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J J Manni

Publications and source records attributed to J J Manni.

At least 73 records · Page 4Linked to original sources
PubMed1995

The importance of correct stage grouping in oncology. Results of a nationwide study of oropharyngeal carcinoma in The Netherlands.

BACKGROUND: In the frame of a nationwide study of oropharyngeal carcinoma in the Netherlands (1986-1990), the current International Union Against Cancer 1992/American Joint Committee on Cancer 1988 staging system was evaluated with respect to patient distribution and prognostic value. METHODS: Data related to epidemiology, treatment and survival from 640 patients referred for primary treatment were analyzed. Staging was first evaluated in a proportional-hazard regression analysis controlled for these data. Next, all possible combinations of T, N, and M were tested in a stepwise backward elimination model until all remaining indicator variables had a P value of less than 0.05. New stages were defined, based on the coefficients of the remaining indicator variables. RESULTS: The revised stages revealed two advantages compared with the UICC 1992/AJCC 1988 version: a more balanced distribution of patients (31% in Stage I, 31% in Stage II, 18% in Stage III, 14% in Stage IV, and 5% unknown in the revised staging system versus 7% in Stage I, 17% in Stage II, 24% in Stage III, 50% in Stage IV, and 2% unknown in the UICC 1992/AJCC 1988 staging system), and an improved prognostic discrimination for the disease specific survival (5-year results in the revised staging were 67% in Stage I, 42% in Stage II, 28% in Stage III, and 11% in Stage IV, versus 68% in Stage I, 64% in Stage II, 44% in Stage III and 27% in Stage IV in UICC 1992/AJCC 1988). CONCLUSION: Improvements in the current staging system in patient distribution in the stages in prognostic discrimination is feasible by regrouping the T, N, and M but without redefining the categories themselves.

Adult↗
PubMed1995

A nationwide study of the epidemiology, treatment and survival of oropharyngeal carcinoma in The Netherlands.

Seven head and neck oncology cooperative groups in the Netherlands have reviewed the epidemiology, staging, treatment and survival of oropharyngeal carcinoma patients treated between 1986 and 1990. In all, 640 patients with squamous cell carcinoma (628, 98%) or undifferentiated carcinoma (12, 2%) referred for primary treatment were analyzed. The total group included 441 males (69%) and 199 females (31%), with a median age of 59 years (range, 30-92). Tumor distribution by subsite was the tonsillar region (372 patients, 58%), base of the tongue/vallecula (179, 28%), soft palate/uvula (62, 10%) and posterior oropharyngeal wall (27, 4%). Forty-four patients (7%) had stage I disease, 106 (17%) had stage II disease, 157 (24%) stage III, and 319 (50%) stage IV. Staging was unknown in 14 patients (2%). Radiotherapy was given to the primary tumor in 408 patients (64%), surgery and radiotherapy to 147 (23%), surgery alone to 42 (7%), other treatments to 14 (2%) and no treatment to 29 patients (4%). The 5-year overall survival was 28% and the 5-year disease-specific survival was 41%. This latter survival was 35% in males and 51% in females (P = 0.003). Five-year survival by subsite was 54% in the soft palate/uvula, 42% in the tonsillar region, 33% in the base of the tongue and 32% in the posterior oropharyngeal wall (P = 0.003). When analyzing survival by stage, 5-year survival in patients with stage I disease was 68% and decreased significantly to 27% in stage IV disease (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Glutathione S-transferases and glutathione in human head and neck cancer.

