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Speciality
Spotlight

 




 


Oncology


 

 





Head
& Neck Cancer

  

  • Hoffman
    GT, Karnell LH, Funk GF, et al [ Univ of Lowa, Lowa
    City; American College of Surgeons, Chicago]

    The
    National Cancer Data Base Report on Cancer of the Head
    and Neck

    Arch
    Otolaryngol Head Neck Surg 124: 951-962, 1998

          

    The
    National Cancer Data Base [NCDB] provides information
    from hospital registries. In United States, Canada and
    Puerto Rico.

          

    On patterns of presentation, treatment and outcome for
    head and neck cancers.

          

    The midwest had the highest number of head and neck
    cancer patients and the mountain areas the lowest.

           

    Tumors were located in larynx[20.8%], lip[17.6%],
    thyroid gland[15.8%], and oropharynx[12.3%].

        

    Advanced
    stage cancers occurred mainly in lower income patient.
    Thyroid cancer occurred more often in women. Lip cancer
    had the highest survival and hypopharynx the lowest.

         

  • Brizel
    DM, Albers ME, Fisher SR, et al [Duke Univ, Durham, NC]

    Hyperfractionated
    Irradiation With or Without Concurrent Chemotherapy for
    Locally Advanced Head and Neck Cancer

    N
    Engl J Med 338: 1798-1804, 1998

         


    The
    therapy of advanced head and neck cancer reviews around
    radiotherapy and or chemotherapy. This study of
    116 patients with advanced head and neck cancer
    were treated either with hyperfractionated irradiation
    alone or with hyperfractionated irradiation plus
    5 day of chemotherapy with 5 fluorouracil plus cisplatin
    during weeks 1 and 6 of irradiation. Two more courses of
    chemotherapy were administered after irradiation.

         

    At 3 years the rate of overall survival was 55% in the
    combined modality versus 34% in the radiation group.
    Local-regional control rates were 70% versus 44% for
    combined modality and radiation alone respectively.

         

    The
    editor comments that by giving irradiation twice a day
    it was possible to curtail the toxicity of the combined
    modality arm.

             

  • Dagum P, Pinto HA, Newman JP, et al (Stanford Univ, Calif)

    Management of the Clinically Positive Neck in Organ Preservation for Advanced Head and Neck Cancer.

    Am J surg 176: 448-452, 1998

        

    Forty-eight patients were prospectively studied. They were in stage III and stage IV squamous cell carcinoma of the Head and Neck and were undergoing organ preserving therapy. Forty-two patients had palpable cervical node.

        

    Treatment consisted of Induction chemotherapy, followed by simultaneous chemotherapy and fractionated external-beam radiotherapy.

        

    It was concluded only Induction chemotherapy is not useful to control cervical node disease. All three treatments with neck dissection for patients with persistent lymph node provides good regional control.

           

  • Cody DT II, Funk GF, Wagner D, et al (Univ of Iowa, Iowa City)

    The Use of Granulocyte Colony Stimulating Factor to Promote Wound Healing in a Neutropenic Patient After Head and Neck Surgery.

    Head Neck 21: 172-175, 1999

         

    Development of pharyngocutaneous fistula in 7.6% to 50% was noted in laryngectomy patients. Low neutrophil counts have been observed after other surgical procedure. The use of Granulocyte Colony Stimulating Factor (G-CSF) promoted healing in neutropenic patients.

        

    This is the first known report of a patient with neutropenia and persistent pharyngocutaenous fistula. After laryngectomy G-CSF was administered as adjunctive treatment.

            

  • Nakfoor BM, Spiro IJ, Wang CC, et al [ Massachusetts Gen Hosp, Boston; Harvard Med School]

    Results of Accelerated Radiotherapy for Supraglottic Carcinoma: A Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary Experience

    Head Neck 20: 379-384, 1998

           

    This study of 190 patients with supraglottic laryngeal carcinoma were treated with accelerated hyperfractionated radiotherapy and followed up for a median of 56 months.

