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PubMed2001

Radiotherapy for advanced adenoid cystic carcinoma: neutrons, photons or mixed beam?

PURPOSE: To compare retrospectively radiotherapy with neutrons, photons, and a photon/neutron mixed beam in patients with advanced adenoid cystic carcinoma of the head and neck. Local control, survival, distant failure, and complications were analyzed. MATERIALS AND METHODS: Between 1983 and 1995, 75 patients with inoperable, recurrent, or incompletely resected adenoid cystic carcinoma of the head and neck received radiotherapy that consisted of either fast 14.1 MV DT neutrons (median dose 16 neutron Gy), linac-based photon irradiation (median dose 64 photon Gy), or both (median dose 8 neutron Gy and 32 photon Gy). Follow-up ranged from 1 to 160 months (median 51 months), and the surviving patients had a minimum follow-up of 3 years at the time of analysis. RESULTS: The actuarial 5-year local control was 75% for neutrons, and 32% for both mixed beam and photons (P = 0.015, log-rank). This advantage for neutrons in local control was not transferred to significant differences in survival (P > 0.1). The survival is dictated by the tumor diseases due to distant metastases occurring in 29 (39%) of the 75 patients. Positive lymph nodes were the only significant factor (P = 0.001) associated with the development of distant metastases although negative lymph nodes did not predict absence of distant metastases, but predicted a delay of occurrence. In multivariate analysis postoperative radiotherapy (P = 0.003) and small tumor size (P = 0.01) were associated with high local control, while primary therapy (P = 0.006) and negative lymph nodes (P = 0.01) were associated with longer survival. While acute toxicity was similar in all three radiotherapy groups, severe late grade 3 and 4 toxicity tended to be more prevalent (P > 0.1) with neutrons (19%) than with mixed beam (10%) and photons (4%). CONCLUSION: Fast neutron radiotherapy provides higher local control rates than a mixed beam and photons in advanced, recurrent or not completely resected adenoid cystic carcinoma of the major and minor salivary glands. Neutron radiotherapy can be recommended in patients with bad prognosis with gross residual disease (R2), with unresectable tumors, or inoperable tumors. The type of radiation does not impact survival, which is dominated by the high number of distant metastases.

Adult↗
PubMed2003

Effect of amoxicillin or clindamycin on the adenoids bacterial flora.

OBJECTIVE: We sought to compare the effect on the adenoid bacterial flora of patients with recurrent otitis media of antimicrobial therapy with amoxicillin (Am) or clindamycin (C). Patients and methods Forty-five children scheduled for elective adenoidectomy participated in a prospective randomized study. They were divided into 3 groups of 15 each to receive either no therapy (control) or 10 days of therapy with Am or C. Core adenoid tissues was quantitatively cultured for aerobic and anaerobic bacteria. RESULTS: Polymicrobial aerobic-anaerobic flora were present in all instances. The predominant aerobes in all groups were alpha-hemolytic and gamma-hemolytic streptococci, Haemophilus influenzae, Staphylococcus aureus, group A beta-hemolytic streptococci, and Moraxella catarrhalis. The prominent anaerobes were Peptostreptococcus, Prevotella, and Fusobacterium spp. The number of isolates was significantly reduced in those treated with Am (n = 110, P < 0.05) or C (n = 58, P < 0.001) compared with control (n = 148). The number of bacteria per gram/tissue was lower in those treated with either antibiotics. The number of potential pathogens was lower in those treated with C compared with the other 2 groups (P < 0.001). The number of beta-lactamase-producing bacteria was lower in those treated with C than in those treated with Am (P < 0.025) or control (P < 0.001). CONCLUSIONS: These data illustrate the ability of C and, to a lesser degree, of Am to reduce the bacterial load as well as potential pathogens and beta-lactamase-producing bacteria from the adenoids of children with recurrent otitis media.

Adenoidectomy↗
PubMedDate not supplied

Age and adenoid size in relation to adenoidectomy in otitis media with effusion.