Glutathione S-transferase (GST) enzyme activity, GST isoenzyme composition and glutathione (GSH) concentration were assessed in normal and squamous cell carcinoma specimens of 14 patients with oral or oropharyngeal cancer and 11 patients with laryngeal cancer. Comparing malignant with normal oral/oropharyngeal tissues, no significant differences in GSH content, GST enzyme activity or isoenzyme composition were found. However, some tumours had up to 3-fold increased GST enzyme activities and 11 malignant samples over-expressed GST-pi. GST-pi was present in all normal and malignant oral/oropharyngeal specimens investigated, whereas class alpha and class mu were detected in only a few samples. GST-mu was present in 28% of the patients with oral/oropharyngeal tumors as compared with approximately 60% in the normal population. GST-alpha, -mu and -pi were detected in 91, 64 and 100% of the normal laryngeal tissues respectively. In laryngeal tumours significantly higher levels of GST-pi and GSH but significantly lower amounts of GST-alpha were detected. Levels of class mu GST were generally lower in cancerous tissues, but differences were not significant. In comparison with normal oral/oropharyngeal tissues, normal laryngeal tissues contained almost twice the amount of GST enzyme activity due to higher class alpha enzyme levels. It is concluded that GST-pi is elevated in 11 out of 14 tumours of the oral cavity and values are significantly increased in tumours of the larynx, which may contribute to the inherent anti-cancer drug resistance of these malignancies. In laryngeal tumours the increased GSH levels may confer additional resistance to radiation therapy.

Aged↗
PubMed1995

Partial vertical laryngectomy for recurrent glottic carcinoma.

Partial vertical laryngectomy for recurrent glottic carcinoma was performed in 61 patients according to stringent criteria. The great majority of the recurrent tumours appeared within 2 years of radiotherapy (80%). The mean follow-up after surgery was 79 months. At 5 years 85% of the patients were free of local recurrence. Nine patients (15%) developed a local recurrence; eight of them underwent total laryngectomy; one patient refused the operation and died. Seven patients died of other causes. The actuarial overall survival rate was 88% at 5 years. Post-operative complications were seen in 12 patients (20%); nine of these patients developed airway problems. One patient underwent total laryngectomy for severe aspiration, the others finally were decannulated. The results of this study indicate that partial vertical hemilaryngectomy for irradiation failures is a safe procedure with good results without undue morbidity.

Adult↗
PubMed1995

Glutathione peroxidases in human head and neck cancer.

Glutathione peroxidases (GPX), enzymes that catalyze the reduction of reactive intermediates have been implicated in the action of several cytostatic drugs. Two major types of GPX have been found: a selenium-dependent form (SeGPX) which is active with both hydrogen peroxide and organic hydroperoxides, and a selenium-independent GPX which is only active with organic hydroperoxides. SeGPX and total GPX (tGPX) activity were assayed in cytosolic fractions from malignant and adjacent normal tissue in 13 patients with oral/oropharyngeal, and 10 patients with laryngeal squamous cell carcinoma. Neck lymph node metastases were available from 2 and 5 of these patient respectively. Tumors from the oral/oropharyngeal region contained significantly less SeGPX and tGPX activity than laryngeal tumors. Primary oral/oropharyngeal and laryngeal tumors had lower SeGPX activities than the matched normal mucosa. tGPX activities were similar in normal and tumor tissue. Metastases contained slightly more SeGPX and tGPX activity than the matched tumor tissue. We conclude that the inherent anti-tumor drug resistance of human neck squamous cell carcinoma is not mediated by increased glutathione peroxidase enzyme activity in the tumor tissue.

Adult↗
PubMed1994

Routine long-term follow-up in patients treated with curative intent for squamous cell carcinoma of the larynx, pharynx, and oral cavity. Does it make sense?

OBJECTIVE: To evaluate whether additional curative treatment was possible in patients for whom routine long-term follow-up had led to the early detection of locoregional recurrence, distant metastases, and second primary tumors (events). DESIGN: Cohort study with a maximum follow-up of 126 months and a consensus questionnaire. SETTING: Department of Head and Neck Oncology at the University Hospital Nijmegen (the Netherlands). PATIENTS: There were 428 patients treated with curative intent for carcinoma of the larynx, pharynx, and oral cavity from 1979 to 1983. MAIN OUTCOME MEASURES: Site, stage, differentiation grade, and type of treatment of index tumor (routine follow-up vs self-referral). RESULTS: There were 205 patients (47.9%) who developed events, 76.1% within 3 years of initial treatment. Eighty-nine patients (43.4%) received curative treatment. The detection rate for events during routine follow-up (6350 appointments) was one in 34, and for self-referrals (54) it was one in 2.7; the cure rates were one in 78 and one in 6.8, respectively. The mean survival after detection of events with routine follow-up was significantly (P < .05) better than with self-referral (58 vs 32 months, respectively). CONCLUSIONS: Routine follow-up is indispensible. Site and stage of the index tumor played a part in the length of routine follow-up, in contrast to the differentiation grade or type of initial treatment. Yearly chest roentgenograms were valuable only for laryngeal index tumors. Patients considered routine follow-up important; however, negative findings at physical examination of complaints did not reassure all patients.

