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Sample records for advanced head-and-neck cancer

  1. Postoperative radiation for advanced head and neck cancers

    International Nuclear Information System (INIS)

    Purpose: To discuss both general and specific indications for radiation following surgery for patients with cancers of the head and neck. Patients with advanced cancers of the head and neck are often not suitable candidates for treatment with definitive radiation, and are treated with surgery. Frequently these patients fail by recurring in either the primary sites or in the necks. Adjuvant radiation is therefore often a critical component in the management of these patients. While radiation can be done either prior to or after surgery, most centers prefer the postoperative setting. This refresher course will review general concepts of postoperative irradiation for the patient with head and neck cancer and apply these concepts to specific situations. The course will begin with a broad review of the indications for postoperative irradiation as not all patients undergoing surgery for cancers of the head and neck require additional treatment. We will also review the concept of using postoperative radiation to allow for more conservative surgery with preservation of function. The second portion of the course will focus on general techniques of postoperative irradiation. We will review concepts of patient setup and treatment portal design and describe how specific techniques are practiced at MDACC. Controversial topics, including field matching, total dose and fractionation, and the timing of postoperative radiation will be discussed. The final section of the course will review the results of postoperative irradiation as applied to the head and neck in general as well as to specific subsites. In addition to results for the common scenarios of squamous cell carcinomas of the oral cavity, pharynx and larynx, we will review results of postoperative irradiation for skin cancers of the head and neck, paranasal sinuses, and salivary glands

  2. Concurrent chemoradiotherapy for advanced head and neck cancer

    International Nuclear Information System (INIS)

    The role of concurrent chemoradiotherapy in treatment of head and neck cancer was evaluated. Authers reviewed the patients with cancer in tongue, mesopharynx and hypopharynx, treated in Kyushu Cancer Center. Of twelve T3-4 mesopharyngeal cancers, complete responses were achieved in four cases (33%). Two of eight cases of T3 hypopharyngeal cancer could obtain complete response with concurrent chemoradiotherapy. However, chemoradiotherapy is not effective for advanced oral cancer patients. On the other hand, there is some patients which could not complete a treatment for complications. Patients should be under careful and strict management through concurrent chemoradiotherapy. (author)

  3. Hypothyroidism after Radiotherapy of Locally Advanced Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Eun; Eun; Kim, Jae Chul; Park, In Kyu [Kyungpook National Yonsei University School of Medicine, Daegu (Korea, Republic of); Yea, Ji Woon [Dongguk University Gyeongju Hospital, Gyeongju (Korea, Republic of)

    2010-11-15

    The aim of the present study was to retrospectively evaluate the incidence of hypothyroidism in locally advanced head and neck cancer patients who received radiotherapy (RT) either with or without neck dissection. From January 2000 to December 2005, 115 patients with locally advanced head and neck cancer and who received definitive RT or postoperative RT including standard anterior low-neck field were recruited to be part of this study. Nineteen patients had undergone ipsilateral neck dissection, whereas, 18 patients underwent bilateral neck dissection, and 78 patients were received RT alone. Patients' ages ranged from 28 to 85 years (median, 59 years) and there were a total of 73 male and 42 female patients. The primary tumor sites were the oral cavity, oropharynx, hypopharynx, larynx, and other sites in 18, 40, 28, 22 and 7 patients, respectively. Radiation dose to the thyroid gland ranged from 44 Gy to 66 Gy with a median dose of 50 Gy. Follow-up time ranged from 2 to 91 months, with a median of 29 months. The 1- and 3- year incidence of hypothyroidism was 28.7% (33 patients) and 33.0% (38 patients), respectively. The median time to detection of hypothyroidism was 8.5 months (range, 0 to 36 months). A univariate analysis revealed that neck node dissection was a risk factor for hypothyroidism (p=0.037). However, no factor was statistically significant from the results of a multivariate analysis. Patients treated for advanced head and neck cancer with radiotherapy with or without neck dissection will develop hypothyroidism. It is important to check the thyroid function periodically in these patients especially with the risk factor of neck node dissection.

  4. Hypothyroidism after Radiotherapy of Locally Advanced Head and Neck Cancer

    International Nuclear Information System (INIS)

    The aim of the present study was to retrospectively evaluate the incidence of hypothyroidism in locally advanced head and neck cancer patients who received radiotherapy (RT) either with or without neck dissection. From January 2000 to December 2005, 115 patients with locally advanced head and neck cancer and who received definitive RT or postoperative RT including standard anterior low-neck field were recruited to be part of this study. Nineteen patients had undergone ipsilateral neck dissection, whereas, 18 patients underwent bilateral neck dissection, and 78 patients were received RT alone. Patients' ages ranged from 28 to 85 years (median, 59 years) and there were a total of 73 male and 42 female patients. The primary tumor sites were the oral cavity, oropharynx, hypopharynx, larynx, and other sites in 18, 40, 28, 22 and 7 patients, respectively. Radiation dose to the thyroid gland ranged from 44 Gy to 66 Gy with a median dose of 50 Gy. Follow-up time ranged from 2 to 91 months, with a median of 29 months. The 1- and 3- year incidence of hypothyroidism was 28.7% (33 patients) and 33.0% (38 patients), respectively. The median time to detection of hypothyroidism was 8.5 months (range, 0 to 36 months). A univariate analysis revealed that neck node dissection was a risk factor for hypothyroidism (p=0.037). However, no factor was statistically significant from the results of a multivariate analysis. Patients treated for advanced head and neck cancer with radiotherapy with or without neck dissection will develop hypothyroidism. It is important to check the thyroid function periodically in these patients especially with the risk factor of neck node dissection.

