Biomedical subjects

G J Hordijk

Publications and source records attributed to G J Hordijk.

At least 19 recordsLinked to original sources

PubMed2004

Reasons for non-standard treatment in elderly patients with advanced head and neck cancer.

Elderly patients with head and neck cancer are less likely to receive standard treatment. This study assessed the influence that age, tumour characteristics, comorbidity, social support, depressive symptoms and quality of life have on treatment choice. One hundred and five patients between 45 and 60 years of age and 78 patients of > or =70 years of age with carcinoma of the oral cavity (stage > or =II), oro- and hypopharynx (stage > or =II) or larynx (stage > or =III) completed a questionnaire on quality of life (EORTC QLQ-C30 and H&N35), depressive symptoms (CES-D) and social support (RSS12-I). In the 45-60 age group, 89% received standard treatment, compared with 62% of the > or =70 age group. A multivariate logistic regression analysis showed that the following factors predicted non-standard treatment: marital status (widowed), advanced tumour stage, comorbidity, less pain, considering the length of life less important than its quality and old age. This study showed that age itself independently influences treatment choice. However, it should be emphasised that the choice of a treatment should be based on a medical assessment and the patient's preferences, not on chronological age.

Aged↗

PubMed2004

Psychological factors and patient delay in patients with head and neck cancer.

There is a rising incidence of patients presenting with advanced cancer in the head and neck region. Late presentation may be due to a delay in seeking medical attention, which is sometimes surprisingly long. The aim of the present prospective study was to investigate the association between patient delay and the psychological factors of optimism, health hardiness, overall defensive functioning, coping styles and psychological distress in 277 patients with cancer of the head and neck. Significant correlations were found between patient delay and the psychological factors. Twenty-six percent of the patients waited more than three months before seeking medical attention and they reported less optimism (P = 0.0001), less health hardiness (P = 0.008), less active coping (P = 0.019) and less seeking support as a coping style (P = 0.017) than patients presenting within three months. Excessive drinkers (5+ alcoholic drinks/day) tended to show more delay than patients who did not drink or were moderate drinkers (0-2 drinks/day) or moderate-heavy drinkers (3-4 drinks/day). Together, the psychological factors could explain 25% of the variance of patient delay in excessive drinkers compared with 21% and 6% in moderate-heavy drinkers and non-drinkers to moderate drinkers, respectively. These results suggest that psychological factors affect health-care seeking behaviour. Health education aimed at the risk group of excessive drinkers should take psychological factors into account that influence their health behaviour.

Adult↗

PubMed2004

Simultaneous radio- and chemotherapy for squamous cell carcinoma of the head and neck in daily clinical practice: 5 years experience in a University Hospital.

Several randomized studies and meta-analyses have shown that simultaneous radio- and chemotherapy prolongs survival in patients with unresectable squamous cell carcinoma of the head and neck as compared with conventional radiotherapy. We assessed the feasibility and effectiveness of simultaneous radiotherapy (35 x 2 Gy) and chemotherapy [cisplatinum 100 mg/m(2) or carboplatin (AUC 6) on days 1, 22 and 43] in daily clinical practice in a cohort of 87 patients treated at our institute between 1998 and 2002. Eighty patients completed radiotherapy according to schedule. Eighty patients received two courses of chemotherapy and 50 patients three courses. Nephrotoxity, bone marrow suppression and ototoxicity were the most frequent side-effects. Median weight loss was 8.5%. Median survival was 15 months and 44% of the patients were alive at 2 years. Patients receiving three courses of chemotherapy had a better survival than patients receiving two or less courses. Treatment with simultaneous radio- and chemotherapy for advanced head and neck cancer is a demanding, but feasible treatment in daily clinical practice. Survival seems to be comparable with the results achieved in patients selected for clinical trials.

Adult↗

PubMed2003

[Tumor growth during the waiting period for radiotherapy in patients with oropharyngeal carcinoma].

