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PubMed2002

Lymphoepithelial carcinoma of the larynx.

Lymphoepithelial carcinoma is a very rare tumour of the larynx, with an exhaustive review of the literature having disclosed only 33 documented cases. The relationship between lymphoepithelial carcinoma of the larynx and Epstein-Barr virus is still controversial. We describe one new case of this tumour involving the supraglottis. The patient was treated with supraglottic laryngectomy and left modified neck dissection. Three years and 4 months later, the right side of the neck was found positive for metastatic disease and a right modified neck dissection was performed. No evidence of disease was exhibited 4 years after the diagnosis of metastatic disease. The diagnostic problems and therapy associated with this rare tumour are discussed.

Adult↗
PubMed2004

Impact of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in patients with biochemical evidence of recurrent or residual medullary thyroid cancer.

BACKGROUND: Conventional imaging such as with (99m)Tc(V)dimercaptosunnic acid (DMSA), (111)In-octreotide scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI) rarely localizes occult medullary thyroid cancer (MTC). The role of (18)F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) is not well defined. The aim of this study was to examine the usefulness of postoperative FDG-PET in localizing MTC metastases. METHODS: FDG-PET was performed in 26 patients with elevated serum tumor markers after total thyroidectomy with central compartment dissection and additional neck dissection on indication. Patient- and lesion-based results were compared with the findings of conventional nuclear imaging and validated by morphological imaging (CT, MRI, ultrasonography), including bone scintigraphy and pathology when possible. Clinical impact was evaluated. RESULTS: FDG-PET detected foci in 50% of patients with lesion-based sensitivity of 96%. (111)In-octreotide detected foci in 19% with sensitivity of 41%, and (99m)Tc(V)DMSA scintigraphy and morphological imaging detected foci in 21% and 40%, respectively, with sensitivity of 57% and 87%. No lesions were found in 11 patients (42%). Positive FDG-PET findings led to surgical intervention in nine patients (35%). They all underwent surgery for removal of residual tumor or metastases. One patient achieved disease-free status. In all patients who underwent surgery, serum calcitonin levels were reduced by an average of 58 +/- 31%. CONCLUSIONS: For detection of occult MTC lesions, FDG-PET is superior to conventional nuclear imaging and is the best detection method yet available. FDG-PET in postoperative follow-up has clinical value and may be used for guiding reoperation and additional morphological imaging preoperatively.

Adolescent↗
PubMed2005

[Platysma myocutaneous flaps in reconstruction of oral defect caused by tumor resection].

OBJECTIVE: To study the method and feasibility of platysma myocutaneous flap in reconstruction of oral defects. METHODS: From March 2003 to June 2004, 15 patients with defects of tongue, floor of mouth, bucca, lateral pharynx and soft palate were treated with platysma myocutaneous flaps. There were 12 males and 3 females with an age range of 41-77 years. Defect was caused by resection of bucca (11 cases), tongue (1 case), floor of mouth (2 cases)and lateral pharyngeal and soft palate (1 case) squamous cell carcinoma. All patients were given primary cancer dissection and radical neck dissection. The defect sizes were from 3.0 cmX 3.5 cm to 7.0 cm X 4.0 cm. The sizes of the platysma myocutaneous flap were from 7.0 cm x 3.5 cm to 12.0 cm x 4.0 cm. RESULTS: All the patients were followed up for 6-12 months. In 15 patients, the flap survived, and the color and appearance of the flaps were normal. Mouth-opening was not limited. Eight patients had cutaneous fistula after 10-15 days of operation and were cured by secondary operation. No complication of ankyloglossia and tumor relapse occurred. The operation results were satisfactory. CONCLUSION: Platysma myocutaneous flap has generous blood supply, it is useful in reconstruction of oral tissue defects.

Adult↗
PubMed2005

[Long term follow up of laser surgery under micro-endoscopy for laryngeal carcinoma].

OBJECTIVE: To observe the long term curative effect for laryngeal carcinoma treated with CO2 laser under micro-endoscopy. METHOD: Twenty cases of laryngeal cancer were treated by CO2 laser under micro-endoscopy. All patients were followed up at least 5 (5-8) years by phone, letters or clinical review. RESULT: During 5 to 8 years following up, one patient died of recurrence 1 year later. Another was operated on with partial laryngectomy due to local recurrence 2 years after laser surgery. The third one was operated with selective neck dissection because of neck metastasis 5 years later. Other 17 cases were alive without recurrent signs. The 5 years total cure rate was 85% and survival rate was 95%, the 5 years local recurrence rate was 10% and the neck metastasis rate was 5%. All survivals had normal breath and good phonation. Among them 8 resumed their daily works, 5 were used to do house works and 4 did them sometimes. CONCLUSION: T1 and earlier glottic or supraglottic cancers are indications of laser surgery under micro-endoscopy. Its 5 years survival rate as well as live quality were satisfactory and proved the method to be a choice of treatment for earlier laryngeal carcinoma.

