 patients, either as a primary treatment (seven patients) or as salvage surgery (nine patients). For the larger T3 lesions the treatment of choice is surgery followed by post-operative radiotherapy where appropriate. Regional nodal metastases at the time of presentation were a significant indicator of local and regional recurrence and of prognosis. The cause specific five-year survival for patients with an uninvolved neck (22 patients) was 100 per cent compared with 38 per cent for patients with nodal metastases at presentation (eight patients). Elective treatment for uninvolved regional nodes is not considered necessary.
Adult↗
Ectopic parasellar pituitary adenoma with subarachnoid seeding.
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Biomarkers, Tumor↗
Assessment of quality of life in patients treated for low-grade glioma: a preliminary report.
In this pilot study quality of life was assessed in fourteen adult patients who were treated for a low-grade glioma with surgery and radiotherapy at least one year previously. Apart from widely used parameters, such as the neurological and functional status, the patients' cognitive functioning and actual affective status were determined. In addition the patients were interviewed to evaluate various aspects of quality of life. Generally no serious focal neurological deficits were found, although psychological examination showed serious cognitive and affective disturbances in most cases. Self report measures concerning cognitive functioning were not in all cases in accordance with objective test results. When the results of treatment in glioma patients are evaluated assessment of quality of life, including neuropsychological functioning, should be performed, especially as new therapeutic strategies are being developed.
Activities of Daily Living↗
[Radiation injury presenting as tumor recurrence following irradiation for non-small-cell bronchus carcinoma].
Case records of two irradiated patients, each with an inoperable non-small cell carcinoma of the bronchus, are presented. After an initial period of 1.3 and 2.3 years, respectively, of regression of the tumour symptoms occurred, viz. severe pain due to multiple rib fractures in one and a superior vena cava syndrome in the other, suggestive of tumour regrowth. Careful comparison of results of all radiographic images and radiotherapy data suggested osteoradionecrosis as the cause of the rib fractures in one patient. The long time interval and the stabilization of the symptoms in the other made tumour regrowth unlikely. The so called late tissue reaction after radiotherapy as a possible cause of symptoms in both patients is discussed.
Aged↗
Local control in T3 laryngeal cancer treated with radical radiotherapy, time dose relationship: the concept of nominal standard dose and linear quadratic model.
In a retrospective study of the Dutch cooperative head and neck group 104 evaluable patients with T3NxMO squamous cell carcinoma of the larynx were treated primarily with a full course of radiotherapy. The results of treatment are presented in terms of locoregional control. The actuarial 3-year local control rate was 53%. Regional control was 77% for node positive patients and 96% for N0 patients (p = 0.01). Surgical salvage was successful in 53% of cases with a local recurrence and in 3/8 regional recurrences, resulting in an ultimate locoregional control rate of 83% for N0 patients and 68% for N+ patients. A uni- and multivariate analysis of local control rate versus total dose, nominal standard dose, and extrapolated response dose has been done. To calculate extrapolated response dose the linear quadratic equation was used, assuming an a/b of 10 and a potential doubling time of clonogenic cells of 3, 5, and 7 days. In multivariate analysis the extrapolated response dose with a potential doubling time of 5 days was the only independent prognostic factor for local control (p = 0.069) and ultimate locoregional control (p = 0.0015). Nominal standard dose showed no dose-response relationship. Based on the S-shaped dose response curve, using the LQ model, several therapeutical options are discussed.
Aged↗
A critical look at the TNM classification for laryngeal carcinoma.
A total number of 564 patients with glottic (427) and supraglottic (137) laryngeal carcinoma was prospectively staged clinicoendoscopically (CS) and radiologically (RS). These patients were treated from 1974 to 1985 with quality-controlled high-dose radiation therapy. The validity of CS versus RS was checked in this study with the parameter of recurrence-free adjusted survival (RFADS) at 3 and at 5 years. It appears that RS is more valid and has therapeutic implications in planning the target volume for irradiation. The CS should be regarded as inadequate for radiotherapeutic considerations. The International Union Against Cancer (UICC) 1987 norms for staging laryngeal carcinoma (clinical, endoscopic, and imaging) should be strictly followed.
Adult↗
Ovarian cancer: radiation sensitivity in vitro.
The radiosensitivity of four human ovarian cancer cell lines was investigated in vitro by a clonogenic assay and analyzed using the linear-quadratic model. Two cell lines were found to be highly radiosensitive (mean inactivation dose (D) 0.82-0.92 Gy; surviving fraction 2 Gy (SF2) less than or equal to 0.13). Two other cell lines were less sensitive to radiation (D 1.31-1.94 Gy; SF2 0.22-0.38). Although the use of external radiotherapy in ovarian cancer has been limited due to the pattern of metastatic spread of this cancer, the present data support the view that ovarian carcinomas are radiosensitive tumors. Investigations on the effects of new approaches, such as delivering radiation more specifically to intraperitoneal ovarian cancer cells, are warranted.
Cell Count↗
Ethmoid and upper nasal cavity carcinoma: treatment, results and complications.
From 1970 to 1985, 45 patients with carcinoma of the upper nasal cavity and ethmoid sinuses were radically treated. The tumor parameters, treatment strategy, radiotherapy technique and the results of treatment of these patients are retrospectively analysed in this study with particular reference to complete blindness as a major complication. In most cases tumor was removed by meticulous surgical dissection, and thereafter quality-controlled radiation therapy (external therapy: mean dose 65 Gy in about 7 weeks, or external therapy with brachytherapy boost: mean dose 82 Gy in about 10 weeks) was used for this group of patients. The results show 68% recurrence-free survival at 5 years, adjusted for intercurrent deaths. Complications of treatment were seen in seven patients (16%) who developed eye damage with some loss of visual acuity, none however leading per se to complete blindness. It may be concluded that blindness may be avoided to a major extent while treating carcinomas in the nose-ethmoid areas without compromising loco-regional control.
Blindness↗