OBJECTIVE: To quantify the potential increase in tumour volume during the waiting time for radiotherapy in patients with oropharyngeal squamous cell carcinoma. DESIGN: Retrospective study. METHOD: The tumour volumes as assessed on the diagnostic CT scan and the planning CT scan were compared. Thirteen patients with oropharyngeal carcinoma were included in this study. Both their diagnostic CT scan (CT-1) and their planning CT scan (CT-2) were performed in the Utrecht university medical centre. Tumour volume was calculated by delineating the tumour on CT slices and multiplying the surface area by the inter-slice distance. Tumour volumes were delineated by three independent observers. Tumour growth during the waiting time was defined as the difference in tumour volume on CT-2 and CT-1, calculated as the average of three observations. RESULTS: The mean time between CT-1 and CT-2 was 33 days. The mean waiting period between the histopathological diagnosis and the start of radiotherapy was 56 days. Three groups could be distinguished: in one group the growth was less than 25% (n = 4), in one group the growth varied between 25 and 100% (n = 5), and in a third group there was growth of more than 100% (n = 4). Apart from this, in three cases the TNM stage had to be adjusted as a result of tumour progression. CONCLUSION: This study showed that the tumour volume increased by more than 50% during the waiting time for radiotherapy in 8 out of 13 patients with squamous cell carcinoma of the oropharynx.

Aged↗

PubMed2003

Current indications for (adeno)tonsillectomy in children: a survey in The Netherlands.

OBJECTIVE: Despite the fact that (adeno)tonsillectomy is one of the procedures most frequently performed on children, studies of current indications are scarce. The purpose of this study is to determine the indications for (adeno)tonsillectomy in children younger than 15 years of age according to Dutch ENT surgeons and general practitioners (GPs). METHODS: During a period of 8 months, 18 ENT surgeons in seven ENT practices and 210 referring GPs filled out standard questionnaires for 349 children listed for tonsil surgery. RESULTS: Apart from recurrent tonsillitis (ENT: 40%, GP: 35%), findings such as enlarged tonsils (ENT: 42%, GP: 24%) and tonsillar crypt debris (ENT: 29%, GP: 17%) and non-specific symptoms such as listlessness (ENT: 28%, GP: 19%) and poor appetite (ENT: 28%, GP: 16%) were considered important criteria for surgery. Symptoms of obstructive sleep apnea were present in 25% (ENT) and 6% (GP) of patients but were considered indicative for surgery in only 11% (ENT) and 4% (GP). In contrast to ENT surgeons, GPs considered otitis media and hearing loss relatively important for (adeno)tonsillectomy. CONCLUSIONS: Apart from the generally accepted indications such as recurrent tonsillitis and obstructive sleep apnea, other indications play an equally important role in the decision to perform tonsil surgery in The Netherlands.

Adenoidectomy↗

PubMed2003

Increasing incidence of advanced stage head and neck tumours.

The aim of this study was to determine whether the incidence of advanced stage (T4) head and neck tumours has increased. We analysed retrospectively 3178 patients diagnosed with oral, pharyngeal or laryngeal cancer in the period 1980-2000 at the University Medical Center Utrecht (UMCU), The Netherlands. There was a statistically significant increase in the proportion of T4 head and neck tumours compared with non-T4 tumours over the period 1980-2000. Linear regression analysis estimated an increase of 0.9% every year. The observed increase in T4 tumours at UMCU shows up in figures from the Netherlands Regional Cancer Registry (IKMN) and the National Cancer Registration (NCR). Although these bodies report for fewer years, this finding refutes the possibility of selected referral to the University Medical Center Utrecht. In conclusion, the number of head and neck cancer patients presenting with an advanced stage carcinoma (T4) has increased over a period of 21 years.

Head and Neck Neoplasms↗

PubMed2003

Elderly patients with head and neck cancer: short-term effects of surgical treatment on quality of life.

