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Biomedical subjects

F J Hilgers

Publications and source records attributed to F J Hilgers.

At least 37 records · Page 2Linked to original sources
PubMed1998

The impact of treatment time and smoking on local control and complications in T1 glottic cancer.

PURPOSE: To define the optimal treatment regimen, patients with T1N0M0 glottic larynx carcinoma were treated with six different radiotherapy (RT) schedules. To assess the influence of patient characteristics, complication rates, and to evaluate the overall larynx preservation. METHODS AND MATERIALS: Out of a consecutive series of 383 patients treated for T1N0M0 glottic larynx carcinoma between 1965 and 1992, 352 evaluable patients were treated with six different "standard" fractionation schedules: 65 Gy (20 x 3.25 Gy), 62 Gy (20 x 3.1 Gy), 61.6 Gy (22 x 2.8 Gy), 60 Gy (25 x 2.4 Gy), 66 Gy (33 x 2 Gy) and 60 Gy (30 x 2 Gy). The median follow-up of all patients was 89 months. Patient factors analyzed included: age, sex, concurrent illness, smoking habits, tumor localization and extension, tumor differentiation, the effect of tumor biopsy or stripping of the vocal cord, and the presence of visible tumor at the start of radiotherapy. Treatment parameters evaluated were: year of treatment, beam energy, treatment planning, field size, fractionation schedule, fraction size, number of fractions, total dose, treatment time and treatment gap, the use of wedges, and neck diameter. RESULTS: The overall 5-year actuarial locoregional control was 89%, varying between 83 and 93% for the different schedules. Univariately, local control decreased with increasing treatment time. This could not be explained by the confounding variables sex, tumor extension, and field length (p = 0.0065). Adjusted for these variables, 5-year local control percentage decreased from 95% (SE 2%) for 22-29 days to 79% (SE 6%) for treatment time > or = 40 days. The overall complication rate (grade I-IV) at 5 years was 15.3%, and varied between the different schedules, from 7 to 17%. No relation was found between complications and treatment factors. Patients who continued smoking had a higher complication rate than those who never smoked or stopped smoking, univariately as well as adjusted for tumor extension, macroscopic tumor, and neck diameter (p = 0.0038). Twenty-eight percent (SE 6%) of the patients who continued smoking had complications at 10 years, compared to about 13% (SE 4%) of those who stopped before or after RT. No evidence was found for any other relation between complications and patient or tumor factors. Severe edema and necrosis (grade III and IV) were not observed in the 2 Gy fraction schedules. A laryngectomy was performed in 36 patients: 30 for recurrence, 3 for complications (at 40, 161, and 272 months), and 3 for a second primary. The overall larynx preservation was 90% at 10 years, and for the different schedules it was 20 x 3.25 Gy: 97%; 20 x 3.1 Gy: 96%; 22 x 2.8 Gy: 92%; 25 x 2.4 Gy: 89%; 33 x 2 Gy: 78%; and 30 x 2 Gy: 80%. CONCLUSION: Overall treatment time is the most significant factor for locoregional control of T1 glottic cancer. A schedule of 25 x 2.4 Gy appeared to be the optimal treatment schedule considering both tumor control and long term toxicity. The complication rate was increased in patients who continued smoking.

Aged↗
PubMed1998

[Referred earache; an important symptom of head-and-neck cancers].

Otalgia is a common symptom in general practice and represents the sensation of pain in the ear. In four patients, three women aged 63, 57 and 37 years, and a man aged 64 years, ear pain was found to be caused by laryngeal carcinoma (two patients), oropharyngeal carcinoma and nasopharyngeal carcinoma (in a Turkish patient). Referred otalgia is an earache that is caused by a nonotologic source. In many cases it is difficult to identify the underlaying disease of referred otalgia. It may be the first symptom of a head-and-neck carcinoma. In case of otalgia with normal otologic findings, the differential diagnostic process must be specifically directed to the common sensory innervation of the ear and the head-and-neck structures. By carefully taking the patient's history with special attention to epidemiological factors such as smoking and drinking habits, racial traits, a positive family history of head-and-neck neoplasms and accompanying complaints and by performing repeated ENT examination including advanced imaging techniques, long delay in diagnosing head-and-neck cancer can be prevented.