Adult↗
PubMed2006

High dose rate brachytherapy in the treatment of oral cancer--the preliminary one institution experience.

Low dose rate brachytherapy is well established treatment modality of oral cancer. Data about high dose rate brachytherapy (HDR BT) are still scarce with heterogenous results. The aim of our study was to evaluate preliminary results in a small group of oral cancer patients treated by HDR BT. Seventeen applications were performed on 16 patients in years 2001-2004, in 15 cases for new tumor (mobile tongue 10x, floor of mouth 2x, lip 3x) and in 2 cases for local recurrence after radiotherapy. Ten treatments (for T1-2N0 tumors and recurrences) were performed with brachytherapy alone (18 x 3 Gy twice daily), seven patients (T2-3 N0-2 tumors) were treated with a combination of external beam radiotherapy (40-68 Gy) and brachytherapy (2-6 x 3 Gy twice daily). The plastic tubes technique was used for brachytherapy. Follow-up periods were between 8-46 months (median 17). Fifteen patients were disease free during follow-up period. One patient (brachytherapy alone for T2N0M0 mobile tongue cancer) died immediately after neck dissection for the neck recurrence due to the heart failure. The other one died due to distant metastases but without local recurrence. Acute complications were mucositis gr. II at maximum, late complications were ulcer of soft tissues in 3 and superficial bone necrosis in 2 cases. The evaluation of the brachytherapy implants was done according ICRU 58 recommendations. Hyperfractionated high dose rate brachytherapy alone or as a boost to external beam radiotherapy is feasible with promising local control. Carefull planning of the implant and mandibular shielding are necessary to avoid complications.

Adult↗
PubMed1985

Combined chemotherapy, cryosurgery, and radiotherapy/surgery for oral cancer.

UNLABELLED: One hundred and twelve patients (95 males, 17 females) with untreated squamous-cell carcinoma of the oral cavity underwent a multidisciplinary treatment. FOLLOW-UP: 6-72 months (median 51 months). T1-4N0M0 lesions (tongue, 31 patients; floor, 31 patients; cheek, 17 patients; retromolar, 9 patients) were treated with cryosurgery (T1-2: 1-2 sessions, T3-4: 2-4 sessions) and contemporaneously with (cyclophosphamide, methotrexate, fluorouracil)(CMF) (T1-2:2 courses; T3-4: 3 courses). The patients, 15-20 days after the end of cryo-chemotherapy, underwent TCT (T1: 50 Gy on tumour and lymph nodes; T2-3-4: same with an extra dose of 10-15 Gy on the primary lesion). T1-4N1-3M0 patients (tongue: 8, floor: 13, cheek: 2, retromolar: 1) received the same cryotherapy and chemotherapy, followed by surgery (16 widened suprahyoid dissections, 8 conservative laterocervical dissections, 1 radical neck dissection). Overall actuarial survival at six years was 61.9%: T1-4N0M0 (88 patients) 66.6% (T1-2 76.0%; T3-4 56.9%); T1-4N1-3M0 (24 patients) 44.4% (T1-2 66.6%; T3-4 33.3%). Six-year actuarial survival by site was: tongue (39 patients) 79.2% (N0 85.9%); floor (44 patients) 55.2% (N0 57.1%); cheek (19 patients) 74.2% (N0 68.9%); retromolar (10 patients) 0% (N0 0%). Complete remission was reached four months after treatment by 97 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Squamous Cell↗
PubMed1997

[Significance of lymph node metastases of differentiated thyroid gland carcinomas and C-cell carcinomas for prognosis--a meta-analysis].

Surgical therapy of differentiated thyroid cancer (DTC) includes thyroidectomy plus central lymph node dissection and postoperative radioiodine therapy. In cases of lymph node metastasis, T3/T4 tumors and C-cell-carcinoma (after thyroidectomy) uni- or bilateral modified radical lymph node dissection of the neck (neck dissection) and of the mediastinum is recommended. The importance of lymph node metastasis for prognosis of survival in papillary, follicular and C-cell-carcinoma is discussed controversial, however. Even the kind of surgical radicality is questioned. Thus a metaanalysis of 35 studies in 29 independent publications from a pool of 2186 studies was performed. Univariate analysis demonstrates lymph node metastasis as a negative prognostic factor in papillary carcinoma with a 3.25/2.97, in follicular carcinoma with a 7.62/4.0 and in C-cell-carcinoma with a 3.33/3.37 higher probability of mortality 5 and 10 years after operation. Modification of the present surgical therapy can therefore only be accepted after univariate and multivariate analysis of all prognostic factors (age, sex, cell type, tumor extent, lymph node- and distant metastasis) and after it has proven superiority to the present strategy in prospective randomised trials.