A previously reported study showed that adenoidectomy resolved effusions in chronic bilateral otitis media with effusion in 36 to 46 per cent of 103 children. This work includes 52 additional cases and assesses the effect of age and adenoid size in relation to adenoidectomy. Pre-operative lateral cephalometric radiographs showed the adenoid size and postnasal space airway. Surgery was allocated randomly into three groups: adenotonsillectomy, adenoidectomy, and no surgery. In addition, in all cases a unilateral myringotomy and ventilating tube insertion were performed. The ear not operated upon was assessed for clearance of the effusion at 3, 6, 9, and 12 months postoperatively. Following adenoidectomy the effusion resolved in the ear not operated upon in 31 to 45 per cent of cases assessed after 1 year. Tonsillectomy conferred no additional benefit. There was a trend for improved clearance of effusions in children more than 6 years of age, compared with those less than 6 years of age. There was also a trend for improved clearance after removal of larger adenoids from children with smaller postnasal space airways, but this was only significant for 3 months postoperatively.

Adenoidectomy↗
PubMedDate not supplied

Adenoids and otitis media with effusion: a morphological study.

PURPOSE: Adenoidectomy, especially for the treatment of suppurative otitis media, has been used for a very long time. In this study, the role of adenoids in the origin of otitis media with effusion was investigated by using light microscopy, immunocytochemistry, enzyme chemistry, and electron microscopy. MATERIALS AND METHODS: A group of 28 children with otitis media with effusion (OME) was identified. Ages ranged from 3 to 12 years. A control group of 10 age-matched children without any middle ear and upper respiratory tract infection served as the basis for comparison. Specimens obtained at surgeries from both groups were divided into groups for light microscopy, immunocytochemistry, enzyme cytochemistry, and electron microscopy and then all were examined blindly. Also, quantitative analysis of antigen-presenting cells was performed blindly on 10 patients and 10 controls. RESULTS: There was an increase in the number of lymphocytes, mast cells, plasma cells, macrophages, dendritic cells, and M cells in the adenoids of patients with OME when compared with the normal cases. Stratified squamous epithelial areas, collagenous fibers, and fibrocytes were also increased in the patient group. Antigen-presenting functions of epithelial cells are shown by major histocompatibility complex (MHC) class II positivity of some ciliated-columnar epithelial cells in the patient group. CONCLUSION: Adenoid tissues of patients with OME in this study seem to be infectious foci, aggravating immune reactions, which might attack the middle ear through an ascending route.

Adenoidectomy↗
PubMed1996

Neutron radiotherapy for adenoid cystic carcinoma of minor salivary glands.