Adult↗
PubMed1998

Computed tomography for the detection of neck node metastases in melanoma patients.

AIMS: To assess the value of CT scanning for detection of lymph node metastases in the neck. METHODS: The appearance and site of the metastases was studied, as well as the sensitivity and specificity of CT. RESULTS: Nodal metastases did not always show a high contrast uptake and nodal density therefore cannot be used as a criterion for metastasis. Irregular contrast enhancement was seen in seven of the 21 tumour-positive necks. Frequently, metastases in the parotids, superficial nodes in the neck and in the posterior triangle were seen. The sensitivity and specificity of palpation and CT scanning were 87 and 100%, respectively. CONCLUSIONS: However, because small, clinically occult, melanoma metastases were frequently overlooked on CT, the role of this imaging modality in assessing occult metastases remains limited. Based on recent data from literature it is reasonable to speculate that ultrasound guided fine needle aspiration cytology (FNAC) will prove to be more effective than a non-invasive staging procedure of the neck in melanoma patients.

Adult↗
PubMed1998

Metastasizing pleomorphic adenoma: a report of three cases.

Three cases of metastasizing pleomorphic adenoma are described. All three had a history of incomplete surgery of the primary tumour and several surgical procedures for local recurrences before systemic metastases became apparent. The histology of the primary tumour, recurrences and metastases were typical of pleomorphic adenoma. In view of the lack of information in the literature, it is concluded that inadequate surgical procedures, such as incomplete surgery or enucleation, leading to multiple recurrences, appear to be a prerequisite for the development of systemic disease.

Adenoma, Pleomorphic↗
PubMed1998

Acoustical analysis and perceptual evaluation of tracheoesophageal prosthetic voice.

Voice analysis was performed on 21 "standard" laryngectomized, male patients with a Provox voice prosthesis, along with an age- and sex-matched control group of 20 normal speakers, using acoustical analyses (MDVP and CSL, Kay Elemetrics Corp.), maximum phonation time measurements, and perceptual evaluations. Comparison between MDVP and CSL revealed that the latter was not useful for the analysis of laryngectomized prosthetic voices. In contrast, MDVP seems suitable for this purpose, and contains a large number of parameters that significantly differentiate between patient and control speakers, as did the perceptual ratings and the maximum phonation time. Fundamental frequency appeared to be comparable for patients and control speakers. A significant influence of stoma occlusion and age was found for some voice parameters. Factor analyses showed correlations between the different MDVP parameters and correlations between the MDVP parameters and the perceptual ratings.

Adult↗
PubMed1998

Structured assessment of the consequences of composite resection.

A structured quality of life questionnaire was developed as an instrument for the assessment of the functional, physical, psychosocial, and counselling problems in patients treated surgically for an oropharyngeal cancer. The questionnaire was tested in a pilot study in a relatively homogeneous group of 15 selected patients (all of whom had a comparable surgical defect, i.e. a composite resection of the oropharynx and neck, and had undergone an identical reconstruction method, i.e. a pedicled pectoralis major myocutaneous flap). All but two patients were irradiated as well. A high reliability (Crombach's alpha) was found in most of the applied subscales, indicating good internal consistency of the different questions. Significant correlations were found between several quality of life dimensions. The most frequently reported complaints concerned problems related to eating, speaking, and facial disfigurement. Problems with mastication, oral transport, and swallowing prohibited 11 patients returning to their normal diet. Regarding speech, 11 patients reported decreased intelligibility, in eight this was due to some degree of rhinolalia aperta. A significant association was found between moderate intelligibility and anxiety about speaking in public (P < 0.05). Eleven patients felt that the surgery had caused considerable facial disfigurement. For five of them this had a negative influence on their social interactions and activities outdoors. Thus, the consequences of the surgical treatment of oropharyngeal cancer can be assessed in a systematic and formal way with this specially designed structured questionnaire. Despite the small sample size, the selection of a homogeneous patient group appeared to give significant information, and to establish meaningful correlations.