Adolescent↗
PubMed1994

A prospective longitudinal study on radiation-induced hearing loss.

Recent clinical reports indicate that patients receiving radiotherapy that includes the auditory system in the treatment volume are likely to develop an irradiation-induced hearing loss. Although the early, presumed reversible, conductive hearing impairment due to secretory otitis media following radiotherapy is a sequela well known by radiation oncologists, permanent hearing loss, both conductive and sensorineural, is believed to be rare. A prospective study was performed enrolling patients receiving postoperative radiotherapy for unilateral parotid tumors. Audiometric results prior to irradiation were compared with those obtained 2 years later. Up to 50% of the patients (9 of 18) developed a clinically relevant hearing loss in the irradiated ear, both conductive and/or sensorineural. The contralateral ear remained unaltered. The hearing loss was permanent in 6 patients (33%) and affected their quality of life. The data suggest that changes occur in the inner ear as well as in the auditory nerve and auditory brain stem with conventional irradiation schemes with daily fractions of 2 to 2.5 Gy with a total dose of 50 Gy.

Adolescent↗
PubMed1994

[Experiences with the Groningen voice prosthesis after laryngectomy].

The tracheoesophageal puncture technique with insertion of a valved prosthesis for speech rehabilitation after total laryngectomy is a reliable and simple procedure for successful vocal rehabilitation. The available voice prosthesis can be separated into indwelling and non-indwelling types. The details of the indwelling long-term prostheses (low-pressure Groningen Prosthesis, Nijdam, prosthesis, Provox prosthesis) are discussed. These prostheses need limited patient care. Replacement of the indwelling prosthesis is a simple out-patient procedure, although it is best performed by an ENT-specialist. The local complication rate is low and generally not significant. Hand-free speech is now possible by placement of a tracheostoma valve. Current experiences are encouraging for continued use.

Contraindications↗
PubMed1993

E-cadherin expression in head and neck squamous-cell carcinoma is associated with clinical outcome.

The cell-cell adhesion molecule E-cadherin has been shown to suppress invasive growth of epithelial cells in vitro, and loss of its expression is thought to be important in invasion and metastatic potential of epithelial tumors in vivo. We retrospectively studied the level of E-cadherin expression in 50 primary head and neck squamous-cell carcinomas (HNSCC) by immunohistochemical methods, on frozen sections, using anti-E-cadherin monoclonal antibody (MAb) 6F9. It concerned patients with different stages of carcinoma of larynx or oral cavity who had been treated with curative intention 30 months or more before. Percentages of membranous stained tumor cells were scored in 1 of 5 categories. Scores were generally low, as in 11/50 lesions < or = 5% cells were stained, and in 19/50 lesions only 6-25% cells showed membranous staining. In 9 lymph-node metastases evaluated, E-cadherin expression was in the same range as in the primary tumors. There was a significant correlation between the level of membranous E-cadherin expression in the primary tumor and the degree of differentiation. No relation was found with tumor size (pT) or regional lymph-node classification (pN). Nevertheless, 29 patients surviving > or = 30 months without evidence of disease had significantly higher levels of membranous E-cadherin expression in their primary tumors than 10 patients with unfavorable clinical course clearly related to recurrent and/or metastatic HNSCC. Moreover, this could only partially be explained by distinctions in differentiation grade between both groups. Our results suggest that membranous E-cadherin expression has prognostic importance in patients with HNSCC.