Elderly patients with head and neck cancer are less likely to be treated surgically. However, little is known about surgical outcome and quality of life (QOL) in elderly patients after a major surgery. This prospective study compared the QOL and the surgical outcome of 54 elderly (> or =70 years) and 75 younger patients (45-60 years) with carcinoma of the oral cavity (stage > or = II), pharynx (stage > or = II) or larynx (stage > or = III). Before and 3 months after surgery, the patients completed questionnaires about QOL (EORTC QLQ-C30 and QLQ-H&N35) and depression (CES-D). Before treatment, elderly and younger patients did not differ in QOL. Three months after the treatment, both groups scored worse on most QOL aspects, but there were no significant differences between the elderly and the younger patients. Surgical and systemic complication rates were similar for both the groups. In conclusion, we found no significant differences in the complication rate and QOL aspects between surgically treated elderly and younger patients.

Age Factors↗

PubMed2002

[Rising incidence of invasive (T4) head-neck carcinoma at the Utrecht University Medical Center, 1980-1998].

OBJECTIVE: To determine whether there is an increase in the incidence of diagnosed head and neck tumours at an advanced stage (T4). DESIGN: Secondary data-analysis. METHOD: Data of patients registered in 1980-1998 at the Utrecht University Medical Centre, the Netherlands, were analysed for the relative prevalence of T4 tumours in the oral cavity, pharynx and larynx on the basis of sex, age and tobacco and alcohol usage. The results were compared with figures from the Dutch national cancer registry (1989-1997). RESULTS: Data were collected for 2993 patents (2256 men and 737 women; average age 63 years (SD 12)). Of these 35 had a carcinoma situated on the lips, 1091 in the oral cavity, 1321 in the larynx and 546 in the pharynx. There was an increase in T4 tumours of 12.2% (43/353) of all tumours in 1980-1984 to 27.2% (252/1033) in 1995-1998. Linear regression analysis estimated an increase of 0.9% every year. Selected referral to the Utrecht University Medical Centre was unlikely because the increased incidence of T4 tumours could be recognised in the national cancer registry. There was no change in the sex distribution over the study period. The increase in the 40 to 50-year-old age group was greater than that of the patients aged 80 years and over. T4 tumours were more prevalent than T1 tumours in patients who had smoked 20 or more cigarettes per day or drank more than 4 units of alcohol per day. CONCLUSION: The percentage of cancer patients presenting with an advanced stage (T4) of head-neck tumours increased during the study period.

Adult↗

PubMed2002

P53 tumor suppressor gene mutations in laryngeal cancer and in recurrent disease following radiation therapy.

In this study we performed p53 sequencing based mutation analysis in laryngeal cancers and matched recurrent disease following irradiation. The question is if irradiation affects the DNA and introduces or deletes mutations so that p53 cannot be used as a clonal marker anymore. P53 mutations were identified in fresh-frozen laryngectomy specimens with either primary laryngeal cancers, treated by surgery and irradiation post-operative with local failure during follow-up, or with recurrent laryngeal cancers following primary irradiation. In 21 tumors the p53 status was analyzed by direct sequencing full-length mRNA through RT-PCR. DNA sequencing analysis of exons 2 through 11 was performed when RNA isolation could not be performed. The marker mutation identified in this way was detected by DNA sequencing of the corresponding exon in formalin-fixed deparaffinized tumor biopsy samples in respectively matched recurrent disease following surgery and irradiation or primary tumor before irradiation. DNA sequencing analysis of the corresponding exon of peripheral blood leukocytes excluded the presence of germline mutations or polymorphisms. In 16 out of 21 tumors (71%), a mutation was identified. Fifteen of these marker mutations were detected in the matched tumor biopsy sample (94%). The only case lacking the marker mutation probably was a second primary tumor. We conclude that we find no direct evidence for induction or loss of p53 mutations following irradiation. Consequently, p53 may be used as a diagnostic tool when histological examination fails, for example in discriminating between the presence of a second primary tumor in the same area versus recurrent disease.