Aged↗
PubMed1998

The influence of stoma occlusion on aspects of tracheoesophageal voice.

In this study, speech of 21 laryngectomized patients is investigated under 2 different stoma occlusion conditions, i.e. direct digital occlusion of the stoma (by thumb or finger), and digital occlusion (by finger) via a special heat and moisture exchanger with speech valve (Provox Stomafilter). For both conditions, acoustical analyses of voice quality (various pitch, amplitude, tremor and harmonicity measures) were performed on a sustained /a/, the mean maximum phonation time was calculated, and a phonetogram was made. Acoustical analysis was possible in 13 of the 21 voices (for the other voices, the pitch was too low or the voice was too aperiodic), but no statistical significant differences were found for any of the acoustical parameters studied. However, the maximum phonation time was significantly longer, and the dynamic range significantly larger, under the Stomafilter occlusion condition. The maximum phonation time showed a relevant improvement in 57% of the patients, while the dynamic range showed a relevant improvement in 35% of the patients. In total, 75% of the patients experience an improvement in one or both of these speech characteristics when using the Stomafilter occlusion. It can be concluded that optimal stoma occlusion by means of a specialized device has a positive influence on two relevant parameters of prosthetic voice production: maximum phonation time and dynamic loudness range.

Aged↗
PubMed1998

Long-term compliance of laryngectomized patients with a specialized pulmonary rehabilitation device: Provox Stomafilter.

Previous studies have demonstrated the positive effect of a heat and moisture exchanger (HME) on the respiratory system in patients after laryngectomy. However, patient compliance with these devices was reduced by device-related problems and troublesome combination with a voice prosthesis. Recently a more specialized device has become available. This is an HME combined with a valve for easy digital occlusion of the stoma (Provox Stomafilter; Hörby, Sweden). In the authors' initial study of this revised device, a clear improvement in short-term compliance was demonstrated. To investigate long-term compliance, 69 consecutive patients were interviewed by means of a structured questionnaire. The results show that all patients expressed their satisfaction with the valve used for digital occlusion of the stoma. Sixty-three percent of the patients reported that voicing was facilitated. Subjective intelligibility improved in 55% of the patients. Previous problems with other devices (e.g., plaster adherence, skin irritation, and handling) were clearly diminished, increasing the long-term compliance of the patients to 78%. This new HME can be considered as a beneficial pulmonary rehabilitation tool for laryngectomized patients.

Adult↗
PubMed1997

[Nasopharyngeal carcinoma: epidemiology and treatment outcome].

OBJECTIVE: To determine epidemiology, symptoms and treatment results of patients with nasopharyngeal carcinoma. DESIGN: Descriptive and retrospective. SETTING: The Dutch Cancer Institute (Antoni van Leeuwenhoek Hospital), Amsterdam, the Netherlands. METHODS: The clinical, epidemiological and radiotherapy data of the 129 patients with a nasopharyngeal carcinoma referred between 1977 and 1993 to our hospital were analysed. Twenty patients were referred for a second opinion only, presented with recurrent disease, or had received their treatment elsewhere. Data of 109 patients were analysed. RESULTS: During the last decade more patients born in Asia and North-Africa were referred (p = 0.0057), a total of 52 (48%) out of 109 referred patients. There were 62 (58%) patients in whom an enlarged cervical lymph node at level II (upper jugular group) was the presenting symptom. In 53 (50%) cases hearing loss due to otitis media with effusion was the first symptom. In 54 (54%) patients the delay between the first symptoms and diagnosis of carcinoma was > 20 weeks. 5-year survival was 48% (SE 6%) for the whole group (n = 109) of patients and 52% (SE 6%) for the patients treated with curative intent (n = 96). CONCLUSION: During the last decade the population of patients with nasopharyngeal carcinoma in the Netherlands contained more patients from Asia and North-Africa. Suspicious cervical lymph node swellings and (or) (unilateral) otitis media with effusion may be indicative of a nasopharyngeal carcinoma.

Adolescent↗
PubMed1997

[An innocuous prolonged unilateral nose blockage?].

