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At least 253 records · Page 14Linked to original sources
PubMed2003

[Lateral neck dissection vs radical neck dissection in the management of supraglottic carcinoma with pathologically negative nodes].

OBJECTIVE: To compare the effectiveness of lateral neck dissection (LND) with radical or modified radical neck dissection (RND) for the management of supraglottic carcinoma with pathologically negative nodes (pNO). METHODS: Two treatment groups with pNO supraglottic carcinoma were retrospectively compared: 39 patients who were treated with RND between March of 1980 and December of 1996, and 54 patients who were treated with LND between January 1997 and December 2001. RESULTS: The neck recurrent for LND population was 2.3%, which was not statistically different from the neck recurrent in the RND population (0.0%). Also, the 5-year survival rates were no statistic difference between LND and RND groups (97% vs 94%). Complications and period of hospitalization were both decreased in LND group comparison of RND group (6.7% vs 38.5%; 28 days vs 39 days). CONCLUSION: Comparing to the radical or modified neck dissection, the LND offers less invasive surgery and less morbidity without oncologic compromise for patients with pNO supraglottic carcinoma.

Adult↗
PubMed1998

Neck training and +Gz-related neck pain: a preliminary study.

This study compared the effects of two neck training methods on workdays lost or flying under +Gz restrictions because of +Gz-related neck pain, and on neck muscle strength and the passive cervical range of motion among fighter pilots. One group (n = 10) participated in dynamic neck and shoulder muscle training, and another (n = 10) participated in helmet training with additional weights. The measurements were done at 0, 3, 6, and 12 months. The loss of workdays or restrictions in +Gz flights were recorded during the 1-year training period and the year preceding it. Neck muscle strength increased similarly in both groups. Nevertheless, during the training year, the pilots doing dynamic exercises had fewer sick leaves and +Gz restrictions than the pilots doing helmet exercises. Because the number of subjects was small and the study included no control group, firm conclusions on the effects of the training methods cannot be drawn.

Absenteeism↗
PubMed2000

Modified Pereyra bladder neck suspension in patients with intrinsic sphincter deficiency and bladder neck hypermobility: patient satisfaction with a mean follow-up of 4 years.

OBJECTIVES: To determine the long-term success rate for the modified Pereyra bladder neck suspension and to identify preoperative characteristics that create differences in surgical outcome. We attempted retrospectively to separate those patients with what we now recognize was significant intrinsic sphincter deficiency (ISD) before routine use of Valsalva leak point pressures (VLPPs) was available. METHODS: The charts and videourodynamic reports of 208 patients who underwent a modified Pereyra bladder neck suspension from June 1988 to June 1996 were reviewed, and survey questionnaires were mailed to all patients. All videourodynamic study reports and charts were reviewed to identify those with what we now recognize was significant ISD and compare them with a group that we believed had more pure descent problems. RESULTS: A total of 135 patients or 65% of the population responded. The mean time after surgery was 4.14 years. At the follow-up survey, 14% reported no leakage at all, 42% reported very little or mild leakage, 38% reported moderate leakage, and 6% reported severe leakage. Fifty-three percent of patients continued to wear pads. Seventy-nine percent reported improvement in their leakage compared with the preoperative state, and 69% were satisfied with the results. When patients with preoperative ISD were compared with patients with pure bladder neck hypermobility, the ISD group had more leakage and less improvement after surgery than patients with bladder neck hypermobility. CONCLUSIONS: With an average follow-up of greater than 4 years, most women continued to leak with symptoms of stress urinary incontinence. Even though 79% reported improvement over their preoperative condition and 69% were satisfied, the results were disappointing. Patients with significant ISD had a worse outcome (2.6% dry) than patients with pure bladder neck hypermobility (20% dry). Given the above data, significant ISD is a contraindication for a modified Pereyra transvaginal needle suspension, and these data cast further doubt on the ability of the modified Pereyra needle suspension to consistently cure even anatomic incontinence.

Female↗
PubMed2001

Efficacy of selective neck dissection: a review of 503 cases of elective and therapeutic treatment of the neck in squamous cell carcinoma of the upper aerodigestive tract.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of selective neck dissection (SND) in elective and therapeutic treatment of the neck. METHODS: A retrospective review was undertaken of 503 previously untreated patients undergoing 711 SNDs as a part of initial therapy for squamous cell carcinoma of the larynx, oral cavity, oropharynx, and hypopharynx from August 1986 to June 1997 at a single institution. Lymph nodes were pathologically negative in 249 and positive in 254 patients. Postoperative radiotherapy was given to 14.5% of the node-negative and 62.2% of the node-positive patients. The median follow-up interval was 41 months. RESULTS: The 3-year regional recurrence rates estimated according to Kaplan-Meier were as follows: pN0, 4.7%; pN1, 4.9%; pN2, 12.1%. A comparison of recurrence rates with respect to the extent of neck disease and postoperative radiotherapy demonstrated a tendency to an improved regional control in irradiated patients with one metastasis and a distinctly improved regional control in patients with multiple metastases or metastases with extracapsular spread. CONCLUSION: The results achieved with SND compare favorably with the results reported for modified radical neck dissection. The application of SND might be extended to more advanced neck disease.