  5. Chemotherapy of the patients with advanced head and neck cancers

    International Nuclear Information System (INIS)

    Purpose: Treatment of advanced head and neck carcinomas are a problem of worldwide. Cancer remains incurable when it is metastatic or unresectable, and only palliative treatment can improve quality of life of these patients. The aim of this retrospective study was to compare patients treated by radio / chemotherapy with a group of patients treated by radiotherapy alone. Patients and methods: 26 patients with advanced inoperable head and neck cancer were treated at our clinic between the years 1991-1995. Medium age was 62 (range 41-78). Primary tumor sites were: oropharynx in 4 cases, hypopharynx in 4 cases, larynx in 8 cases, oral cavity in 6 cases and parotid gland in 2 cases. The primary treatment consisted of radiotherapy alone in 13 patients, and a combination of radio / chemotherapy in 13 patients. Tumor size was T3 (8 patients) and T4 (18 patients), all of patients had metastases in regional lymph nodes (N1-N3). Chemotherapy was started after radiotherapy course and cisplatin was always included. The main side effects were myelotoxicity, nephrotoxicity, nausea and vomiting. Results: There are five patients with partial respons, four patients with stable disease and four patients with progressive disease. Medial stable disease time was 3,5 month in radio / chemotherapy group and 2,7 months in radiotherapy group. Median survival was 13,2 months for patients of radio / chemotherapy group and 11,5 months for patients of radiotherapy group. Conclusion: Addition of chemotherapy to radiotherapy improves survival of patients with advanced head and neck carcinoma and reliefs pain. (Full text)

  6. Concurrent chemoradiation for unresectable advanced head and neck cancer

    International Nuclear Information System (INIS)

    Concurrent chemoradiotherapy were performed for 18 patients with unresectable head and neck squamous cell cancer. Chemotherapy, consisting of CDDP (40 mg/m2, Day 1 and 8) and 5-FU (200 mg/m2, 24-h continuous infusion through Day 1-5 and 8-12), with concurrent radiotherapy (2 Gy/day, 5 days/w) were administered and repeated 2-3 courses in every 5 weeks. Mucositis and myelo-suppression were the main side effects observed, but all of them were tolerable. Total response rate and complete response rate was 94.4% and 55.6%, respectively. Out of six patients requiring tracheotomy for airway obstruction due to bulky tumor, four achieved sufficient tumor shrinkage by the treatment and could obtain closure of the stoma. Two patients whose neck lymph nodes were still remaining after chemoradiotherapy, could obtain local control by supplemental neck dissection surgery. These regimen is feasible and effective for locally advanced head and neck cancer. (author)

  7. Concurrent chemoradiation for unresectable advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Shimizu, Wakako; Ogino, Takashi; Ishikura, Satoshi [National Cancer Center, Kashiwa, Chiba (Japan). Hospital East] [and others

    1998-03-01

    Concurrent chemoradiotherapy were performed for 18 patients with unresectable head and neck squamous cell cancer. Chemotherapy, consisting of CDDP (40 mg/m{sup 2}, Day 1 and 8) and 5-FU (200 mg/m{sup 2}, 24-h continuous infusion through Day 1-5 and 8-12), with concurrent radiotherapy (2 Gy/day, 5 days/w) were administered and repeated 2-3 courses in every 5 weeks. Mucositis and myelo-suppression were the main side effects observed, but all of them were tolerable. Total response rate and complete response rate was 94.4% and 55.6%, respectively. Out of six patients requiring tracheotomy for airway obstruction due to bulky tumor, four achieved sufficient tumor shrinkage by the treatment and could obtain closure of the stoma. Two patients whose neck lymph nodes were still remaining after chemoradiotherapy, could obtain local control by supplemental neck dissection surgery. These regimen is feasible and effective for locally advanced head and neck cancer. (author)

  8. Hyperfractionation radiation therapy in advanced head and neck cancer

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    Kim, Jin Hee; Ye, Ji Won [College of Medicine, Keimyung Univ., Daegu (Korea, Republic of)