A woman aged 35 and a man aged 59 had been suffering for years from unilateral clogged nose. Adequate diagnostic examination revealed in both of them a papilloma inversum from which a squamous carcinoma had developed. After extensive surgical resection of the tumour and irradiation, tumour progression and metastasization occurred. Both patients were given palliative chemotherapy; they died soon after the last course. Problems concerning nasal breathing are common in general practice. They are often attributed to common cold or to an allergy. Unilateral blocking of the nose is usually caused by a congenital or a traumatic deviation of the nasal septum. However, in adult patients, it may rarely be due to a tumour.

Adult↗
PubMed1997

Overexpression of cyclin D1 indicates a poor prognosis in squamous cell carcinoma of the head and neck.

OBJECTIVES: To evaluate the overexpression of cyclin D1 and p53 as a prognostic marker of squamous cell carcinoma of the head and neck and to investigate whether deregulation of these genes is associated with an unfavorable course of disease. DESIGN: Retrospective study. MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded tumor materials that were obtained from a well-characterized series of 115 patients with resectable head and neck cancer at The Netherlands Cancer Institute, Amsterdam, were analyzed by immunohistochemical methods using antiserum samples that were directed against 2 proteins (ie, cyclin D1 and p53), which are crucial in the regulation of the G1 phase of the cell cycle. RESULTS: Overexpression of cyclin D1 protein was found in 49% of the patients with squamous cell carcinoma of the head and neck. This overexpression was not associated with known prognostic factors (eg, the T and N stages). Tumors recurred more frequently and in a shorter period in patients whose primary tumors showed an overexpression of cyclin D1 protein. This difference (P = .05) was statistically significant in a stepwise proportional hazard regression analysis. However, since a discrepancy in staining results was observed between the biopsy and resection materials that were taken from the same patient, this result may not have been applicable in the evaluation of biopsy specimens only. This discrepancy is most likely owing to tissue heterogeneity. The overexpression of p53 that was found in 42% of the patients was of no prognostic significance. CONCLUSIONS: These data provide evidence that overexpression of cyclin D1 protein in resection material of squamous cell carcinomas of the head and neck is indicative of a poor prognosis, independently of other known prognostic factors. Whether overexpression of cyclin D1 may therefore be used to select patients for more intensive treatment should be examined in the context of a clinical trial.

Adult↗
PubMed1997

Variability of tumor volumes in T3-staged head and neck tumors.

BACKGROUND: The Tumor Node Metastasis (TNM) classification system describes head and neck tumors using anatomic or unidimensional criteria and may therefore fail to define the actual three-dimensional tumor bulk. To investigate this we measured variability of tumor volumes (Vvol) in T3-staged head and neck tumors. METHODS: Patient material consisted of pretreatment computerized tomography (CT) scans of 71 patients, seen between 1990 and 1995, with T3 head and neck carcinoma involving different subsites. Computerized tomographic scans of 42 patients displayed distinct tumor boundaries and were free of motion and/or dental artifacts. Using these scans, tumor volumes were measured using the summation-of-areas technique, and Vvol was determined. RESULTS: Following are the tumor-volume measurements: T3 larynx carcinoma (n = 12) Vvol, 1.7-17.0 mL (median 3.7 mL); T3 oropharynx carcinoma (n = 13) Vvol, 10.0-41.2 mL (median 18.3 mL); T3 hypopharynx carcinoma (n = 10) Vvol, 8.9-67.8 mL (median 17.4 mL); T3 nasopharynx carcinoma (n = 3) Vvol, 3.7-30.1 mL; T3 maxillary sinus carcinoma (n = 4) Vvol, 56.0-103.1 mL. CONCLUSIONS: T3-Staged tumors of the head and neck show considerable variability of tumor volumes. Incorporation of tumor volume data may further refine the TNM staging system.

Adult↗
PubMed1997

Osteoid and bone formation in a nasal mucosal melanoma and its metastasis.