Carcinoma, Squamous Cell↗
PubMed2006

Hypothyroidism when the thyroid is included only in the low neck field during head and neck radiotherapy.

OBJECTIVE: The minimum dose required to electively irradiate all of part of the low neck for squamous cell carcinoma of the oropharynx is 50 Gy in 25 fractions or its radiobiological equivalent. The purpose of our study is to determine the incidence of hypothyroidism when the thyroid is treated only in the low-neck radiotherapy (RT) field to approximately 50 Gy. METHODS AND MATERIALS: 390 patients with oropharyngeal carcinoma received RT between 1990 and 2000, had no prior thyroid disease or surgery, and had RT involving the standard anterior low-neck field including the thyroid with a dose equivalent to 50 Gy at 2Gy/fx with or without a boost to a portion of the field to 60 to 70 Gy. The end point was hypothyroidism defined as thyroid stimulating hormone (TSH) above the upper limit of the normal range. RESULTS: As we did not routinely monitor TSH during this study, it was obtained in 169 of 390 patients. Median follow-up on all 390 patients was 6.1 years. The incidence of hypothyroidism was calculated for 2 groups: 169 patients with TSH data and the total population of 390 patients. For both analyses, patients were censored at last follow-up if the TSH level was normal, or if TSH was not checked. The incidence of hypothyroidism at 5 years was 31% for all 390 patients and 54% for the subset of 169 patients with TSH data. Adjuvant chemotherapy and/or planned neck dissection may be associated with a small increased risk of hypothyroidism. CONCLUSIONS: Including the thyroid in the low-neck field to 50 Gy results in hypothyroidism in 30% to 50% of patients at 5 years, suggesting that the threshold for this complication is <50 Gy.

Carcinoma, Squamous Cell↗
PubMed1986

The role of modified neck dissection in the treatment of cutaneous melanoma of the head and neck.

One hundred eighty-one patients were treated with a modified neck dissection for suspected or proved metastatic melanoma during a ten-year period. The overall failure rate in the neck was 16%. Eighty-three percent of the patients with neck recurrence died of disseminated disease. A modified neck dissection that preserves important functional and cosmetic structures but does not compromise cancer control seemed to be appropriate treatment for actual or suspected melanoma metastatic to cervical nodes.

Female↗
PubMed1998

Internal jugular vein thrombosis following modified neck dissection: implications for head and neck flap reconstruction.

BACKGROUND: The incidence of internal jugular vein thrombosis (IJVT) following a modified neck dissection remains uncertain. The effect of, or consequences following, IJVT upon pedicled and free flap head and neck reconstructions remains unexplored. METHODS: Twenty-nine preserved internal jugular veins in 24 patients undergoing modified neck dissection were available for prospective study. All patients required a pedicled or free flap reconstruction and received a modified, unilateral or bilateral cervical lymphadenectomy. The patency of all jugular veins was determined preoperatively and postoperatively using a combination of computed tomography (CT) scanning, high-resolution ultrasound, and color-flow Doppler (CFD). RESULTS: The IJVT rate was 14%. The presence of a pedicled myocutaneous flap and left-sided jugular dissections may represent risks to the postoperative patency of the internal jugular vein. Preoperative radiotherapy did not appear to impact negatively upon the thrombosis rate. CONCLUSIONS: Thrombosis of the internal jugular vein may result in significant morbidity for the postoperative oncologic patient. An internal jugular-dependent-free-tissue transfer may risk venous compromise of the flap, whereas the use of a pedicled flap may place the jugular at increased risk for thrombosis. Strategies for deep venous system microvascular recipient recruitment in the head and neck are discussed. Wherever possible, we employ two deep venous systems, the internal jugular, and subclavian (via the external jugular) for flap drainage.

Aged↗
PubMed1992

Value of the supraomohyoid neck dissection with frozen section analysis as a staging procedure in the clinically negative neck in squamous cell carcinoma of the oral cavity.