Aged↗

PubMed2001

Quantitative dose-volume response analysis of changes in parotid gland function after radiotherapy in the head-and-neck region.

PURPOSE: To study the radiation tolerance of the parotid glands as a function of dose and volume irradiated. METHODS AND MATERIALS: One hundred eight patients treated with primary or postoperative radiotherapy for various malignancies in the head-and-neck region were prospectively evaluated. Stimulated parotid flow rate was measured before radiotherapy and 6 weeks, 6 months, and 1 year after radiotherapy. Parotid gland dose-volume histograms were derived from CT-based treatment planning. The normal tissue complication probability model proposed by Lyman was fit to the data. A complication was defined as stimulated parotid flow rate <25% of the preradiotherapy flow rate. RESULTS: The mean stimulated preradiotherapy flow rate of 174 parotid glands was 0.34 mL/min. The mean flow rate reduced to 0.12 mL/min 6 weeks postradiotherapy, but recovered to a mean flow rate of 0.20 mL/min at 1 year after radiotherapy. Reduction in postradiotherapy flow rate correlated significantly with mean parotid dose. No threshold dose was found. Increasing the irradiated volume of parotid glands from 0%-40% to 90-100% in patients with a mean parotid dose of 35-45 Gy resulted in a decrease in flow ratio from, respectively, approximately 100% to less than 10% 6 weeks after radiation. The flow ratio of the 90%-100% group partially recovered to 15% at 6 months and to 30% at 1 year after radiotherapy. The normal tissue complication probability model parameter TD(50) (the dose to the whole organ leading to a complication probability of 50%) was found to be 31, 35, and 39 Gy at 6 weeks, 6 months, and 1 year postradiotherapy, respectively. The volume dependency parameter n was around 1, which means that the mean parotid dose correlates best with the observed complications. There was no steep dose-response curve (m = 0.45 at 1 year postradiotherapy). CONCLUSIONS: This study on dose/volume/parotid gland function relationships revealed a linear correlation between postradiotherapy flow ratio and parotid gland dose and a strong volume dependency. No threshold dose was found. Recovery of parotid gland function was shown at 6 months and 1 year after radiotherapy. In radiation planning, attempts should be made to achieve a mean parotid gland dose at least below 39 Gy (leading to a complication probability of 50%).

Adult↗

PubMed2001

[CBO guideline 'larynx carcinoma'].

The guideline 'Larynx carcinoma' aims at preventing divergent views on the treatment of different stages of larynx carcinoma between the major referral centres. Strict criteria are proposed for the radiological diagnostic procedures and the pathology report in order to accurately classify the patient in the appropriate prognostic category. Taking into consideration possible subsequent treatments, surgery--preferably by laser--is proposed for severe dysplasia and carcinoma in situ. For all other stages the treatment of choice is radiotherapy as a larynx conserving therapy. Only in cases of massive tumour volumes with invasion through the laryngeal skeleton where the chance of cure is low with radiotherapy, surgery is the treatment of choice. Minimal criteria are described for rehabilitation and supportive care. Due to the relative rarity of the disease and the complexity of the treatment, all patients with a laryngeal carcinoma should be seen at least once in a dedicated head and neck clinic.

Carcinoma↗

PubMed2001

Proliferative capacity in head and neck cancer.

