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PubMed1992

Control of neck nodes in squamous cell carcinoma of the head and neck by radiotherapy: prognostic factors.

313 patients with cervical metastases from a squamous carcinoma of the head and neck treated with radiotherapy, were studied by means of a multivariant analysis in order to determine the prognostic factors for cure. These were: lymph node response to irradiation (P = 0.0000), size of node (P = 0.0000), radiotherapy dose (P = 0.0037), condition of the primary (controlled vs non-controlled) (P = 0.0015), recurrent cervical metastases post-surgery (P = 0.0286).

Adolescent↗
PubMed1998

The American Society of Head and Neck Radiology. Head and neck imaging: the next 10 years.

In the future, we will see continued advancements in all areas of head and neck radiology. Because of the rapid pace of developments in the areas of metabolic and functional imaging and gene therapy, it is likely that currently unsuspected and unknown future applications will also fall within the purview of radiologists. It is imperative that our specialty increase our investment in areas of investigation that were once believed to be outside the realm of imaging. Only then will be able to maintain our participation in multidisciplinary investigations that use imaging-based techniques.

Head↗
PubMed1975

[Regional neck lymph nodes and primary tumors. 1. Neck lymph node metastases].

The metastasis are situated in the primary regional lymphnodes. Preoperative palpation of the neck gives unreliable results. The extent of the primary tumor has no correlation to the occurence of metastasis. When the tumor is localized in the supraglottic, transglottic or in the tongue base region the frequency of metastasis in lymph nodes is approximately equal; more than half of them have metastasis. When the tumor is localised in sinus piriformis or in the marginal region a still higher frequency of metastasis is found.

Head and Neck Neoplasms↗
PubMed1989

[Prolongation of the QT interval in the ECG following surgery of the neck (neck dissection)].

The QT interval on the ECG was determined in 40 patients undergoing major resection plus neck dissection. The readings were taken before operation, between 1 and 3 h after operation, and the 1st and the 7th day after the operation. The QT interval was prolonged significantly more often and more intensively in patients undergoing surgery on the right side (from 411 +/- 17 to 459 +/- 50 ms) than in those operated on the left side (409 +/- 14 to 431 +/- 32 ms; all values mean +/- SD). The cause of the prolongation of QT interval is thought to be either direct surgical damage to the sympathetic cardiac nerves during the operation, or a temporary disturbance of nerve function due to pressure, tension or oedema in the wound. An explanation for the observed side difference might be differing functional effects of right- and left-sided sympathetic innervation of the heart. Attention is drawn to the meaning of these findings as a predisposing factor for ventricular tachyarrhythmias.

Adult↗
PubMed1984

Predictive factors for tumor response to preoperative chemotherapy in patients with head and neck squamous carcinoma. The Head and Neck Contracts Program.

The high tumor response rates associated with intensive chemotherapy in previously untreated patients with advanced head and neck squamous cell carcinoma (HNSCC) led to the initiation of a multi-institutional National Cancer Institute trial. This trial used preoperative chemotherapy in patients with resectable Stage III and IV squamous cell carcinoma of the oral cavity or larynx/hypopharynx. Response rates, toxicity, and a variety of patient and tumor characteristics were analyzed to determine which factors might be useful in predicting tumor response to preoperative chemotherapy. Two hundred eighty-two patients received one course of preoperative cisplatin and bleomycin chemotherapy and were evaluable. There were 22 complete responses (CR) and 114 partial responses (PR) at the primary site (48% response rate). Of 197 patients with clinically positive regional adenopathy, 29 CRs and 73 PRs were observed (52%). Toxicity associated with the chemotherapy regimen was minimal. Primary tumor and regional node responses to chemotherapy were strongly correlated. No significant differences were found in primary or nodal response rates with respect to differing tumor site, stage, histologic differentiation, patient performance status, nutritional status, leukocyte count, hemoglobin level, age, sex, or alcohol use. Primary tumor response, however, was significantly related to T classification (P = 0.048). Nodal response was strongly associated with N classification and nodal size (P = 0.02 and P = 0.075, respectively). These findings suggest that, of the patient and tumor characteristics analyzed, none were more useful in predicting tumor response than clinical tumor staging parameters.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1976

The fate of the articular cartilage in intracapsular fracture of the femoral neck (articular cartilage in femoral neck fracture).