Adult↗
PubMed1993

[Prognostic significance of the histological classification and staging for patients with a malignant non-Hodgkin lymphoma].

OBJECTIVE: To assess the prognostic significance of histological classification, grade and stage with regard to overall survival in patients with non-Hodgkin's lymphoma (NHL). DESIGN: Retrospective analysis. SETTING: University Hospital St Radboud, Nijmegen. METHOD: All consecutive 346 patients with NHL diagnosed in the period January 1978-December 1990 were included in this one-centre study. Recorded data included histological type according to the Kiel classification, histological grading according to the International Working Formulation (IWF), Ann Arbor stage, age, sex, tumour mass, number of extranodal sites, serum LDH and ESR. Grading according to the IWF was assessed retrospectively for those patients whose primary disease had been diagnosed before 1982. The observation period ended September 1st, 1991. Overall survival was calculated according to Kaplan-Meier. The significance of the prognostic parameters was studied using both univariate and multivariate stepwise regression analysis. RESULTS: There were 209 men and 137 women with a median age of 56 years (range 15-85). No initial treatment was given to 8% of the patients. After a median follow-up of 52 months, 179 patients (52%) had died; the calculated median survival time was 49 months. Patients with low-grade NHL had a significantly better short-term prognosis than the remaining patients. Related to clinical stage, only patients with stage I disease had distinctly longer survival times than those with more advanced disease. Multivariate analysis revealed serum LDH, age, stage and histological classification to be the most important independent prognostic variables. CONCLUSION: Even in multivariate analysis, histological classification and Ann Arbor stage have prognostic significance with regard to overall survival in patients with NHL. However, serum LDH levels proved to be the most important prognostic parameter.

Adolescent↗
PubMed1993

Increased expression of cytokeratins 8, 18 and vimentin in the invasion front of mucosal squamous cell carcinoma.

The immunohistochemical expression patterns of cytokeratins 8 and 18 and vimentin were examined in frozen sections of 120 human mucosal squamous cell carcinomas with special emphasis on the topological distribution in the tumour. This was done in order to evaluate in squamous cell carcinoma a particular expression pattern observed recently by us in transitional cell carcinoma of the urinary tract and designated as an 'interface phenomenon'. This phenomenon implying maximum expression of cytokeratins 8 and 18 at the tumour front, and to a lesser extent also in areas of intratumorous stroma contact, was also found in about 50 per cent of the squamous cell carcinomas examined. It was even found for vimentin, which contrasted with transitional cell carcinoma. The percentages of occurrence of the phenomenon varied for the different sites of origin of the tumour. Tumour grade did not influence the results. These findings further support the idea that invasive carcinoma cells interacting with the stromal micro-environment display a characteristic intermediate filament phenotype that deviates from the pattern expected on the basis of their direction of differentiation. These changes might reflect phenotype involved in invasive, migrating, and proliferating activities.

Carcinoma, Squamous Cell↗
PubMed1993

The value of twice yearly bronchoscopy in the work-up and follow-up of patients with laryngeal cancer.

The aim of this retrospective study was to investigate the usefulness and feasibility of twice-yearly bronchoscopy and sputum cytology in patients with laryngeal cancer. In 170 selected patients, 500 (both initial and during follow-up) bronchoscopies were performed. There was a maximum follow-up of 34 months. 5 (2.8%) male patients developed lung cancer. In only 2 of them was the diagnosis based on bronchoscopy alone. After treatment with curative intent, both patients developed a recurrent lung carcinoma. According to most patients' experience, regular bronchoscopy is unpleasant. It is concluded that twice-yearly bronchoscopy and sputum cytology in patients with laryngeal cancer is not useful as a routine procedure. At present, chemoprevention of second primary tumours seems the most promising adjunctive treatment modality.

Adult↗
PubMed1993

[Uni- and multivariate analysis of prognostic factors in T3 laryngeal cancers].