    2003-03-01

    The effects of hyperfractionation radiation therapy, such as the failure pattern and survival, on the treatment results in advanced stage head and neck cancer were studied. Between September 1990 and October 1998, 24 patients with advanced stage (III, IV) head and neck cancers, were treated using hyperfractionation radiation therapy in the Department at Radiation Oncology at the Keimyung University Dongsan Medical Center. The male to female ratio was 7 ; 1, and the age range from 38 to 71 years with the median of 56 years. With regard to the TNM stage, 11 patients were stage III and 13 were stage IV. The sites of primary cancer were the nasopharynx in six, the hypopharynx in 6, the larynx in five, the oropharynx in three, the maxillary sinus in three, and the oral cavity in one patient. The radiotherapy was delivered by 6 MV X-ray, with a fraction size of 1.2 Gy at two fractions a day, with at least 6 hours inter-fractional interval. The mean total radiation doses was 72 Gy, (ranging from 64.4 to 76.8 Gy). Fallow-up periods ranged between 3 and 136 months, with the median of 52 months. The overall survival rates at 3 and 5 years in all patients were 66.7% and 52.4%. The disease-free survival rates at 3 and 5 years (3YDFS, 5YDFS) in all patients Were 66.7% and 47.6%. The 3YDFS and 5YDFS in stage III patients were 81.8% and 63.6%, and those in stage IV patients were 53.8% and 32.3%. Ten patients were alive with no local nor distant failures at the time of analyses. Six patients (25%) died due to distant metastasis and 12.5% died due to local failure. Distant metastasis was the major cause of failure, but 2 patients died due to unknown failures and 3 of other diseases. The distant metastasis sites were the lung (3 patients), the bone (1 patient), and the liver (2 patients). One patient died of second esophageal cancer. There were no severe late complications, with the exception of 1 osteoradionecrosis of the mandible 58 months after treatment. Although this study was

  9. Hyperfractionation radiation therapy in advanced head and neck cancer

    International Nuclear Information System (INIS)

    The effects of hyperfractionation radiation therapy, such as the failure pattern and survival, on the treatment results in advanced stage head and neck cancer were studied. Between September 1990 and October 1998, 24 patients with advanced stage (III, IV) head and neck cancers, were treated using hyperfractionation radiation therapy in the Department at Radiation Oncology at the Keimyung University Dongsan Medical Center. The male to female ratio was 7 ; 1, and the age range from 38 to 71 years with the median of 56 years. With regard to the TNM stage, 11 patients were stage III and 13 were stage IV. The sites of primary cancer were the nasopharynx in six, the hypopharynx in 6, the larynx in five, the oropharynx in three, the maxillary sinus in three, and the oral cavity in one patient. The radiotherapy was delivered by 6 MV X-ray, with a fraction size of 1.2 Gy at two fractions a day, with at least 6 hours inter-fractional interval. The mean total radiation doses was 72 Gy, (ranging from 64.4 to 76.8 Gy). Fallow-up periods ranged between 3 and 136 months, with the median of 52 months. The overall survival rates at 3 and 5 years in all patients were 66.7% and 52.4%. The disease-free survival rates at 3 and 5 years (3YDFS, 5YDFS) in all patients Were 66.7% and 47.6%. The 3YDFS and 5YDFS in stage III patients were 81.8% and 63.6%, and those in stage IV patients were 53.8% and 32.3%. Ten patients were alive with no local nor distant failures at the time of analyses. Six patients (25%) died due to distant metastasis and 12.5% died due to local failure. Distant metastasis was the major cause of failure, but 2 patients died due to unknown failures and 3 of other diseases. The distant metastasis sites were the lung (3 patients), the bone (1 patient), and the liver (2 patients). One patient died of second esophageal cancer. There were no severe late complications, with the exception of 1 osteoradionecrosis of the mandible 58 months after treatment. Although this study was

  10. Prostaglandin inhibitor and radiotherapy in advanced head and neck cancers

    International Nuclear Information System (INIS)

    Radiotherapy is the usual mode of treatment for unresectable head and neck cancer. To improve cure rates, extend survival, and reduce morbidity, we use accelerated hyperfractionation radiotherapy and an adjuvant drug to inhibit prostaglandin synthesis. In this study, 19 patients received 300 rad/day of radiotherapy in two equally divided doses to a total dose averaging 6,200 rad. Either indomethacin, 25 mg, or placebo was given four times a day in a double-blind fashion during therapy. Radiation mucositis was graded as 0 to 4+; pain, nutritional status, and tumor status were monitored daily and recorded biweekly. Evaluation of the data showed delayed mucositis in the experimental group for grades 1 to 3, with a significant difference at grade 3 compared with controls. The significance of a long-term comparison of cure rates would be doubtful considering the heterogeneity of the primary sites and regional disease in this group coupled with the small size of our study

  11. Accelerated radiotherapy in advanced head and neck cancer

    International Nuclear Information System (INIS)