A retrospective analysis was performed to evaluate with the efficacy of elective supraomohyoid neck dissection (SOND) with frozen section (FS) analysis in 57 newly diagnosed patients (62 SONDs) with squamous cell carcinoma of the oral cavity. The protocol included sampling of both the most suspect and largest node in the jugulodigastric region (if present) and the most distal jugulo-omohyoid lymph node (if present). These nodes were then studied with FS histological examination. In the absence of evident nodes for FS analysis during surgery, histological examination uncovered occult metastatic disease in 3 of 11 SOND specimens. Among the remaining patients FS analysis revealed occult metastatic disease in 10 of the 51 samples (19.6%). In these latter cases surgery was continued using standard or modified radical neck dissection en bloc with the primary tumor. In 1 specimen only a single metastasis was found outside the original extent of the SOND. Among 41 FS analysis reports stating the absence of metastatic disease, histological examination of the SOND specimens demonstrated occult nodal disease in 7 (17%). All of the cervical metastases appeared in the ipsilateral side of the neck. False FS reports did not occur. In the histologically proven absence of metastatic disease in the SOND specimens, disease recurrence in the neck occurred only in 3 cases (7%), all in the presence of local failure: once in the previous SOND area, once in the ipsilateral supraclavicular region and once on the contralateral side.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

[Femoral neck prosthesis in the case of femoral neck fracture and ipsilateral long stem-knee tumour prosthesis].

Femoral neck fracture in the case of a previously implanted ipsilateral tumour knee-prosthesis represents a challenging situation because of the long proximal stem of the knee implant. Avoiding total femur replacement, we implanted a femoral neck prosthesis (Eska Cut 2000) in a 65 year old patient to preserve as much of the femur free of implant as possible, minimizing the risk of a periprosthetic or interprosthetic fracture. At 2.5 years postoperatively, there were no signs of loosening, migration or periprosthetic fracture with a good functional result. In our case, the femoral neck prosthesis avoided the implantation of a total femur replacement. Nevertheless, this prosthesis must be considered critically and cannot be recommended as the standard implant for femoral neck fracture in the case of an ipsilateral long stem-knee prosthesis.

Aged↗
PubMed2003

Neck dissection following radiochemotherapy of advanced head and neck cancer--for selected cases only?

PURPOSE: To address the value of neck dissection (ND) in patients with advanced head and neck cancer following primary radiochemotherapy and to specifically analyse its impact on locoregional tumour control, survival and toxicity. PATIENTS AND METHODS: Between 1987 and 1997 (9,335), a total of 142 patients (pts) were treated by primary radiochemotherapy (RCT) according to prospective protocols. There were 64 pts with involvement of the hypopharynx, 57 pts with oropharyngeal and 21 with oral cavity carcinoma. UICC (1997) stages included: 16 pts in stage III, 113 pts in stage IV A, 13 pts in stage IV B. All pts received platin-based RCT up to a median total dose of 70 Gy (range, 60-72 Gy). Six weeks after RCT, pts with complete response of the primary tumour (N=97) were offered a uni- or bilateral ND depending on the initially diagnosed nodal disease as part of a strict institutional policy. Fifty-six pts consented to ND and 41 refused. These two groups were analysed in terms of characteristics, local and regional tumour control, survival and long-term side effects. Median follow-up was 37 months (range, 22-124 months). RESULTS: Among the 56 pts receiving ND, a total of 13 (23%) was found to have residual tumour in the neck specimen. The rates of positive histology according to clinical N category after RCT were: yN0 (2/22[9%]), yN1 (2/10[20%]), yN2a-b (2/10[20%), yN2c-3 (7/14[54%]). Five-year overall survival and disease-specific survival rates for pts with ND were 44 and 55%, for pts without ND 42 and 47%, respectively (P=0.9). No difference was seen for long-term local and regional control between the two patient groups. Comparing the group of patients with and without ND, a trend towards higher subjective morbidity of grade 3 and 4 (LENT-SOMA), i.e. pain recording (24% vs. 17%), dysphagia (48% vs. 35%) and hoarseness (20% vs. 9%) was evident in patients with ND. CONCLUSION: No clear evidence for routine clinical use of ND after RCT in advanced head and neck tumours can be derived from these data. ND may be contemplated in selected cases with multiple residual nodes only.

Adult↗
PubMed1985

Neck node immunoactivity in head and neck cancer.