PURPOSE: To examine the efficacy of fast neutron radiotherapy for the treatment of patients with locally advanced, adenoid cystic carcinoma of minor salivary glands and to identify prognostic variables associated with local control, overall survival, and cause specific survival. METHODS AND MATERIALS: Eighty-four patients having adenoid cystic carcinoma of minor salivary glands were treated with fast neutron radiotherapy during the years 1985-1994. All patients had either unresectable disease or gross disease remaining after attempted surgical extirpation. Seventeen patients had previously received conventional radiotherapy and their subsequent treatment fields and doses for neutron radiotherapy were modified for critical sites (brainstem, spinal cord, brain). Although the median doses (tumor maximum and tumor minimum) only varied by < or = 10%, treatment portals were substantially smaller in these patients because of normal tissue complication considerations. Twelve patients (13%) had distant metastases at the time of treatment and were only treated palliatively with smaller treatment portals and lower median tumor doses (< or = 80% of the doses delivered to curatively treated patients). Seventy-two patients were treated with curative intent, with nine of these having recurrent tumors after prior full-dose radiotherapy. The median duration of follow-up at the time of analysis was 31.5 months (range 3-115). Sites of disease and number of patients treated per disease site were as follows: paranasal sinus-31; oral cavity-20; oropharynx-12; nasopharynx-11; trachea-6; and other sites in the head and neck-4. RESULTS: The 5-year actuarial local-regional tumor control rate for all patients treated with curative intent was 47%. Patients without involvement of the cavernous sinus, base of skull, or nasopharynx (51 patients) had a 5-year actuarial local-regional control rate of 59%, whereas local-regional control was significantly lower (15%) for patients with tumors involving these sites (p < 0.005). In the latter cases, normal tissue injury considerations precluded delivery of the full dose to the entire tumor. Patients with no history of prior radiotherapy (63 patients) had an actuarial local control rate of 57% at 5 years compared to 18% for those (9 patients) who had been previously irradiated with conventional photons (p = 0.018). Eliminating the dose-limiting factors of prior radiation therapy and/or high risk sites of involvement, the 5-year actuarial local-regional control rate for these 46 patients was 63%, with an actuarial cause specific survival rate of 79%. Lymph node status was a predictor of distant metastasis: 57% of node positive patients developed distant metastases by 5 years compared to 15% of patients with negative nodes (p < 0.0005), and patients who had nodal involvement developed distant metastases sooner than node negative patients (p < 0.0001). The 5-year actuarial overall survival and cause specific survival for the 72 patients treated with curative intent were 59% and 64%, respectively. CONCLUSIONS: Fast neutron radiotherapy offers high local-regional control and survival rates for patients with locally advanced, unresectable adenoid cystic carcinomas of minor salivary glands. It should be considered as initial primary treatment for these patients, as well as for other patients in whom surgical extirpation would cause considerable morbidity.

Adolescent↗
PubMed1997

Cisplatin and 5-fluorouracil for symptom control in advanced salivary adenoid cystic carcinoma.

Adenoid cystic carcinoma is a relatively rare tumour which arises in the parotid and submandibular salivary glands. Initial management is surgical, often with post-operative radiotherapy, but local relapse is common and distant metastasis not infrequent. Chemotherapy is generally reserved for cases where symptoms are not controlled by other means, since the tumour is slow growing and the response rate frequently disappointing. Cisplatin and 5-fluorouracil (5-FU) both show single agent activity in this disease but had not been previously investigated in combination. All patients referred for palliative chemotherapy of metastatic, symptomatic, histologically confirmed adenoid cystic carcinoma between November 1990 and February 1994 were considered for this study. The drugs were administered as follows: cisplatin 100 mg/m2 with appropriate pre- and post-hydration and 5-FU on a 4-day schedule of 1 g/m2/day. A total of 11 patients (7 male, 4 female) with median age 53 years (range 34-69) received 46 courses of chemotherapy (median four, range one to six). All patients had prior surgery and 8 had previously received radiotherapy. There were no objective responses of > 50% reduction in tumour size. 3 patients had a minor response and two progressed on treatment. The symptomatic response rate, however, was 64%, which compares favourably with other previously reported regimens. Toxicity was manageable. The median time to tumour progression was 9 months (range 0-38) and median survival was 12 months (range 1-65). This cisplatin/5-FU regimen would appear to produce a low rate of objective response but useful palliative benefits in advanced symptomatic adenoid cystic carcinoma. Prior series suggest that a higher objective response rate may be possible with a platinum/anthracycline/fluorouracil combination, and investigation of such a regimen is warranted.

Adult↗
PubMed2000

The role of basement membrane proteins on the expression of neural cell adhesion molecule (N-CAM) in an adenoid cystic carcinoma cell line.

We investigated the presence of neural cell adhesion molecule (N-CAM) in the adenoid cystic carcinoma cell line CAC2 using immunofluorescence microscopy. Additionally, we analysed the role of laminin and type IV collagen in N-CAM expression. We demonstrated that cultured adenoid cystic carcinoma cells express N-CAM. Control cells presented a scattered N-CAM expression on cell membrane, and type IV collagen had no effect in N-CAM distribution. CAC2 cells grown on laminin-coated coverslips expressed N-CAM concentrated on cell lamellipodia suggesting relationship with migratory activity. Our results showed that cultured adenoid cystic carcinoma cells express N-CAM and this expression is modulated by extracellular matrix.