          

    This form of therapy could bring excellent locoregional control, relapse free survival and laryngeal preservation. The T and N stages significantly predicted outcomes. The T4 tumor and node-positive neck disease indicated a poor prognosis.

             

  • Mortimore S, Thorp MA, Nilssen ELK, et al [ Groote Schuur Hosp, Cape Town, South Africa]

    Hypoparathyroidism After the Treatment of Laryngopharyngeal Carcinoma

    J Laryngol Otol 112: 1058-1060, 1998

          

    This study determined the incidence of hypoparathyrodism in the patients with laryngopharyngeal carcinoma undergoing surgery and radiotherapy. The risk was highest in patients who received radiotherapy followed by surgery. The symptoms of chronic hypoparathyroidism may be unrecognized or confused with psychoneurosis.

         

  • Charles L. Bennett, David Lane, Tammy Stinson, Michael Glatzel, and Jens Buntzel (The Chicago VA Healthcare System/Lakeside Division, the Robert H. Lurie Cancer Center and the Department of Medicine, Northwestern University, Chicago, Illinois; the Ear, Nose, and Throat Diseases and Plastic Surgery Clinical, Klinikum Suhl, Suhl, Germany)

    Economic Analysis of Amifostine as Adjunctive Support for Patients with Advanced Head and Neck Cancer: Preliminary Results from a Randomized Phase II Clinical Trial from Germany

    Cancer Investigation 2001 Vol. 19 (2) Pg. 107-113

         


    The combined modality i.e. chemotherapy and radiotherapy has major limitation due to local toxicities such as severe mucositis, infection, and neutropenia. Amifostine has the potential to ameliorate these toxicities.

       


    This study of 28 analysable stage III or IV squamous cell carcinoma of head and neck received radiotherapy and chemotherapy consisting of carboplatinum 70 mg/m2 day 1-5 and days 21-25. Amifostine is administered prior to carboplatin. 

          


    Patients on amifostine required less supportive measures i.e. fever, transfusions, hospitalized less often and less erythropoetin but these differences were not statistically significant. 

          


    Patients on amifostine had lower cost for supportive care resources. This study has taken the German Health Care System and economic analysis revealed in a phase II clinical trial amifostine decreased the toxicities and resource use for alimentation, infections and haematological support in the intensive radiochemotherapy arm.

          

  • John C. Grecula, David E. Schuller, Roy Smith, Chris A. Rhoades, Subir Nag, Constance J. Bauer, Amit Agrawal, Jessie L.-S. Au, Donn Young, and Reinhard A. Gahbauer (Division of Radiation, Oncology; Department of Otolaryngology; Division of Medical Oncology; College of Pharmacy; Biostatistics Unit, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio)

    Long-term Follow-up on an Intensified Treatment Regimen for Advanced Resectable Head and Neck Squamous Cell Carcinomas 

    Cancer Investigation 2001 Vol. 19 (2) Pg. 127-136

        


    This study of 37 patients with stage with stage III – IV squamous cell carcinomas of the oral cavity, oropharynx or hypopharynx (stage II – IV) received cisplatinum 80 mg/m2 continuous infusion with hyperfractionated external beam radiotherapy, surgical resection, intraoperative radiotherapy and postoperative radiotherapy with concurrent cisplatin 100 mg/m2. The overall local control at the primary tumor site was 97% and distant metastasis, free rate was 81%.

         


    Chemotherapy dose reduction was required in 8% and 73% of patients completed all courses of treatment as per protocol, 8% developed renal insufficiency.

         


    Previous studies have shown concurrent regimen in advanced head and neck cancers have demonstrated improvement in loco-regional control, disease free survival and in some overall survival. This protocol although has excellent long term loco-regional control impact on distant failure was dismal.