In 511 patients with T3N0-3M0 laryngeal carcinoma, 24 possible prognostic factors were analysed retrospectively. The factors were age, sex, mode of treatment, duration of several clinical symptoms, the presence of sore throat, otalgia, dyspnoea, and dysphagia, previous tracheotomy, tumour extension, lymph node status (five items), histologic grading, smoking habits, and alcohol intake. For 300 patients in whom surgery was part of the primary treatment, pathologic staging of the primary tumour and of lymph nodes in neck dissection specimens, cartilage invasion, radicality of the operation, differentiation grade, and subglottic extension were also evaluated. Univariate analysis revealed prognostic significance on survival for tumour extension (limited to the glottic region), lymph node status (clinically palpable lymph nodes, cytologically confirmed positive lymph nodes), level of lymph node metastasis (high and midjugular site), histologic grading (poor differentiation grade), and treatment modality (planned combined therapy). In the group that underwent surgery, all factors derived from specimens of the larynx and neck dissections had prognostic significance. Multivariate analysis revealed that the glottic site of the tumour, the presence of cyto- and histopathologically proven metastatic lymph nodes, pretreatment tracheotomy, positive resection margins, and planned combined treatment had a significant influence on corrected actuarial survival.

Adult↗
PubMed1993

The use of the startle reflex measurement in patients with various types of fixation of the ossicular chain.

The results of startle and acoustic stapedius reflex measurements can be used to subclassify various types of fixation of the ossicular chain. Reflex measurements were performed on a group of subjects with normal hearing and on a group of patients with surgically verified ossicular chain fixation. In 97% of the subjects with normal hearing (n = 30), reproducible impedance changes were observed as part of a startle reaction and four different reaction patterns could be distinguished. In a subgroup of subjects with normal hearing who had a relatively, statistically significant, high acoustic reflex threshold, a characteristic response was found which was most probably caused by contraction of the tensor tympani muscle only. The same response was detected in 77% of the patients (n = 22) with otosclerosis. In the remaining 23%, no middle ear impedance changes occurred as part of a startle reaction. In five out of six patients with fixation of the malleus, no response was observed. Although the startle reflex measurement is a valuable tool for distinguishing between stapes fixation and multiple ossicular chain fixations, the results are not conclusive.

Acoustic Impedance Tests↗
PubMed1992

Primary carcinoid tumors of the middle ear. Report on four cases and a review of the literature.

Carcinoid tumors are rare in the middle ear. To our knowledge, only 17 cases could be found in the literature, the first of which was described in 1980. In addition to enlarging on a previous observation we present three new cases. The neoplasms showed a striking, heterogeneous aspect ranging from solid trabecular to tubuloglandular growth patterns resembling the classic carcinoid tumor and adenomatous middle ear tumor, respectively. Based on immunohistochemistry and electron microscopy, three cell types were found. A review was made of our four patients and the cases described in the literature. The medical histories ranged from 1 month to 9 years. Presenting symptoms and signs were not characteristics, but hearing loss predominated. In two patients, the eardrums were perforated, in all the others it was intact and often bulging. Surgery, usually radical mastoidectomy, was performed in all cases. Often the tumor encased the ossicular chain, without infiltration. In two patients, local recurrence occurred that was treated successfully with surgery. All the cases showed an indolent biological course and the tumors were clinically nonfunctional, despite the recognition of biogenically active products by immunohistochemistry. To our knowledge, regional or distant metastases have never been reported. Conservative surgery with radical removal of the primary or recurrent tumor is the treatment of choice.

Adult↗
PubMed1992

Inflammatory pseudotumor of the subglottis.

A rare case of an idiopathic inflammatory pseudotumor of the larynx is described. Management consisted of midline vertical thyrotomy with anterior cricoid splitting, excision of the subglottic tumor and temporary stenting of the lumen with a siliconized tube. While these lesions are benign, the therapeutic consequences of misdiagnosis can be serious. Effective treatment consists of surgical excision, which results in a permanent cure.

Female↗