The fate of the articular cartilage of the hip joint with intracapsular neck fracture was studied by histological, histochemical and autoradiographic techniques and by using a polarized microscope and a scanning electron microscope. Cartilage specimens from 93 femoral heads and 7 acetabula were obtained from fractured hips 2 days to 4 1/3 years postfracture and from control hips with various disorders. The cartilage degeneration appeared 2 weeks after fracture and advanced steadily with time. The matrix was covered, invaded and ultimately replaced by the fibrous tissue. Chondrocyte viability, though it was lost from the surface, was recognized in the deep matrix even in the oldest fracture examined. It is concluded that the humoral factor directly caused by the injury as well as the biomechanical impairment, i.e. a loss of physical stress, may play an essential role in the pathogenesis of the degeneration. The possibility of regeneration was discussed.

Acetabulum↗
PubMed1991

The effect of local-regional control on distant metastatic dissemination in carcinoma of the head and neck: results of an analysis from the RTOG head and neck database.

A retrospective analysis of the effect of local control on the development of distant metastases was performed in 2648 patients with carcinoma of the head and neck selected from the RTOG database. The 5-year time-adjusted incidence of distant metastases was 21% for patients who were in local-regional control at 6 months after the start of treatment, compared to 38% for local-regional failure patients (p less than 0.001). The incidence of distant metastases detected between the interval of 6 months to 2.5 years after treatment was significantly increased in patients with tumors of the oral cavity, oropharynx, supraglottic larynx, and glottis who developed local-regional failure within this time period, compared to those who remained locally controlled (19% distant metastases for local-regional failure vs 7% for local-regional control (p less than 0.001)). In contrast, there as no difference in the incidence of distant metastases in patients with carcinoma of the nasopharynx or hypopharynx regardless of the local-regional disease status. A Cox proportional hazards regression analysis demonstrated that local-regional control was the most significant variable affecting the development of distant metastases, followed by tumor site, N-stage, and T-stage. For all tumor sites, except for the hypopharynx and nasopharynx, improvements in local-regional control are likely to improve survival. Tumors of the hypopharynx and nasopharynx have a higher probability of micro-metastatic dissemination at the time of initial diagnosis, and until effective methods to treat disseminated disease are developed, the effect of local control on survival will not be readily discerned.

Carcinoma, Squamous Cell↗
PubMed2006

Treatment of pain after head and neck surgeries: control of acute pain after head and neck oncological surgeries.

OBJECTIVE: To devise an effective postoperative analgesic protocol. STUDY DESIGN AND SETTING: Two consecutive groups participated in this study. In the first group (n = 100), the pain-control management was pro re nata (PRN). In the second group, (n = 109) we tailored a procedure-specific pain-control protocol for each patient according to the level of pain recorded in the first group. These patients were treated with analgesics given at predetermined hours. Pain was evaluated by using a verbal scale of 1 to 10. RESULTS: In the first group, a significant reduction in the level of pain was monitored 1 hour after PRN drug administration; however, patients reported the return of pain several hours later, after the drug effect subsided. Overall, the patients suffered a substantial level of pain during the entire postoperative period. In the second group, significant reduction in the level of pain was recorded throughout the hospitalization. CONCLUSION: The PRN protocol is not adequate for management of pain after head and neck surgeries. SIGNIFICANCE: We can substantially reduce our patients' postoperative pain by adopting a procedure-specific analgesic regimen instead of a PRN regimen. EBM RATING: B-3b.

Adult↗
PubMed2003

Set-up improvement in head and neck radiotherapy using a 3D off-line EPID-based correction protocol and a customised head and neck support.