         

  • Jackson SM, Hay JH, Flores AD, et al (British Columbia Cancer Agency, Vancouver; Cancer Centre for the Southern Interior, Kelowna, Canada)

    Cancer of the Tonsil: The Results of Ipsilateral Radiation Treatment

    Radiother Oncol 51: 123-128, 1999

        

    This is a retrospective study of 271 patients with invasive squamous carcinoma of tonsils. 178 received ipsilateral radiation treatment and overall primary tumor control rate was 75%, and for T1 and T2 tumors 84%.

        

    Thus ipsilateral treatment yielded survival rates at least as good as those reported for bilateral treatment. This has fewer side effects and very low risk failure in the contralateral neck.

        

  • Ho W, Wei WI, Kwong DLW, et al (Univ of Hong Kong, China; Saskatchewan Cancer Agency, Regina, Canada)

    Long-Term Sensorineural Hearing Deficit Following Radiotherapy in Patients Suffering from Nasopharyngeal Carcinoma: A Prospective Study

    Head Neck 21: 547-553, 1999

        

    Radiotherapy is the mainstay treatment for most head and neck cancer. This study has evaluated the effect of radical external radiotherapy on inner ear function in patients with nasopharyngeal carcinoma, sensorineural hearing loss was evident shortly after radiotherapy.

         

    Early changes were reversible but persistent hearing loss was also noted. This article is hence a motivation for the use of conformal radiation treatment for managing nasopharyngeal carcinoma to prevent such hearing loss.

         

  • Davidson BJ, Newkirk KA, Harter KW, et al (Georgetown Univ, Washington, DC)

    Complications From Planned, Posttreatment Neck Dissections

    Arch Otolaryngol Head Neck Surg 125: 401-405, 1999

       

    This study of 34 patients with clinically positive neck disease underwent organ preservation treatment i.e. radiation and chemotherapy for the primary site followed by planned neck dissection after radiation is over.

       

    Complications were evident in 38% most of these were wound related problems. These complications were not related to the previous chemotherapy or brachytherapy to the primary site but was definitely related to the dose of local radiotherapy.

       

    A preoperative dose of higher than 70 Gy and preoperative albumin less than 38 g/L were associated with complications i.e. skin flap necrosis.

        

 



 

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Speciality Spotlight

 

 

Head & Neck Cancer
  

  • Hoffman GT, Karnell LH, Funk GF, et al [ Univ of Lowa, Lowa City; American College of Surgeons, Chicago]
    The National Cancer Data Base Report on Cancer of the Head and Neck
    Arch Otolaryngol Head Neck Surg 124: 951-962, 1998
          
    The National Cancer Data Base [NCDB] provides information from hospital registries. In United States, Canada and Puerto Rico.
          
    On patterns of presentation, treatment and outcome for head and neck cancers.
          
    The midwest had the highest number of head and neck cancer patients and the mountain areas the lowest.
           
    Tumors were located in larynx[20.8%], lip[17.6%], thyroid gland[15.8%], and oropharynx[12.3%].
        
    Advanced stage cancers occurred mainly in lower income patient. Thyroid cancer occurred more often in women. Lip cancer had the highest survival and hypopharynx the lowest.
         

  • Brizel DM, Albers ME, Fisher SR, et al [Duke Univ, Durham, NC]
    Hyperfractionated Irradiation With or Without Concurrent Chemotherapy for Locally Advanced Head and Neck Cancer
    N Engl J Med 338: 1798-1804, 1998
         
    The therapy of advanced head and neck cancer reviews around radiotherapy and or chemotherapy. This study of 116 patients with advanced head and neck cancer were treated either with hyperfractionated irradiation alone or with hyperfractionated irradiation plus 5 day of chemotherapy with 5 fluorouracil plus cisplatin during weeks 1 and 6 of irradiation. Two more courses of chemotherapy were administered after irradiation.
         
    At 3 years the rate of overall survival was 55% in the combined modality versus 34% in the radiation group. Local-regional control rates were 70% versus 44% for combined modality and radiation alone respectively.
         
    The editor comments that by giving irradiation twice a day it was possible to curtail the toxicity of the combined modality arm.
             