Current conventional treatment for head and neck cancer is a non-specific approach which erradicates not only disease-containing but non-disease containing tissue. It was unknown whether or not this is a desirable feature. The experiments described in this report were designed to evaluate the regional immunoreactivity of lymphocytes derived from human neck nodes in patients with head and neck cancer. The stem cell assay was used to evaluate tumor-lymphocyte interactions. The results demonstrate that there is an active regional immune system within the neck nodes. This regional immune system is capable of being immunomodulated with non-specific immune stimulants. These results support the need to further study the regional immune system of the cervical lymphatics and to further pursue tumor-specific treatment programs.

Animals↗
PubMed2005

Positron emission tomography scan to determine the need for neck dissection after chemoradiation for head and neck cancer: timing is everything.

UNLABELLED: We present a case of a negative positron emission tomography (PET) scan in a patient with pathologic viable cancer at neck dissection. STUDY DESIGN: Case Report. METHODS: A 69-year-old man presented with clinical stage T2N2c squamous cell cancer of the left tonsil and was treated with definitive chemoradiation. Left-sided adenopathy decreased but remained palpable after therapy. RESULTS: PET scan performed 23 days after completion of treatment showed no suspicious uptake in the left neck. Neck dissection performed at 2 months post-therapy revealed viable tumor in left cervical nodes. CONCLUSIONS: Persistent adenopathy after chemoradiation for head and neck cancer remains a clinical dilemma. A negative PET scan is accurate but only if the scan is performed 3 to 4 months after therapy.

Aged↗
PubMed2002

Extracapsular spread in ipsilateral neck and contralateral neck metastases in laryngeal cancer.

We investigated the incidence of extracapsular spread (ECS) and the impact of ECS on contralateral neck metastasis in 67 patients with ipsilateral nodal metastasis (IpN+) whose records were extracted retrospectively from those of 155 laryngeal cancer patients. The incidence of ECS in association with variables was determined: T stage, N stage, tumor location, tumor extension, number of positive nodes, and contralateral neck status. The variables were evaluated to identify their impact on the rates of contralateral neck metastasis (CNM) and 3-year survival. Of the 67 patients, 30 (44.7%) had ECS. A significant relationship was found between ECS positivity and increased N stage, tumor extension up to the midline, number of positive nodes, and CNM (p = .04, p = .0001, p = .018, p = .0001, respectively). Multivariate analysis revealed that N stage (p = .002; odds ratio, 3.5517) and the presence of ECS (p = .0036; odds ratio, 7.7840) in IpN+ were associated with the greatest risk of CNM. The 3-year survival rate of patients with ipsilateral ECS was significantly lower than that of patients without ECS (43% versus 81%, p = .0002). Both CNM and presence of ECS in IpN+ emerged as significant independent predictors for survival with Cox multivariate analysis (p = .0086 and p = .0234, respectively). This result indicates the necessity of treating the contralateral N0 neck in cases of IpN+ with ECS.

Adult↗
PubMed1997

Is selective neck dissection sufficient treatment for the N0/Np+ neck?

OBJECTIVE: The purpose of this study was to evaluate the therapeutic role of selective neck dissection performed electively in the N0 patient. METHOD: Fifty-four patients with squamous cell carcinoma of the oral cavity, pharynx, and larynx, without clinical evidence of lymph node metastases, underwent 72 selective neck dissections over a 6-year period. The preoperative tumour and patient data were recorded in all patients. Mean follow-up was 59 months. Outcome data pertaining to pathologic nodal status, tumour recurrence, and survival were recorded on all patients. RESULTS: Eighty-one percent of patients were histologically and clinically node negative. Seven percent of N0/Np0 patients failed in the neck compared to 50% of patients with occult nodal metastases (N0/Np+). Salvage treatment following nodal recurrence was successful in only one patient. CONCLUSION: Selective neck dissection does not compromise survival and may minimize surgical morbidity in the N0/Np+ population.

Adult↗
PubMed1998

The effects of more conservative neck dissections and radiotherapy on nodal yields from the neck.