    The purpose of the study is to present the reasons for introducing concomitant boost accelerated radiotherapy (CBAR) and its practical aspects at advanced head and neck carcinomas (HNC). Accelerated clonogenic repopulation of the tumor during radiotherapy necessitates its termination within the shortest possible term. The differentiated effect of the fractionated dose on both early and late response of tissues requires the use of several smaller daily fractions with an interval between exceeding six hours during all the time of radiotherapy or a part of it. If there is no data about earlier kinetics of the tumor cells, schemes with total dose 69-72 Gy are given preference. The practical aspects of CBAR also are presented: 1. specificity of the clinical target volume (ICRU 50) considering the requirements for beam and fields; 2. irradiation techniques most frequently used and 3. the method of patient immobilization. The characteristic features of CBAR are also discussed: 1. The primary tumor and its subclinical diffusion are irradiated in standard fields or in such with exclusion of the spinal cord at dose up to 54 in 30 fractions for 5.5 weeks. During the first two days, two daily fractions at six-hours interval are delivered with partial exclusion of the spinal cord. The primary tumor is given during the last 2.5 weeks up to total dose 69-72 Gy with a second daily fraction of 1.5 Gy six hours after the first one; 2. The current concepts for spinal cord radiation tolerance and very high risk of transverse myelitis in some accelerated radiotherapeutical schemes are also discussed. The therapeutic approach described is based on the experience got from the conventional fractionation; 3. Without neglecting enhanced acute toxicity CBAR is recommended as a well tolerated radiotherapeutical method

  12. Short-course neutron therapy for advanced head and neck cancer

    International Nuclear Information System (INIS)

    This was a Phase I/II clinical study, concentrating mainly on the assessment of treatment tolerance, performed in a small group of patients with advanced head and neck cancer. The complete remission observed for 7 and 9 months after treatment in two out of 12 patients with very advanced head and neck cancer encourages the authors to continue further clinical trials using the high tumour dose of 12 Gy/10 F given over 2 weeks, as early cutaneous and mucosal reactions were acceptable. (author)

  13. Post-operative radiation therapy for advanced head and neck cancers

    International Nuclear Information System (INIS)

    Purpose: To discuss both general and specific indications for radiation following surgery for patients with cancers of the head and neck. Patients with advanced cancers of the head and neck are often not suitable candidates for treatment with definitive radiation, and are treated with surgery. Frequently these patients fail by recurring in either the primary sites or in the necks. Adjuvant radiation is therefore often a critical component in the management of these patients. While radiation can be done either prior to or after surgery, most centers prefer the postoperative setting. This refresher course will review general concepts of postoperative irradiation for the patient with head and neck cancer and apply these concepts to specific situations. The course will begin with a broad review of the indications for postoperative irradiation as not all patients undergoing surgery for cancers of the head and neck require additional treatment. We will also review the concept of using postoperative radiation to allow for more conservative surgery with preservation of function. The second portion of the course will focus on general techniques of postoperative irradiation. We will review concepts of patient setup and treatment portal design and describe how specific techniques are practiced at MDACC. Controversial topics, including field matching, total dose and fractionation, and the timing of postoperative radiation will be discussed. The final section of the course will review the results of postoperative irradiation as applied to the head and neck in general as well as to specific subsites. In addition to results for the common scenarios of squamous cell carcinomas of the oral cavity, pharynx and larynx, we will review results of postoperative irradiation for skin cancers of the head and neck, paranasal sinuses, and salivary glands

  14. Hyperthermia with radiation in the treatment of advanced head and neck cancers

    International Nuclear Information System (INIS)

    Hypoxic cells are deterrent to cure with radiotherapy. Hyperthermia (HT) which has the potential to be cytocidal can be complementary to radiation therapy. HT can be complementary to radiation as the targets of cellular lethality are different and hypoxic cells are more sensitive. The present study involves radiation of locally advanced Head and neck cancer with weekly HT as an adjuvant

  15. Image-guided radiotherapy for locally advanced head and neck cancer

    Directory of Open Access Journals (Sweden)

    NamPhongNguyen

    2013-07-01

    Full Text Available Treatment of locally advanced head and neck cancer remains a challenge because of the head and neck complex anatomy and the tumor invasion to the adjacent organs and/or metastases to the cervical nodes. Postoperative irradiation or concurrent chemoradiation may lead to damage of radiosensitive structures such as the salivary glands, mandible, cochlea, larynx, and pharyngeal muscles. Xerostomia, osteoradionecrosis, deafness, hoarseness of the voice, dysphagia, and aspiration remain serious complications of head and neck irradiation and impair patient quality of life. Intensity-modulated and image-guided radiotherapy by virtue of steep dose gradient and daily imaging may allow for decreased radiation of the organs at risk for complication while preserving loco-regional control.