  • Dagum P, Pinto HA, Newman JP, et al (Stanford Univ, Calif)
    Management of the Clinically Positive Neck in Organ Preservation for Advanced Head and Neck Cancer.
    Am J surg 176: 448-452, 1998
        
    Forty-eight patients were prospectively studied. They were in stage III and stage IV squamous cell carcinoma of the Head and Neck and were undergoing organ preserving therapy. Forty-two patients had palpable cervical node.
        
    Treatment consisted of Induction chemotherapy, followed by simultaneous chemotherapy and fractionated external-beam radiotherapy.
        
    It was concluded only Induction chemotherapy is not useful to control cervical node disease. All three treatments with neck dissection for patients with persistent lymph node provides good regional control.
           

  • Cody DT II, Funk GF, Wagner D, et al (Univ of Iowa, Iowa City)
    The Use of Granulocyte Colony Stimulating Factor to Promote Wound Healing in a Neutropenic Patient After Head and Neck Surgery.
    Head Neck 21: 172-175, 1999
         
    Development of pharyngocutaneous fistula in 7.6% to 50% was noted in laryngectomy patients. Low neutrophil counts have been observed after other surgical procedure. The use of Granulocyte Colony Stimulating Factor (G-CSF) promoted healing in neutropenic patients.
        
    This is the first known report of a patient with neutropenia and persistent pharyngocutaenous fistula. After laryngectomy G-CSF was administered as adjunctive treatment.
            

  • Nakfoor BM, Spiro IJ, Wang CC, et al [ Massachusetts Gen Hosp, Boston; Harvard Med School]
    Results of Accelerated Radiotherapy for Supraglottic Carcinoma: A Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary Experience
    Head Neck 20: 379-384, 1998
           
    This study of 190 patients with supraglottic laryngeal carcinoma were treated with accelerated hyperfractionated radiotherapy and followed up for a median of 56 months.
          
    This form of therapy could bring excellent locoregional control, relapse free survival and laryngeal preservation. The T and N stages significantly predicted outcomes. The T4 tumor and node-positive neck disease indicated a poor prognosis.
             

  • Mortimore S, Thorp MA, Nilssen ELK, et al [ Groote Schuur Hosp, Cape Town, South Africa]
    Hypoparathyroidism After the Treatment of Laryngopharyngeal Carcinoma
    J Laryngol Otol 112: 1058-1060, 1998
          
    This study determined the incidence of hypoparathyrodism in the patients with laryngopharyngeal carcinoma undergoing surgery and radiotherapy. The risk was highest in patients who received radiotherapy followed by surgery. The symptoms of chronic hypoparathyroidism may be unrecognized or confused with psychoneurosis.
         

  • Charles L. Bennett, David Lane, Tammy Stinson, Michael Glatzel, and Jens Buntzel (The Chicago VA Healthcare System/Lakeside Division, the Robert H. Lurie Cancer Center and the Department of Medicine, Northwestern University, Chicago, Illinois; the Ear, Nose, and Throat Diseases and Plastic Surgery Clinical, Klinikum Suhl, Suhl, Germany)
    Economic Analysis of Amifostine as Adjunctive Support for Patients with Advanced Head and Neck Cancer: Preliminary Results from a Randomized Phase II Clinical Trial from Germany
    Cancer Investigation 2001 Vol. 19 (2) Pg. 107-113
         
    The combined modality i.e. chemotherapy and radiotherapy has major limitation due to local toxicities such as severe mucositis, infection, and neutropenia. Amifostine has the potential to ameliorate these toxicities.
       
    This study of 28 analysable stage III or IV squamous cell carcinoma of head and neck received radiotherapy and chemotherapy consisting of carboplatinum 70 mg/m2 day 1-5 and days 21-25. Amifostine is administered prior to carboplatin. 
          
    Patients on amifostine required less supportive measures i.e. fever, transfusions, hospitalized less often and less erythropoetin but these differences were not statistically significant. 
          