PURPOSE: First, to investigate the set-up improvement resulting from the introduction of a customised head and neck (HN) support system in combination with a technologist-driven off-line correction protocol in HN radiotherapy. Second, to define margins for planning target volume definition, accounting for systematic and random set-up uncertainties. METHODS AND MATERIALS: In 63 patients 498 treatment fractions were evaluated to develop and implement a 3D shrinking action level correction protocol. In the comparative study two different HN-supports were compared: a flexible 'standard HN-support' and a 'customised HN-support". For all three directions (x, y and z) random and systematic set-up deviations (1 S.D.) were measured. RESULTS: The customised HN-support improves the patient positioning compared to the standard HN-support. The 1D systematic errors in the x, y and z directions were reduced from 2.2-2.3 mm to 1.2-2.0 mm (1 S.D.). The 1D random errors for the y and z directions were reduced from 1.6 and 1.6 mm to 1.1 and 1.0 mm (1S.D.). The correction protocol reduced the 1D systematic errors further to 0.8-1.1 mm (1 S.D.) and all deviations in any direction were within 5 mm. Treatment time per measured fraction was increased from 10 to 13 min. The total time required per patient, for the complete correction procedure, was approximately 40 min. CONCLUSIONS: Portal imaging is a powerful tool in the evaluation of the department specific patient positioning procedures. The introduction of a comfortable customised HN-support, in combination with an electronic portal imaging device-based correction protocol, executed by technologists, led to an improvement of overall patient set-up. As a result, application of proposed recipes for CTV-PTV margins indicates that these can be reduced to 3-4 mm.

Head and Neck Neoplasms↗
PubMed1990

A phase III randomised trial of cistplatinum, methotrextate, cisplatinum + methotrexate and cisplatinum + 5-FU in end stage squamous carcinoma of the head and neck. Liverpool Head and Neck Oncology Group.

We describe a phase III trial on 200 patients with end stage squamous cell carcinoma of the head and neck. The patients were randomised to one of four treatment arms: cisplatinum alone, methotrexate alone, cisplatinum + 5-FU and cisplatinum + methotrexate. There was no significant difference in the response rates, but the survival of the cisplatinum arm was significantly better than that of the methotrexate arm. The survival of patients receiving cisplatinum as a single agent was longer than that of patients receiving cisplatinum in combination with methotrexate or 5-FU, but not significantly so. Nausea/vomiting and anaemia were significantly more common in the cisplatinum arms than in the methotrexate arm, but the toxicity of combination regimens was not significantly greater than that of cisplatinum used as a single agent.

Aged↗
PubMed1998

Consensus standards for the process of cancer care: a modified expert panel method applied to head and neck cancer. South and West Expert Tumour Panel for Head and Neck Cancer.

There are many pressures to improve the standard of care delivered to cancer patients, including the reforms subsequent to the Calman-Hine report. The establishment of standards is a prerequisite for audit, benchmarking and certification of cancer centres and units. Randomized trials of head and neck cancer are uncommon, and other forms of evidence often conflicting. In the south and west of England, a multidisciplinary expert panel consensus method has been applied to the development of standards. A panel representative of specialties involved in the process of care at all three levels, plus social medicine and lay members, was constructed. A model for the process of care was developed consisting of activity areas. For each activity, a near exhaustive list of tasks and standards was established. A three-iteration method with statistical group response was then used to refine the standards. The same method was also applied to the production of a minimum data set for registration, recording and audit. The resulting standards will be regularly reviewed. We have developed a model of the care process, and an expert panel methodology that is applicable to a wide range of problems in clinical oncology.

Head and Neck Neoplasms↗
PubMed1993

Epirubicin in patients with advanced or recurrent adenoid cystic carcinoma of the head and neck: a phase II study of the EORTC Head and Neck Cancer Cooperative Group.