Adenocarcinoma, Follicular↗
PubMed1998

[Combined chemotherapy with low-dose cisplatin, tegafur and uracil in a case with neck recurrence of laryngeal cancer].

The patient was a 60-year-old man with progressive neck recurrence of laryngeal squamous cell carcinoma. As a previous treatment, he had undergone irradiation (primary: 60 Gy; neck: 45 Gy) after two cycles of neoadjuvant chemotherapy (cisplatin 100 mg/m2 daily; day 1:5-fluorouracil 1,000 mg/m2 daily; day 1-5) and planned neck dissection. For a neck recurrence, he had received five cycles of low-dose cisplatin (5 mg/body daily: day 1-5) with tegafur and uracil (600 mg/body daily: day 1-7) every week. As an outpatient, he then received ten cycles of low-dose cisplatin (10 mg/body daily: day 3, 6) with tegafur and uracil (600 mg/body daily: day 1-7) every week. The size of the tumor did not decrease with the above chemotherapy, but no remarkable growth of the cancer was seen, and no toxic effect of the chemotherapy was observed. He continued his job for 30 weeks just as before he had fallen sick. Chemotherapy of low-dose cisplatin with tegafur and uracil was suggested to be useful for the patient with recurrent laryngeal squamous cell carcinoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[Necessity of cervical lymph node dissection by retrospective analysis of submucosal cancer in mid-thoracic esophagus].

The frequency and distribution of metastatic lymph node of submucosal cancer (sm) located in mid-thoracic esophagus were investigated retrospectively to evaluate the significance of cervical lymph node dissection, so-called "radical neck dissection". In the further investigations of lymph node dissection in sm cancer located only in mid-thoracic esophagus, cervical lymph node metastasis was found only in 2 cases of 19 mid-thoracic esophageal sm cancer, which were both at paraesophageal area, resectable from the thoracic approach. Comparison of the survival cases receiving esophagectomy for sm cancer located in mid- and lower esophagus, with cervical lymph node dissection (n = 26) and without (n = 16) showed no significant differences. Therefore cervical lymph node dissection can be omitted in cases of mid-thoracic esophageal sm cancer.

Contraindications↗
PubMed2005

A historical prospective cohort study of carotid artery stenosis after radiotherapy for head and neck malignancies.

PURPOSE: To determine carotid artery stenosis incidence after radiotherapy for head-and-neck neoplasms. METHODS AND MATERIALS: This historical prospective cohort study comprised 44 head-and-neck cancer survivors who received unilateral neck radiotherapy between 1974 and 1999. They underwent bilateral carotid duplex ultrasonography to detect carotid artery stenosis. RESULTS: The incidence of significant carotid stenosis (8 of 44 [18%]) in the irradiated neck was higher than that in the contralateral unirradiated neck (3 of 44 [7%]), although this difference was not statistically significant (p = 0.13). The rate of significant carotid stenosis events increased as the time after radiotherapy increased. The risk of ipsilateral carotid artery stenosis was higher in patients who had undergone a neck dissection vs. those who had not. Patients with significant ipsilateral stenosis also tended to be older than those without significant stenosis. No other patient or treatment variables correlated with risk of carotid artery stenosis. CONCLUSIONS: For long-term survivors after neck dissection and irradiation, especially those who are symptomatic, ultrasonographic carotid artery screening should be considered.

Adult↗
PubMed1992

[Clinical issues of tuberculous cervical lymphadenitis: evaluation of 5 cases with packet formation].

Cervical lymphadenopathy with packet formation as the sole presentation of tuberculosis is very rarely seen in modern Japan. During the four years from 1987 to 1990, 5 cases of cervical scrofula with packet formation were treated with selective neck dissection followed by antituberculous chemotherapy at the ENT-department of Haibara General Hospital. Clinical evaluation of these cases suggested the following: 1) The physician must keep in mind that cervical scrofula should be included in the differential diagnosis of any neck masses, and malignant neck tumors particularly should be differentiated from cervical scrofula. 2) The treatment of cervical scrofula should be appropriate to the clinical stage diagnosed by CT or MRI. Recommended therapy for cervical scrofula with packet formation is selective neck dissection followed by antituberculous chemotherapy, which can shorten the period of treatment. 3) We present here a 22-year-old female from the Philippines with cervical scrofula and suggest that, in the future in Japan, tuberculosis may frequently be encountered in the immigrant population from the countries with high incidences of tuberculosis.

Adult↗