AIMS: To present a literature review and a case history concerning bone and osteoid formation by a metastasizing (mucosal) melanoma. CASE DETAILS: Osteocartilaginous differentiation and production of osteocartilaginous structures in malignant melanoma have been described only in 12 previous cases (osteoid in 11. bone in four), all of which involved dermal melanomas. Five of these melanomas were recurrent and one was associated with neurofibromatosis. The case report concerns a 75-year-old man with a nasal mucosal melanoma which was treated surgically. One year later, the patient developed a local recurrence and a cervical lymph node metastasis. Both the recurrent tumour and the metastasis showed clear evidence of bone and osteoid formation. CONCLUSIONS: This case is the first report in the literature, clearly demonstrating bone and osteoid formation by a mucosal melanoma, not only at the primary site, but even more convincingly in a cervical lymph node metastasis.

Aged↗
PubMed1997

Development and clinical evaluation of a second-generation voice prosthesis (Provox 2), designed for anterograde and retrograde insertion.

Prosthetic voice restoration has considerably improved the results of vocal rehabilitation after total laryngectomy, and is presently the method of choice for many health-care providers treating laryngectomized patients. The Provox voice prosthesis, developed in the Netherlands Cancer Institute, is an indwelling device that has been applied in recent years with regular success. Its retrograde replacement method, using a disposable guide wire, assures reliable, atraumatic positioning of the prosthesis in the tracheoesophageal fistula. However, the method sometimes may be uncomfortable for the patient; therefore an adapted prosthesis and new replacement equipment were developed, which enable bidirectional insertion, i.e. not only in the traditional retrograde manner through the pharynx, but especially in an anterograde manner through the stoma. This second-generation voice prosthesis (Provox 2) was studied in a prospective clinical trial in 44 patients (33 experienced patients, seven first-time replacements and four primary insertions). The study demonstrated that the anterograde insertion with the Provox 2 system was applicable in all patients, making the voice prosthesis even easier to handle than with the traditional retrograde method. A stenosis of the pharyngoesophageal segment no longer interfered with the replacement. In addition, the patients judged the new method as being favourable, reporting significantly less discomfort during the replacement procedure (paired Student's t-test: p < 0.0001). Furthermore, the adapted voice prosthesis could be removed from the tracheoesophageal fistula without excessive force (mean 7.9 N, range 6.0-14.0 N), more easily than the original Provox (mean 20.9 N, range 5.5-25.0 N). It can be concluded that this second-generation indwelling voice prosthesis (Provox 2) seems to be a further improvement in the application of this voice rehabilitation system, not only simplifying the replacement procedure, but also diminishing the discomfort for the patient.

Aged↗
PubMed1997

Thallium-201 SPECT in the diagnosis of head and neck cancer.

UNLABELLED: The accuracy of SPECT with 201Tl-chloride for the diagnosis of primary tumors, lymph node metastases and recurrences in head and neck cancer was evaluated for clinical applicability. METHODS: SPECT images, obtained 60 min after administration of 150 MBq 201Tl-chloride, were compared with clinical, CT and/or MRI and histology results. In addition, whole-body images were obtained to detect distant metastases. RESULTS: In 79 patients studied for primary tumors (principally larynix, hypopharynx, oropharynx, nasopharynx and oral cavity), 201Tl SPECT correctly identified 69 of 73 (95% versus 88% for CT/MRI) histologically confirmed malignancies including 63 squamous-cell carcinomas. The method localized four occult naso- and oropharynx carcinomas not seen on CT/MRI and was correctly negative in two patients without tumor and in three of four patients with no confirmed primary tumor in the head and neck. With respect to regional spread, only patients who had cervical lymph node dissection were evaluated, and the findings were recorded per side of the neck. Thallium-201 SPECT correctly identified metastases in 31 of 36 neck dissections with proven lymph node involvement (86%), was correctly negative in nine and false-positive in one. Although the sensitivity of CT/MRI was clearly higher (97%), considerably more false-positive cases affected its accuracy (81% versus 87% for SPECT). In 30 patients investigated for recurrences, 201Tl SPECT correctly identified 27 of 29 microscopically confirmed tumor sites (93%) and was correctly negative in seven. Sensitivity of CT/MRI was lower (76%), and a greater number of false-positives (seven versus three for SPECT) further decreased its accuracy (64% versus 87% for SPECT). Distant metastases were detected in five patients. CONCLUSION: Thallium-201 SPECT appears to be an accurate method for the diagnosis of head and neck cancer. The method is particularly useful for detection of occult head and neck tumors and for assessing recurrences. It also may be of complementary value in the staging of primary tumors, in the differentiation of metastatic from reactive lymph nodes in the neck and, on the basis of whole-body scanning, for screening of distant metastases.