BACKGROUND: Because of the rarity of salivary gland cancer, little is known about the single-agent activity of most anticancer agents in the different histologic types of these cancers. PATIENTS AND METHODS: Twenty patients with advanced or recurrent adenoid cystic carcinoma of the head and neck were treated with epirubicin on a low-dose weekly schedule (30 mg/m2/week) for eight weeks and, in instances of no response, a high-dose three-weekly schedule (> or = 90 mg/m2). Thirteen patients had locoregional disease (12 recurrences), seven of them also had distant metastases and seven had distant metastases only. All had documented progressive disease, and 17 were symptomatic. RESULTS: Two objective responses of 7.5 and 20 months were observed in patients with locally recurrent disease, and ten patients showed disease stabilization. The median time to progression was 16 weeks (range 2-250 weeks) and the median survival 67 weeks (range 13-272+ weeks), with three patients still alive more than five years after the initiation of chemotherapy. Contrary to the rather modest objective response rate, symptomatic improvement occurred more frequently (29.4%) and was evident within 8 weeks of treatment. CONCLUSIONS: This type of chemotherapy should be reserved for patients with rapidly progressive disease or those with symptomatic disease.

Adult↗
PubMed1986

Lipomatosis of the neck (Madelung's neck).

Benign symmetrical lipomatosis of the neck is a rare disease that has to be differentiated from goiter, sialadenitis, obesity or a lymphatic tumor. Most patients are severe alcoholics, but they may have other endocrine disorders, such as diabetes mellitus, hyperuricemia, or hyperlipidemia. Aside from the cosmetic disfigurement and consequent psychological stress, respiratory distress may be the indication for surgical treatment. Excision of the lipomatosis requires technical skill because the extensive and sometimes infiltrative growth makes dissection of muscle and nerves difficult. The computer tomogram provides good information on the extent of the disease. Three of our 5 patients died 2 1/2 to 6 years after the first operation because of their primary disease.

Adult↗
PubMed1999

Human papillomavirus in head and neck squamous cell carcinoma: are some head and neck cancers a sexually transmitted disease?

There is abundant epidemiologic and virologic evidence that high-risk human papillomaviruses (HPVs) are tumorigenic in human epithelia, particularly in the cervix, where HPV infection is necessary for cancer development. HPV DNA has been detected in a proportion of head and neck squamous cell carcinomas (HNSCCs) in numerous case series. The mere presence of the virus in tumor specimens, by itself, does not imply a causal relationship. However, recent studies support an etiologic role for HPVs in a subset of HNSCC, particularly poorly differentiated tumors arising from Waldeyer's tonsillar ring. Epidemiologic studies have shown that exposure to HPV increases the risk of HNSCC, and HPV infection may interact with alcohol and tobacco exposure in tumor promotion. Molecular studies indicate that transcriptionally active virus is confined to tumor cells. It will be important to clarify further the role that HPV has in HNSCC development, because HPV-based therapeutic vaccines which are currently being developed for cervical cancer may also be of benefit in the management of HNSCC.

Carcinoma, Squamous Cell↗
PubMed1983

Recurrences in the soft tissues of the neck after surgery or radiotherapy plus surgery on regional lymph nodes in patients bearing carcinomas of the head and neck.

A series of 45 recurrences in the soft tissues of the neck following lymph node dissection in 497 patients bearing carcinoma of the upper aerodigestive passages is reported. Only 22 cases that presented perilymph node metastases and/or in which there were reasons to indicate insufficient surgical radicality had been subjected to radiotherapy after surgical lymph node dissection; the other 23 cases had not been subjected to radiotherapy because the aforementioned premises had been lacking. All the recurrences therefore occurred in patients with clinically and histologically ascertained metastatic lymph nodes. The presence of perilymph node metastases and the judgment of surgical radicality was thus found insufficient criteria to plan future complementary postoperative radiotherapy. However, even in those cases in which postoperative radiotherapy was performed, there was a rather high incidence of recurrences, as high as 64.7% in patients with carcinoma of the tongue. Our data indicate the opportunity of a clinical trial with preoperative radiation therapy in patients with clinically evident lymph node metastases. Thirty-six of these recurrences were situated in the upper parts of the cervical region. The prognosis is very poor in such cases, so much so that only 2 of our series were disease free at 3 years after the treatment.