  16. MR spectrsocopy of head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Abdel Razek, Ahmed Abdel Khalek, E-mail: arazek@mans.edu.eg [Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura 13557 (Egypt); Poptani, Harish, E-mail: Harish.Poptani@uphs.upenn.edu [Department of Radiology, University of Pennsylvania, Philadelphia (United States)

    2013-06-15

    The aim of this review is to discuss the technique and potential applications of magnetic resonance spectroscopy (MRS) in head and neck cancer. We illustrate the technical issues related to data acquisition, post processing and interpretation of MRS of head and neck lesions. MRS has been used for differentiation of squamous cell carcinoma from normal tissue. The main potential clinical application of proton MRS ({sup 1}H-MRS) is monitoring patients with head and neck cancer undergoing therapy. Pretreatment prediction of response to therapy can be done with phosphorus MRS ({sup 31}P-MRS). Although performance of MRS of head and neck is challenging, technological advances in both software and hardware has the potential to impact on the clinical management of patients with head and neck cancer.

  17. MR spectrsocopy of head and neck cancer

    International Nuclear Information System (INIS)

    The aim of this review is to discuss the technique and potential applications of magnetic resonance spectroscopy (MRS) in head and neck cancer. We illustrate the technical issues related to data acquisition, post processing and interpretation of MRS of head and neck lesions. MRS has been used for differentiation of squamous cell carcinoma from normal tissue. The main potential clinical application of proton MRS (1H-MRS) is monitoring patients with head and neck cancer undergoing therapy. Pretreatment prediction of response to therapy can be done with phosphorus MRS (31P-MRS). Although performance of MRS of head and neck is challenging, technological advances in both software and hardware has the potential to impact on the clinical management of patients with head and neck cancer

  18. Advances in Supportive Care for Late Effects of Head and Neck Cancer.

    Science.gov (United States)

    Murphy, Barbara A; Deng, Jie

    2015-10-10

    As the population of head and neck cancer survivors increases, it has become increasingly important for health care providers to understand and manage late complications of therapy. Functional deficits can be categorized as general health deficits resulting in frailty or debility, head and neck-specific functional deficits such as swallowing and speech, and musculoskeletal impairment as a result of tumor and treatment. Of critical importance is the growing data indicating that swallow therapy and physical therapy may prevent or ameliorate long-term functional deficits. Oral health complications of head and neck therapy may manifest months or years after the completion of treatment. Patients with hyposalivation are at high risk for dental caries and thus require aggressive oral hygiene regimens and routine dental surveillance. Swallowing abnormalities, xerostomia, and poor dentition may result in dietary adaptations that may cause nutritional deficiencies. Identification and management of maladaptive dietary strategies are important for long-term health. Follow-up with primary care physicians for management of comorbidities such as diabetes and hyperlipidemia may help to limit late vascular complications caused by radiation therapy. Herein, we review late effects of head and neck cancer therapy, highlighting recent advances. PMID:26351334

  19. Long-term oropharyngeal and laryngeal function in patients with advanced head and neck cancer

    OpenAIRE

    Kraaijenga, S.A.C.

    2016-01-01

    Radiotherapy or combined chemoradiotherapy (CRT) regimens are increasingly used as primary treatment for patients with advanced head and neck cancer (HNC). Unfortunately, these organ-preserving protocols are associated with substantial adverse functional events. Previous research has shown that preventive swallowing rehabilitation can significantly reduce the functional disabilities. This thesis focuses on oropharyngeal and laryngeal function following CRT for advanced HNC, including long-ter...

  20. Head and neck cancer imaging

    Energy Technology Data Exchange (ETDEWEB)

    Hermans, R. (ed.) [University Hospitals, Leuven (Belgium). Dept. of Radiology

    2006-07-01

    This book provides a comprehensive review of state-of-the-art imaging in head and neck cancer. Precise determination of tumor extent is of the utmost importance in these neoplasms, as it has important consequences for staging of disease, prediction of outcome and choice of treatment. Only the radiologist can fully appreciate submucosal, perineural, and perivascular tumor spread and detect metastatic disease at an early stage. Imaging is also of considerable benefit for patient surveillance after treatment. All imaging modalities currently used in the management of head and neck neoplasms are considered in depth, and in addition newer techniques such as PET-CT and diffusion-weighted MRI are discussed. This book will help the reader to recommend, execute and report head and neck imaging studies at a high level of sophistication and thereby to become a respected member of the team managing head and neck cancer. (orig.)

  1. Hypofractionated palliative radiotherapy in locally advanced inoperable head and neck cancer: CMC vellore experience

    Directory of Open Access Journals (Sweden)