Carcinoma, Adenoid Cystic↗
PubMed2006

Comparison between radiological and nasopharyngolaryngoscopic assessment of adenoid tissue volume in mouth breathing children.

The pharyngeal tonsil (adenoid) constitutes the upper portion of the Waldeyer's ring and is located at the top of the nasopharynx, next to the auditory tube and choana. It plays an important role in recurrent otitis of the middle ear and many times its enlargement is responsible for upper airway obstruction. Tonsillectomy is often the treatment of choice for tonsillar diseases. So far, it is the most frequent and one of the oldest surgical procedures performed in children and young adults. The criteria for tonsillectomy, its effect on patient's immunological integrity and the surgical risks are widely controversial. Image study using paranasal sinuses x-ray is a very simple, easy and comfortable method to evaluate the sizes of adenoids and the grade of upper airway obstruction. Cohen et al. supported that paranasal sinuses x-ray is the best way to determine pharyngeal tonsil hypertrophy. On the other hand, nasopharyngolaryngoscopy can provide more accurate data on the nasopharynx, as it can dynamically reveal its structures and the obstruction status of the upper airway. This study compared the grade of adenoid hypertrophy, as well as upper airway obstruction, using the above-mentioned approaches in children ranging from 3 to 10 years old. The study came to the conclusion that nasopharyngolaryngoscopy is a much more accurate diagnostic procedure than radiological evaluation of the nasopharynx.

Adenoidectomy↗
PubMed1987

The adenoidal-nasopharyngeal ratio (AN ratio). Its validity in selecting children for adenoidectomy.

The present study disclosed that the AN ratio measured on simple lateral skull radiographs reliably expressed the adenoidal size and patency of the nasopharyngeal airway, and correlated well with the clinical assessment score and the weight of adenoids removed at operation. The inter-observer agreement was satisfactory, and for practical purposes, a value of AN ratio greater than 0.73 may be considered indicative of pathological enlargement of the adenoids. Hopefully this study will facilitate more accurate detection of those children most likely to benefit for adenoidectomy.

Adenoidectomy↗
PubMed1991

Effect of enlarged adenoids on arterial blood gases in children.

The enlarged adenoid is a common disorder in children resulting in nasopharyngeal obstruction. Many authors suggest that increased nasal resistance to respiration may cause disturbances in the pulmonary ventilation and carry the risk of obstructive sleep apnoea and/or cardiopulmonary syndrome. This study comprised 30 children complaining of long-standing nasal obstruction due to enlarged adenoids. Adenoidectomy was performed and the arterial blood gases were measured before and one month after surgery. Twelve normal children were also included as controls. Statistical evaluation of the results showed that O2 saturation and arterial O2 tension (PaO2) were significantly low before the operation, and increased significantly after surgery. Arterial CO2 tension (PaCO2) was insignificantly low before operation, but decreased significantly after adenoidectomy. It was concluded that enlarged adenoid may be associated with ventilatory impairment which is reversible after adenoidectomy.

Adenoidectomy↗
PubMed1984

Tympanometric findings in patients with adenoid hyperplasia, chronic sinusitis and tonsillitis.

Tympanograms were done on 120 patients with adenoid hyperplasia, chronic sinusitis and chronic tonsillitis to measure the middle-ear pressure as a parameter to eustachian tube function. The results were compared with those obtained in 50 normal subjects. The statistical significance of the mean values of middle-ear pressure is very highly significant in patients with adenoid hyperplasia, significant in chronic sinusitis group and insignificant in patients with chronic tonsillitis, as compared to the normal control group. Hence, eustachian tube dysfunction is maximum in patients with obstructing adenoids, less in chronic sinusitis and least in chronic tonsillitis.

Acoustic Impedance Tests↗
PubMed1985

Adenoid cystic carcinoma: an unusual neurosurgical entity.