BACKGROUND: Shortening of overall treatment time (accelerated radiotherapy) appears to result in an increase of the efficacy of irradiation. In this study, we compared the proliferative capacity between tumors originating in different sites of the head and neck region. Tumors with a large proliferating capacity might, theoretically, benefit most from accelerated radiotherapy. MATERIAL AND METHODS: BrdUrd was administered intravenously in patients with head and neck carcinomas. Tumor samples were analyzed with flow cytometry. T and N stages were assessed in accordance with the TNM classification system (UICC 1987). RESULTS: No significant differences in proliferation parameters were observed with respect to site of origin of head and neck tumors. For T3/T4 tumors, DNA ploidy is an important tumor characteristic: G1- and S-phase fractions, labeling index, and tumor doubling time Tpot differences were statistically significant; the aneuploid tumors showed the largest proliferative potential. CONCLUSIONS: (1) In general, no significant differences in proliferation parameters were observed with respect to site of origin. (2) Aneuploid head and neck tumors have a higher proliferative capacity than diploid ones, they might benefit most from accelerated irradiation.

Antimetabolites, Antineoplastic↗

PubMed2001

Prediction of depression 6 months to 3 years after treatment of head and neck cancer.

BACKGROUND: Head and neck cancer and its treatment can have important psychosocial implications. Many patients become depressed. The aim of this prospective study is to examine whether pretreatment variables can be used to predict depression up to 3 years after treatment. METHODS: Head and neck cancer patients (n = 197) treated with surgery and/or radiotherapy completed both before and after treatment a questionnaire including items on social support, coping, depressive symptoms, physical functioning, and physical symptoms. RESULTS: Eight pretreatment variables (tumor stage, sex, depressive symptoms, openness to discuss cancer in the family, available appraisal support, received emotional support, tumor-related symptoms, and size of the informal social network) were used to calculate a risk score to determine which patients were depressed at 6 months to 3 years after treatment (positive predicted value, 58%; negative predicted value, 83%). CONCLUSIONS: Eight pretreatment variables can be used to predict accurately those head and neck cancer patients who are likely to become depressed up to 3 years after treatment.

Depression↗

PubMed2001

F-18-fluoro-deoxy-glucose positron-emission tomography scanning in detection of local recurrence after radiotherapy for laryngeal/ pharyngeal cancer.

BACKGROUND: The objective of this investigation was to determine whether F18-fluoro-deoxy-glucose (FDG) positron-emission tomography (PET) could differentiate between local recurrence and late radiation effects after radiotherapy for laryngeal/pharyngeal cancer. METHODS: In a prospective study of 75 patients (67 larynx, eight oro/hypopharynx), 160 laryngoscopies and 109 FDG PET scans were performed on the head and neck region. The mean follow-up time after the first FDG PET scan was 23 months (minimum 1 year). RESULTS: Local recurrence was diagnosed in 37 patients: 19 after the first biopsy and 18 after follow-up biopsies. For all of the negative initial FDG scans (27), the biopsies that were taken at the same time were negative and no recurrence was seen for at least 1 year. The first FDG scan was a true positive in 34 of 48 patients. In 12 of the 14 patients with false-positive results, FDG scans were repeated; a decreased FDG uptake was found in 9 of the 12. The sensitivity and specificity of the first scan were respectively 92% and 63%; including subsequent FDG scans, the rates were 97% and 82%, respectively. CONCLUSIONS: When a local recurrence is suspected after radiotherapy for cancer of the larynx/pharynx, an FDG PET scan should be the first diagnostic step. No biopsy is needed if the scan is negative. If the scan is positive and the biopsy negative, a decreased FDG uptake measured in a follow-up scan indicates that a local recurrence is unlikely.

Adult↗

PubMed2001

Sociodemographic factors and quality of life as prognostic indicators in head and neck cancer.