OBJECTIVE: To determine the effects of conservative neck dissections (NDs) and preoperative radiotherapy on the quantitative recovery of lymph nodes from the neck. DESIGN: Retrospective review of case series. Data were obtained for age, preoperative TNM staging, type of ND, preoperative radiotherapy, total nodal yield (tNY), and positive nodal yield (pNY). The tNY and pNY were analyzed with factorial analysis of variance (ANOVA) to determine differences among types of ND and the effect of radiotherapy. SETTING: Tertiary care center for head and neck cancer. PATIENTS: Consecutive sample of 135 NDs in 110 patients with cancer of the head and neck. RESULTS: A significant difference in tNY was found among dissections (P<.001, ANOVA). Supraomohyoid ND had a significantly lower mean tNY (9.9 nodes) than both radical ND and modified radical ND (21.8 and 26.3 nodes, respectively; P<.05). Functional ND also had a significantly lower tNY (16.1 nodes) than modified radical ND (P<.05); the differences between radical ND and both functional ND and modified radical ND were not statistically significant. Positive nodal yield was not different among the types of dissections (P=.62). Preoperative radiotherapy significantly decreased mean tNY from 22.0 to 17.1 nodes (P=.02) over all types of dissections. Differences in tNY among dissection types were independent of the effect of radiotherapy. The presence or absence of preoperative radiotherapy had no significant effect on pNY (P=.18). CONCLUSIONS: Conservative modifications of the classic radical ND differ with respect to the quantity of cervical lymph nodes excised, but survival may not be altered since the pNY is not significantly different. When compared with the radical ND, the modified radical ND and functional ND do not compromise the quantity of cervical nodes excised. Radiotherapy significantly reduces the quantity of cervical nodes, but a significant number of nodes will still remain.

Adult↗
PubMed2000

Assessing quality of life in patients with head and neck cancer: cross-validation of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Head and Neck module (QLQ-H&N35).

OBJECTIVE: To evaluate the reliability and validity of a new, disease-specific quality-of-life measure for patients with head and neck cancer: the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire--QLQ-H&N35. DESIGN: Cross-sectional study using questionnaire data and medical chart review. SETTING: Academic tertiary care otolaryngology clinic. PARTICIPANTS: One hundred twenty ambulatory patients, including 30 patients with advanced head and neck cancer in each of the following stages of treatment: (1) prior to treatment, (2) during active treatment, (3) within 6 months of completing treatment, and (4) more than 6 months after completing treatment. In addition, (5) a comparison group of 40 patients without malignant disease was included (total sample, N = 160). MAIN OUTCOME MEASURES: Scores on EORTC Quality of Life Core Questionnaire (QLQ-C30) and head and neck module (QLQ-H&N35), Profile of Mood States, and Impact of Events Scale. RESULTS: The QLQ-H&N35 demonstrated acceptable reliability (internal consistency). It successfully discriminated between cancer patients and the comparison group, and among subgroups of cancer patients at different phases of treatment (construct validity). The instrument was sensitive to the effects of radiation treatment and to site of disease. Its low-to-moderate correlations with the EORTC core questionnaire indicated that the QLQ-H&N35 provided unique information (discriminant validity). Scores were significantly associated with a number of demographic variables. CONCLUSION: Results support the use of this disease-specific measure to assess quality of life among patients with advanced head and neck cancer.

Activities of Daily Living↗
PubMed1978

Synovial sarcoma of the neck associated with previous head and neck radiation therapy.

Synovial sarcoma is a rare neoplasm that uncommonly arises in the neck. Fourteen years after facial and neck radiation therapy for acne, synovial sarcoma of the neck developed in a young man. Possible radiation-induced benign and malignant neoplasms that arise in the head and neck region, either of thyroid or extrathyroid origin, remain a continuing medical problem.

Acne Vulgaris↗
PubMed1987

Adjuvant chemotherapy for advanced head and neck squamous carcinoma. Final report of the Head and Neck Contracts Program.

To determine the efficacy of adjuvant chemotherapy in patients with advanced head and neck squamous carcinoma, the National Cancer Institute initiated a multi-institutional, prospective randomized trial termed the Head and Neck Contracts Program. Between 1978 and 1982, 462 patients with resectable Stage III or IV cancers of the oral cavity, larynx, or hypopharynx were randomly assigned to receive one of three treatment options: induction chemotherapy consisting of a single course of cisplatin and bleomycin followed by standard therapy (surgery and postoperative radiotherapy); induction chemotherapy and standard therapy followed by maintenance chemotherapy which consisted of six cycles of monthly cisplatin; or standard therapy alone. Toxicity from the chemotherapy regimens was minimal. Induction therapy resulted in an overall complete response of 3% and a partial response in 34% of patients. With a median follow-up of 61 months, overall survival and disease-free survival were not markedly different among the three groups (P = 0.86 and P = 0.16, respectively). The incidence of distant relapse was reduced in the maintenance group compared to standard or induction groups (P = 0.025 and P = 0.021, respectively) and time to first distant relapse was prolonged (P = 0.032 and P = 0.022, respectively). The results confirm the feasibility of administering chemotherapy prior to surgery or radiation in patients with head and neck cancer but fail to demonstrate a significant impact of one cycle of induction chemotherapy on clinical outcome. The suggestion that distant relapse rates may be reduced with the addition of maintenance chemotherapy supports the need to test traditional adjuvant approaches in patients with advanced head and neck cancer.

Adult↗