Adenoid cystic carcinoma, or cylindroma, usually presents in the salivary glands or in the upper respiratory passages. We report an unusual case of adenoid cystic carcinoma in a 45-year-old woman who presented with a three-year history of progressive right trigeminal sensory palsy, most pronounced in the second division. There was, in addition, a right trigeminal motor palsy and a partial right 6th nerve palsy. CT scanning showed only a small soft tissue mass spanning an enlarged right foramen ovale. Solid adenoid cystic carcinoma was resected from Meckel's cave via a middle cranial fossa approach. A subsequent biopsy of the right maxillary antral mucosa found tumor tissue. We concluded that the tumor originated in the maxillary antrum and spread posteriorly along the infraorbital nerve to enlarge in the foramen ovale. Radiation to a total of 5,000 cGy was given. At 22 months there was neither radiographic nor clinical evidence of recurrence. At 30 months, the development of unsteady gait signalled the presence of recurrent tumor extending backwards from Meckel's cave into the right cerebello-pontine angle.

Carcinoma, Adenoid Cystic↗
PubMed1980

Adenoid involution and developing hypernasality in cleft palate.

Information about the adenoid mass is reviewed, and the phenomenon of gradual development of hypernasality as a result of adenoidal involution is described in two patients selected from a sample of 122 with repaired cleft palate. Three types of radiographically determined closure patterns of the velum against the adenoid pad are presented. Our clinical experience suggests that the results of aerodynamic studies, completed on a longitudinal basis, may identify patients who are at risk in maintaining normal resonance balance one year or more in advance of perceptual or radiographic evidence of velopharyngeal incompetency.

Adenoidectomy↗
PubMed1999

Unusual presentations of pleomorphic adenoma and adenoid cystic carcinoma of the lacrimal gland.

PURPOSE: To report two atypical cases of pleomorphic adenoma and adenoid cystic tumours of the lacrimal gland. METHODS: Two case reports are presented. The first is of a 65-year-old female with a long history of right hypoglobus with sudden recent worsening. Computed tomography (CT) showed a round, well-defined lesion in the fossa for the lacrimal gland with an anterior hypodense extension suggestive of possible malignancy in a pleomorphic adenoma. The tumour in the second case, a 35-year-old male, was diagnosed after presentation following a relatively minor periorbital injury. The smooth rounded mass on CT scan was suggestive of a benign lacrimal gland tumour. RESULTS: The lesion in case 1 was excised with a diagnosis of haemorrhage within a pleomorphic adenoma. The lesion in case 2 was excised with a diagnosis of adenoid cystic carcinoma of the lacrimal gland with pseudocapsule. CONCLUSIONS: Haemorrhagic cyst developing beneath the pseudocapsule of a pleomorphic adenoma should be considered in the differential diagnosis of secondary development of malignancy in a pleomorphic adenoma. Adenoid cystic tumours of the lacrimal gland can present with a pseudocapsule.

Adenoma, Pleomorphic↗
PubMed2002

Outcome of surgery for adenoid cystic carcinoma of head and neck region.

INTRODUCTION: Adenoid cystic carcinoma is an uncommon malignant epithelial tumour of salivary glands. The treatment of choice for these tumours is considered by some to be radical surgery, combined in many centres with postoperative radiotherapy. The goal of such treatment is local control and preservation of function. AIMS: The aim of the retrospective study was to analyse the results of surgery for patients with adenoid cystic carcinoma treated at the Institute of Oncology in Gliwice during the period of 1970-1989. MATERIAL: The analysed group includes 47 patients with adenoid cystic carcinoma. All patients underwent macro- and microscopically proven radical resection of the primary lesion located in major or minor salivary glands. RESULTS: Five- and 10-year survival rate was 85% and 47%, respectively, and 5-year disease-free survival rate was 79%. As the group of patients treated with surgery and radiotherapy was too small (nine cases), the results of combined treatment were not analysed. Local recurrence after surgery occurred in 21% of patients in different time intervals (even as long as 10 years after completion of treatment). CONCLUSION: High risk of local recurrence after surgery suggests that postoperative radiotherapy should always be given. Late development of local recurrences suggests that follow-up should be for a minimum of 10 years.