Pre-treatment quality of life (QOL) has been found to be an independent prognostic factor for survival in cancer patients, in particular in patients with advanced cancer. Sociodemographic factors such as marital and socioeconomic status have also been recognised as prognostic factors. We studied the influence of QOL and mood (measured with the European Organization for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) and the Head and Neck Cancer Questionnaire (EORTC QLQ-H&N35), and with the Center for Epidemiologic Studies-Depression Scale (CES-D)) as measured before treatment, the use of cigarettes and alcohol and sociodemographic factors (age, gender, marital status, income and occupation) on recurrence and survival in 208 patients with head and neck cancer prior to treatment with surgery and/or radiotherapy, using Kaplan-Meier and Cox regression analyses. Cognitive functioning and, to a lesser degree, marital status were independent predictors of recurrence and survival, along with medical factors (stage and radicality). Patients with less than optimal cognitive functioning and unmarried patients had a relative risk (RR) of recurrence of 1.72 (95% confidence interval (95% CI) 1.01-2.93) and 1.85 (95% CI 1.06-3.33), respectively, and a RR of dying of 1.90 (95% CI 1.10-3.26) and 1.82 (95% CI 1.03-3.23), respectively. Performance status, physical functioning, mood and global QOL and smoking and drinking did not predict for recurrence and survival. The influence of cognitive functioning might be related to the use of alcohol. Marital status may influence prognosis through mechanisms of health behaviour and/or social support mechanisms.

Alcohol Drinking↗

PubMed2001

Preoperative determination of the location of parotid gland tumors by analysis of the position of the facial nerve.

PURPOSE: This study examined the usefulness of anatomic lines in predicting the intraparotid course of the facial nerve. MATERIALS AND METHODS: To make the comparison, 3 lines were drawn on 69 transverse sections of 5 cadaver heads. Then, the shortest and the longest distance from the lines to the facial nerve were measured. RESULTS: Of the tested lines, the one that connects the most dorsal point on the ipsilateral half of a vertebra to the dorsal side of the retromandibular vein had the shortest distance to the facial nerve. It also ran more parallel to the facial nerve than the other 2 lines. CONCLUSIONS: Because the line that connects the most dorsal point on the ipsilateral half of a vertebra to the dorsal side of the retromandibular vein best predicts the intraparotid course of the facial nerve, it might be useful in assessing whether parotid tumors are located in the superficial or deep lobe.

Anatomy, Cross-Sectional↗

PubMed2001

Landmarks for parotid gland surgery.

Many surgical landmarks have been suggested to help the surgeon identify the facial nerve when performing parotid gland surgery. There is no conclusive evidence that any one landmark is better than the rest. In this study distances from the most frequently used surgical landmarks to the main trunk of the facial nerve were measured in 30 halves of cadaver heads. Two ENT surgeons assessed the best landmark in each case. The tympanomastoid suture was nearest to the main trunk and was therefore considered the most reliable landmark. Its average distance to the main trunk of the facial nerve was 2.7 mm. This result was consistent with the subjective best score given by two ENT surgeons.

Cadaver↗

PubMed2000

Pretreatment factors predicting quality of life after treatment for head and neck cancer.

BACKGROUND: Quality of life (QOL) has become an important issue in head and neck cancer. Explanation of factors predicting QOL after treatment has important implications for patient management. METHODS: In this prospective study we analyzed which pretreatment factors predicted QOL after surgery and/or radiotherapy with curative intent in a cohort of 153 patients with cancer of the oral cavity, oropharynx, hypopharynx, or larynx. The patients completed the EORTC Core Questionnaire, the EORTC Head and Neck Cancer module, and the Center for Epidemiologic Studies Depression scale before treatment and 6 and 12 months later. The influence of gender, age, performance status, and depressive symptoms at baseline, site, stage, and treatment on QOL (and its dimensions) and depressive symptoms after 6 and 12 months was studied, using linear regression analysis. RESULTS: A high level of depressive symptoms and a low performance status at baseline and combination treatment were significant predictors of increased severity of symptoms and poor functioning after treatment. Treatment was a predictor of head and neck symptoms, whereas performance status and depressive symptoms were predictors of general symptoms and functioning. Gender and age had little predictive value. CONCLUSIONS: Patients with depressive symptoms or a low performance status who receive combination treatment for cancer of the head and neck are at risk for physical and psychologic morbidity after treatment. Special attention should be given to these patients in rehabilitation programs.

Adaptation, Psychological↗