    Saikat Das

    2013-01-01

    Full Text Available Background: A novel, short duration, palliative radiotherapy schedule for inoperable head and neck cancer was evaluated in terms of palliation of cancer-related symptoms and acute toxicities. Materials and Methods: Thirty-six patients with inoperable head and neck cancer were included in the study (2010-2012. All patients received 40 Gy in 10 fractions (equivalent dose: 49.8 Gy in conventional fractionation with 2 fractions per week. Treatment-related toxicity was assessed using Radiation Therapy Oncology Group criteria. Functional Assessment of Cancer Therapy (Head and Neck, FACT H and N quality of life (QOL tool was administered before starting and at the completion of radiotherapy. Mean value before and after treatment was compared (paired t-test, P = 0.05, two-tailed for significance. Results: Thirty-three patients (male: 29, female: 4, mean age: 57.8 ± 9.7 years were included in the analysis (three patients discontinued treatment due to socioeconomic reasons. All patients had advanced inoperable head and neck cancers (27% IVA, 61% IVB, 9% IVC, TNM stage and 3% recurrent disease. Distressing pain at primary site (42%, dysphagia (18%, neck swelling (30%, and hoarseness (10% were common presentations. Incidence of grade III mucositis and dermatitis and pain was 18%, 3%, and 24%, respectively. Planned radiotherapy without any interruptions was completed by 73% patients. QOL assessment showed improvement in social well-being (17.4 vs. 20.01, P = 0.03, but no significant change was observed in head and neck specific score (25.1 vs. 25.0, P = NS after treatment. Reduction of pain was observed in 88% patients and 60% patients had improvement of performance status. Median overall survival of the cohort was 7 months. Conclusions: The study shows that this short duration palliative radiotherapy schedule is a clinically viable option for advanced inoperable head and neck cancer to achieve significant palliation of the main presenting symptoms like

  2. Comparison of postoperative complications in advanced head and neck cancer patients receiving neoadjuvant chemotherapy followed by surgery versus surgery alone

    OpenAIRE

    Poonam Joshi; Amit Joshi; Kumar Prabhash; Vanita Noronha; Pankaj Chaturvedi

    2015-01-01

    Background: Head and neck cancer is the third most common cancer in India with 60% presenting in advanced stages. There is the emerging role of neoadjuvant chemotherapy (NACT) in the management of these advanced cancers. There is a general perception that complication rates are higher with the use of NACT. Materials and Methods: This is a retrospectively collected data of head and neck cancer patients operated at our hospital from March 2013 to September 2014. A total of 205 patients were inc...

  3. Effectiveness of prophylactic retropharyngeal lymph node irradiation in patients with locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    The aim of the study is to assess the effectiveness of intensity-modulated radiotherapy (IMRT) or image-guided radiotherapy (IGRT) for the prevention of retropharyngeal nodal recurrences in locally advanced head and neck cancer. A retrospective review of 76 patients with head and neck cancer undergoing concurrent chemoradiation or postoperative radiotherapy with IMRT or IGRT who were at risk for retropharyngeal nodal recurrences because of anatomic site (hypopharynx, nasopharynx, oropharynx) and/or the presence of nodal metastases was undertaken. The prevalence of retropharyngeal nodal recurrences was assessed on follow-up positron emission tomography (PET)-CT scans. At a median follow-up of 22 months (4–53 months), no patient developed retropharyngeal nodal recurrences. Prophylactic irradiation of retropharyngeal lymph nodes with IMRT or IGRT provides effective regional control for individuals at risk for recurrence in these nodes

  4. Multidisciplinary Treatment of Head and Neck Cancer

    OpenAIRE

    Varkey, Prashanth; Liu, Yi-Tien; Tan, Ngian Chye

    2010-01-01

    Head and neck cancer remains a significant cause of morbidity worldwide. Multimodality treatment is often the only way to achieve improved function, quality of life, and survival, calling for a multidisciplinary team approach, particularly in view of the rapid advances being made in various fields. The roles of the head and neck surgeon and reconstructive surgeon are discussed, together with the input afforded by specialists in areas such as diagnostic imaging, radiation therapy, medical onco...

  5. Phase I trial of concomitant hyperfractionated radiotherapy with docetaxel and cisplatin for locally advanced head and neck cancer

    OpenAIRE

    Allal, Abdelkarim Said; Zwahlen, Daniel; Becker, Minerva; Dulguerov, Pavel; Mach, Nicolas

    2006-01-01

    This study was conducted to determine the maximum tolerated dose of docetaxel when administered concomitantly with radical hyperfractionated radiotherapy and cisplatin in patients with locally advanced head and neck cancer.

  6. Recent advances in head and neck cancer reconstruction

    Directory of Open Access Journals (Sweden)

    Prabha Yadav

    2014-01-01

    Full Text Available Treatment of cancer is race against time! Following radical excision, breathing, speech, mastication and swallowing are hampered. Face is invariably involved. Beside functional normalcy, excellent cosmetic restoration is necessary for patient′s life quality. Primary wound healing, quick resumption of adequate oral intake, prompt initiation of chemo-radiotherapy has direct bearing on cure. Primary reconstruction with pedicle or free flap is the choice of treatment in most protocols. Composite defects are requiring bone, muscle and skin restrict choice of donor site and may have shortfalls in aesthetic and functional requirements. To improve further newer, and newer modalities are being developed and used to give best aesthetic and functions. Navigation, use of three-dimensional imaging, stereo lithic model and custom made implant for reconstruction are recommended as they promise improvement in aesthetics. Robotic surgeries allow access for resection of tumours and reconstruction with free flap in deep oropharynx obviating need of doing mandibulotomy. Researchers in stem cell and tissue engineering are looking forward to regenerating tissues and avoid the need of autologous tissue flaps. Desired tissue combination across counter may be available in the future. Excellent immunosuppressant drugs have made it possible to reconstruct composite facial anatomical units with allotransplant in a single surgery, along sensory and motor recovery! Mythological heterogenic head transplant like clone Ganesha, will be a reality in the near future!!