Adolescent↗
PubMed2001

Primary orbito-cranial adenoid cystic carcinoma with torcular metastasis: a case report and review of the literature.

Adenoid cystic carcinoma is a rare neoplasm arising from the exocrine glands such as salivary glands, lachrymal glands, upper respiratory tract, breast or uterine cervix. Intracranial involvement is commonly from direct skull base involvement, although metastasis may rarely be seen. The predisposition of the adenoid cystic carcinoma for perineural and perivascular invasion is the prime reason for the locally invasive character of the tumour, often extending into the cranium via foramina at the skull base. The authors report a case of primary orbito-cranial extradural adenoid cystic carcinoma and cranial metastasis away from the primary site. This patient initially had a local excision, and later an exenteration of the right eye followed by with radiotherapy. Within months she presented with an extradural cranial recurrence, distant torcular metastasis without any neurological deficit. Craniotomy and radical excision was undertaken as these tumours have slow growth rates, and long term survival of the se patients even in the presence of local recurrence and metastasis has been well documented.

Adult↗
PubMed2002

[Identification of CD11c+ myeloid dentritic cells in adenoids and in nasal mucosa of patients with and without allergies].

BACKGROUND: Dendritic cells form a link between innate and acquired immunity. They are capable to detect pathogens based on the recognition of pathogen-associated microbial molecules and trigger the appropriate type of immune responses. In humans, three major subsets of dendritic cells can be distinguished, Langerhans cells of the skin, myeloid DC (MDC) and plasmacytoid DC (PDC). It was reported that PDC infiltrate nasal mucosa in allergen-induced rhinitis. Information about the role of MDC in nasal mucosa and the corresponding mucosa-associated lymphoid tissue, the nasopharyngeal adenoids, is limited. PATIENTS AND METHODS: : Here we examined the presence of MDC in adenoids and in nasal mucosa of healthy individuals (n = 9) and in patients with allergic rhinitis. MDC were detected by flow cytometry by positive staining for MHC II and CD11c and the lack of lineage markers. Dead cells were excluded from analysis. RESULTS: In adenoids, 0.4 % of all cells were MDC. Considerable numbers of MDC could also be detected in nasal mucosa. No difference was found between healthy individuals and patients with allergies (0.3 % vs. 0.45 % MDC; p = 0.12). Interestingly, MDC were absent in patients who received treatment with glucocorticoids, while very high numbers of MDC were found in patients who recently had upper respiratory tract infections. CONCLUSION: Our results demonstrate for the first time the presence of MDC in nasal mucosa. MDC numbers were similar in healthy individuals and in patients with allergy. This study forms the basis for examining the role of MDC in the pathogenesis of allergic rhinitis, and for the modulation of MDC functional activity with microbial molecules such as CpG oligonucleotides.

Adenoids↗
PubMed1994

[Adenoid cystic carcinoma of the trachea. Case report and review of the literature on malignant tracheal tumors].

Primary tumours of the trachea are rare. In most cases one finds squamous cell carcinoma or adenoid cystic carcinoma. At the Department of Otolaryngology, Head and Neck Surgery at the Christian-Albrechts-Universität of Kiel only 19 malignant tumours of the trachea were diagnosed between 1949 and 1992 among a total of 6000 malignancies. In most cases the patients suffered from invasive thyroid carcinoma. Only five patients had a primary malignancy of the trachea (2 squamous cell carcinomas, 1 adenoid cystic carcinoma, 1 undifferentiated carcinoma, 1 solid, otherwise not classifiable carcinoma). Of these patients we report on the case of a 57-year old female patient who was diagnosed with an adenoid cystic carcinoma of the trachea and is free of disease eight years after open resection. Since initial symptoms are nonspecific emphasis is on the diagnostic process. The latest publications on therapeutic measures are reported.

Carcinoma, Adenoid Cystic↗