    Patients on amifostine had lower cost for supportive care resources. This study has taken the German Health Care System and economic analysis revealed in a phase II clinical trial amifostine decreased the toxicities and resource use for alimentation, infections and haematological support in the intensive radiochemotherapy arm.
          

  • John C. Grecula, David E. Schuller, Roy Smith, Chris A. Rhoades, Subir Nag, Constance J. Bauer, Amit Agrawal, Jessie L.-S. Au, Donn Young, and Reinhard A. Gahbauer (Division of Radiation, Oncology; Department of Otolaryngology; Division of Medical Oncology; College of Pharmacy; Biostatistics Unit, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio)
    Long-term Follow-up on an Intensified Treatment Regimen for Advanced Resectable Head and Neck Squamous Cell Carcinomas 
    Cancer Investigation 2001 Vol. 19 (2) Pg. 127-136
        
    This study of 37 patients with stage with stage III – IV squamous cell carcinomas of the oral cavity, oropharynx or hypopharynx (stage II – IV) received cisplatinum 80 mg/m2 continuous infusion with hyperfractionated external beam radiotherapy, surgical resection, intraoperative radiotherapy and postoperative radiotherapy with concurrent cisplatin 100 mg/m2. The overall local control at the primary tumor site was 97% and distant metastasis, free rate was 81%.
         
    Chemotherapy dose reduction was required in 8% and 73% of patients completed all courses of treatment as per protocol, 8% developed renal insufficiency.
         
    Previous studies have shown concurrent regimen in advanced head and neck cancers have demonstrated improvement in loco-regional control, disease free survival and in some overall survival. This protocol although has excellent long term loco-regional control impact on distant failure was dismal.
         

  • Jackson SM, Hay JH, Flores AD, et al (British Columbia Cancer Agency, Vancouver; Cancer Centre for the Southern Interior, Kelowna, Canada)
    Cancer of the Tonsil: The Results of Ipsilateral Radiation Treatment
    Radiother Oncol 51: 123-128, 1999
        
    This is a retrospective study of 271 patients with invasive squamous carcinoma of tonsils. 178 received ipsilateral radiation treatment and overall primary tumor control rate was 75%, and for T1 and T2 tumors 84%.
        
    Thus ipsilateral treatment yielded survival rates at least as good as those reported for bilateral treatment. This has fewer side effects and very low risk failure in the contralateral neck.
        

  • Ho W, Wei WI, Kwong DLW, et al (Univ of Hong Kong, China; Saskatchewan Cancer Agency, Regina, Canada)
    Long-Term Sensorineural Hearing Deficit Following Radiotherapy in Patients Suffering from Nasopharyngeal Carcinoma: A Prospective Study
    Head Neck 21: 547-553, 1999
        
    Radiotherapy is the mainstay treatment for most head and neck cancer. This study has evaluated the effect of radical external radiotherapy on inner ear function in patients with nasopharyngeal carcinoma, sensorineural hearing loss was evident shortly after radiotherapy.
         
    Early changes were reversible but persistent hearing loss was also noted. This article is hence a motivation for the use of conformal radiation treatment for managing nasopharyngeal carcinoma to prevent such hearing loss.
         

  • Davidson BJ, Newkirk KA, Harter KW, et al (Georgetown Univ, Washington, DC)
    Complications From Planned, Posttreatment Neck Dissections
    Arch Otolaryngol Head Neck Surg 125: 401-405, 1999
       
    This study of 34 patients with clinically positive neck disease underwent organ preservation treatment i.e. radiation and chemotherapy for the primary site followed by planned neck dissection after radiation is over.
       
    Complications were evident in 38% most of these were wound related problems. These complications were not related to the previous chemotherapy or brachytherapy to the primary site but was definitely related to the dose of local radiotherapy.
       
    A preoperative dose of higher than 70 Gy and preoperative albumin less than 38 g/L were associated with complications i.e. skin flap necrosis.