  7. Advanced head and neck cancer: Long-term results of chemo-radiotherapy, complications and induction of second malignancies

    OpenAIRE

    Munker, Reinhold; Purmale, L.; Aydemir, Ü.; Reitmeier, M.; Pohlmann, H.; Schorer, H.; Hartenstein, R.

    2001-01-01

    Background: Chemo-radiotherapy is superior to radiotherapy alone in the treatment of advanced, inoperable head and neck cancer. The long-term treatment results, the induction of second malignant tumors, and other long-term toxicities are not well defined. Patients and Methods: 100 consecutive patients with advanced head and neck cancer who were treated at our center were studied. Treatment results, survival, the occurrence of late complications, and second malignant tumors (SMT) were investig...

  8. Multidisciplinary Service Utilization Pattern by Advanced Head and Neck Cancer Patients: A Single Institution Study

    Directory of Open Access Journals (Sweden)

    Jacqueline C. Junn

    2012-01-01

    Full Text Available Purpose. To analyze the patterns and associations of adjunctive service visits by head and neck cancer patients receiving primary, concurrent chemoradiation therapy. Methods. Retrospective chart review of patients receiving adjunctive support during a uniform chemoradiation regimen for stages III-IV head and neck squamous cell carcinoma. Univariate and multivariate models for each outcome were obtained from simple and multivariate linear regression analyses. Results. Fifty-two consecutive patients were assessed. Female gender, single marital status, and nonprivate insurance were factors associated with an increased number of social work visits. In a multivariate analysis, female gender and marital status were related to increased social work services. Female gender and stage IV disease were significant for increased nursing visits. In a multivariate analysis for nursing visits, living greater than 20 miles between home and hospital was a negative predictive factor. Conclusion. Treatment of advanced stage head and neck cancer with concurrent chemoradiation warrants a multidisciplinary approach. Female gender, single marital status, and stage IV disease were correlated with increased utilization of social work and nursing services. Distance over 20 miles from the center was a negative factor. This information may help guide the treatment team to allocate resources for the comprehensive care of patients.

  9. Radiotherapy combined with cetuximab for locally advanced head and neck cancer: Results and toxicity

    International Nuclear Information System (INIS)

    Purpose. - To describe the clinical results and tolerance of the combined treatment with radiotherapy and cetuximab for locally advanced head and neck cancer. Patients and methods. - From August 2006 and October 2010, 36 patients with advanced squamous cell head and neck carcinoma were treated with radiotherapy (70 Gy/35 fractions) and cetuximab (400 mg/m2 one week before radiotherapy, following by 250 mg/m2 once weekly, until week 7 of radiotherapy). Tolerance was evaluated every week. All patients were examined every 3 months the first 3 years after therapy, and then every year. Results. - The median follow-up was 14 months. The majority of patients were male (31 out of 36). Mean age was 59 years. The tumours sites were: oral cavity (n 8); oropharynx (n = 15); hypopharynx (n = 5); larynx (n = 8). Ninety percent of tumors were T3 or T4, and 45% were N2 or N3. Complete response was seen in 74% of patients, partial response in 17% and no response in 9% of patients. The overall survival was 44.4%. Relapse occurred in six patients. Anaphylactic reaction during the first infusion of cetuximab was observed in one patient. One patient developed severe aplasia after 48 Gy and 5 weeks of cetuximab, and died of sepsis. Eighty percent of patients presented acne, 16 patients developed a mucositis grade 2-3 and 23 patients a grade 2 skin reaction. Conclusion. - The concomitant use of cetuximab and radiotherapy in locally advanced head and neck carcinoma is well tolerated in this group of patients. The results seem comparable to those in the literature. (authors)

  10. Simultaneous chemoradiotherapy with Taxol/Carboplatin in advanced head and neck cancer. Preliminary results

    International Nuclear Information System (INIS)

    Background: The purpose of simultaneous chemoradiotherapy is to increase local-regional control and to decrease the incidence of distant metastases. Regimens containing cisplatin/5-FU chemotherapy are widely accepted as standard treatment in advanced head and neck cancer. Most studies reported promising response and survival data, but also severe mucosal toxicity. In recent years the newly developed drug Taxol demonstrated interesting activity in head and neck cancer as a single agent and as well in combination drug regimens. In the present outpatient phase-II trial we investigated the combination of Taxol/carboplatin with 40 Gy radiotherapy in a neoadjuvant setting of operable Stage-III/IV squamous cell carcinoma of the oral cavity and oropharynx. Patients and Methods: Twelve patients were enrolled in this ongoing trial with a projected number of 30 patients and received 5 cycles of weekly Taxol (40 mg/m2) and carboplatin (AUC 1.5) with conventional radiotherapy (40 Gy). Within 3 to 4 weeks after chemoradiotherapy resection of the primary tumor and the regional neck nodes was performed. Results: So far 12 patients were evaluable for toxicity and response. Complete response was noted in 8/12 patients (Cr 66%). In 6/10 patients (60%) complete pathologic response was documented in the resection specimens. Conclusion: Our preliminary results demonstrated excellent clinical and pathological response rates of concurrent Taxol/carboplatin and radiotherapy as preoperative treatment modality in advanced oral and oropharyngeal cancer. (orig.)