Carcinoma↗
PubMed1995

Randomized phase III trial of edatrexate versus methotrexate in patients with metastatic and/or recurrent squamous cell carcinoma of the head and neck: a European Organization for Research and Treatment of Cancer Head and Neck Cancer Cooperative Group study.

PURPOSE: To compared the response rates and the toxicity of the new antifolate edatrexate (EDX) with that of methotrexate (MTX) in a randomized trial in patients with metastatic or recurrent squamous cell cancer of the head and neck (SCC) and to compare the durations of response and survival. PATIENTS AND METHODS: Two hundred seventy-three patients with SCC were randomized to receive either EDX or MTX as a weekly intravenous (IV) bolus injection. Doses of EDX were initially 80 mg/m2/wk, but because of the toxicity, this was later reduced to 70 mg/m2/wk. MTX was administered at a dose of 40 mg/m2/wk throughout. In both arms, two dose increments of 10% were scheduled in case of no toxicity. RESULTS: Of 264 eligible patients, 131 were treated with EDX and 133 with MTX. There were five treatment-related deaths: four on EDX and one on MTX. Overall, toxicity was similar in both arms; however, stomatitis, skin toxicity, and hair loss were more pronounced on the EDX arm. The overall response rate was 21% (six complete responses [CRs] and 21 partial responses [PRs]) for EDX and 16% (nine CRs and 12 PRs) for MTX (P = .392). Responses were mainly seen in patients with locoregional disease. Tumors that originated from the hypopharynx responded poorly in comparison to tumors from other sites. The median duration of response was 6.1 months for EDX and 6.4 months for MTX (log-rank P = .262). There was no difference in overall or progression-free survival. The median survival duration was 6 months on both treatment groups. CONCLUSIONS: Both EDX and MTX are moderately active against SCC. In this large phase III study, response rates, time to treatment failure, and overall survival appeared to be similar for both antifolates. However, EDX had more side effects than MTX and therefore cannot be recommended for routine palliative treatment of patients with SCC.

Agranulocytosis↗
PubMed1998

Phase III trial of modulation of cisplatin/fluorouracil chemotherapy by interferon alfa-2b in patients with recurrent or metastatic head and neck cancer. Head and Neck Interferon Cooperative Study Group.

PURPOSE: In preclinical experiments, interferon alfa modulates the anticancer activity of fluorouracil (5-FU) and cisplatin (CDDP). To test this effect clinically in patients with recurrent or metastatic head and neck cancer (RMHNC), a multicenter randomized controlled trial with CDDP and 5-FU with or without interferon alfa-2b (IFNalpha) was performed. PATIENTS AND METHODS: Eligible patients had histologically confirmed RMHNC; a good performance status; measurable disease; adequate bone marrow, hepatic, and renal function; no prior chemotherapy for recurrent or metastatic disease; only one chemotherapy regimen administered with previous local therapy; and a treatment-free interval of at least 3 months following previous local therapy. Patients were randomized and stratified according to treatment center, and prior radiotherapy and chemotherapy. The treatment regimen consisted of CDDP 100 mg/m2 on day 1 and 5-FU 1,000 mg/m2/d by continuous infusion for 96 hours (days 1 to 4), without (arm A) or with (arm B) IFNg alpha 3 x 10(6) U/d subcutaneously on days 1 to 5. Cycles were repeated every 21 days. RESULTS: One hundred twenty-two patients were entered on each arm. The response rate (RR) was similar in both arms (arm A: complete response [CR] 10.7%, partial response [PR] 36.4%; arm B: CR 6.8%, PR 31.6%) (.70 < P < .50). There was no difference in median survival between the two arms (arm A 6.3 months v arm B 6.0 months; P = .49). Anorexia, fever, leukopenia, and thrombocytopenia grade III to IV were significantly more frequent in the IFNalpha arm. CONCLUSION: Modulation of CDDP and 5-FU with IFNalpha as used in this study does not improve the RR or the median survival in patients with RMHNC. Patients on both study arms had a poor prognosis, which indicates the need for novel therapies.

Adult↗