Carcinoma, Large Cell↗
PubMed1996

Preliminary experience with thallous chloride T1 201-labeled single-photon emission computed tomography scanning in head and neck cancer.

OBJECTIVES: To test the feasibility of single-photon emission computed tomography (SPECT) scanning with the use of thallous chloride T1 201 in patients with head and neck cancer and to decide its possible applications to improve the diagnosis and staging of head and neck cancer. DESIGN: Findings from SPECT with the use of 4.32 mCi of thallous chloride T1 201 were compared with those from clinical examination, computed tomography (CT), magnetic resonance imaging, ultrasound-guided fine-needle aspiration, and histologic studies. Primary sites and neck nodes were separately studied. Accuracy, sensitivity, and specifically were calculated for 19 patients who were being assessed for initial treatment (primary sites) and for 12 neck node dissections in 10 patients. SETTING: The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam. PATIENTS: A consecutive sample of 25 patients with head and neck cancers of different sites. The average age of the patients was 60.2 years, and there were 19 men and six women. The sites of the primary lesions were as follows: oropharynx (n = 5), larynx (n = 9), oral cavity (n = 4), nasopharynx (n = 1), hypopharynx (n = 3), and unknown (n = 3). RESULTS: For the primary lesions, SPECT identified 94% of the lesions; SPECT was more accurate in delineating four oropharyngeal lesions and one nasopharyngeal lesion. In 12 neck node dissections, SPECT identified all of the positive lesions and two negative lesions, whereas CT detected two false-positive lesions. Single-photon emission computed tomography gave less information about the number of nodes and the anatomy than did CT or magnetic resonance imaging. CONCLUSIONS: Single-photon emission computed tomography with the use of thallous chloride T1 201 appears to be useful in helping to identify occult primary lesions, particularly in the oropharynx. It may assist CT or magnetic resonance imaging in identifying a recurrence of cancer in tissues or in lymph nodes, and in screening for distant metastases. Although no nodes were identified that were not already seen with the use of CT or magnetic resonance imaging, SPECT may help to eliminate the false-positive lesions, and SPECT with the use of thallous chloride T1 201 appears to be a valuable new tool in helping to diagnose and stage head and neck cancer.

Adult↗
PubMed1996

Evidence for early and persistent impairment of salivary gland excretion after irradiation of head and neck tumours.

Salivary gland scintigraphy with technetium-99m pertechnetate was used to follow changes in the excretion and uptake function of the major salivary glands until 1 year after irradiation. Twenty-five patients who received radiotherapy for head and neck tumours were included in the study. Seventy-nine salivary glands (39 parotid and 40 submandibular) were evaluated in relation to the average received radiation dose. Salivary gland scintigraphy was performed before and 1, 6 and 12 months after radiotherapy. For each gland the excretion response to carbachol, evaluated by calculation of the salivary excretion fraction (SEF), the cumulative gland uptake (CGU) and the absolute excreted activity (AEA) at various intervals after radiotherapy were compared with the baseline values. The excretion response decreased in 20 of 25 patients at 1 month after radiotherapy. One month after radiotherapy both SEF and AEA decreased significantly in relation to the radiation dose. These decreases in excretion parameters persisted during the follow-up period. Parotid excretion was affected significantly more than submandibular excretion. CGU values did not change significantly until 6 months after radiotherapy, but at 12 months a significant decrease related to radiation dose was observed. Xerostomia was assessed during radiotherapy and on the days of the scintigraphic tests. The incidence of xerostomia did not correspond to the effects observed in the scintigraphic studies. It is concluded that radiotherapy induces early and persistent impairment of salivary gland excretion, related to the radiation dose. This impairment is stronger in parotid glands than in submandibular glands.

Dose-Response Relationship, Radiation↗