  11. ARCON: experience in 215 patients with advanced head-and-neck cancer

    International Nuclear Information System (INIS)

    Purpose: 'ARCON' combines accelerated radiotherapy to counteract tumor repopulation with carbogen breathing and nicotinamide to reduce chronic and acute hypoxia. The aim of this Phase II study was to assess the feasibility, toxicity, and potential effectiveness of ARCON for advanced head-and-neck cancer. Methods and Materials: The study included 215 patients with head-and-neck carcinoma distributed as follows: larynx, n = 100; hypopharynx, n=50; oropharynx, n=52; oral cavity, n=13; Stage II, n=8, Stage III, n=71, and Stage IV, n=136. Accelerated radiotherapy was given to a total dose of 64-68 Gy in 2-Gy fractions within 36-38 days. This was combined with carbogen breathing during irradiation and administration of nicotinamide (60-80 mg/kg) 1-1.5 h before irradiation. Results: There was full compliance with carbogen breathing in 88% of the patients. A nicotinamide dose of 80 mg/kg produced severe nausea and vomiting, necessitating discontinuation of the drug, in 31% of the patients. Adjustment of the dose to 60 mg/kg and antiemesis prophylaxis reduced the discontinuation rate to 10%. Confluent mucositis was observed in 91% of the patients with a median duration of 6 weeks. Grade 4 late complications occurred in 5% of the patients. The actuarial 3-year local control rates were 80% for larynx, 69% for hypopharynx, 88% for oropharynx, and 37% for oral cavity tumors. For T3-4 tumors, the local control rates were 80% for larynx, 60% for hypopharynx, 87% for oropharynx, and 29% for oral cavity. Regional control rates were 100% for N0, 93% for N1, and 74% for N2 disease. Conclusion: ARCON yields high local and regional control rates in advanced head-and-neck carcinomas, and compliance is satisfactory and morbidity acceptable. The local control rate of 80% for T3 and T4 larynx carcinomas offers excellent possibilities for organ preservation

  12. Head and Neck Cancer

    Science.gov (United States)

    ... cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts ... tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide ...

  13. Head and Neck Cancers

    Science.gov (United States)

    ... working in certain jobs in the construction, metal, textile, ceramic, logging, and food industries may have an ... Zaragoza and Navarra (Spain), Geneva (Switzerland) and Calvados (France). International Journal of Cancer 1988; 41(4):483– ...

  14. Factors that affect response to chemotherapy and survival of patients with advanced head and neck cancer.

    Science.gov (United States)

    Amer, M H; Al-Sarraf, M; Vaitkevicius, V K

    1979-06-01

    A review of 164 patients with far advanced head and neck cancer, treated by a cytotoxic chemotherapy over a ten year period, at WAyne State University, Detroit, Michigan, was done in an attempt to determine factors that may influence the response to chemotherapy and subsequent survival. Response rate to methotrexate was 28%, 5-FU 31%, and porfiromycin 13%. Improved responses were noted with combination chemotherapy. Patients who failed to first line therapy rarely responded to other single agent or combination chemotherapy. Those who did not have prior surgery and/or radiotherapy had better results from drug therapy. Patients with good performance status at the time of initial chemotherapy, had better response to treatment (32% vs. 13% PR & CR) and longer survival (28 weeks vs. 9 weeks, p = 0.01) when compared to those with poor status. Patients who responded to chemotherapy have better survival compared to nonresponders (29 weeks vs. 16 weeks, p = 0.002). This information may prove helpful in future planning of multidisciplinary approach in the treatment of patients with head and neck cancer. PMID:455217

  15. Use of F-18 FDG PET for therapeutic monitoring in locally advanced head and neck cancers

    International Nuclear Information System (INIS)

    Full text: Locally advanced head and neck cancer has a poor prognosis likely, in part, reflecting radioresistance due to tumour-related hypoxia In 12 patients with bulky head and neck cancer, therapeutic response to a novel chemo-radiotherapy including an agent which specifically targets hypoxic cells was evaluated by serial FDG-PET. Standardised uptake values (SUV) were calculated for the primary lesion and lymph node (LN) metastases at 4 weeks (mid-treatment) and 12 weeks after completion of treatment (20 weeks). All patients had a significant reduction in SUV in the primary (Mean 67±8%, range 54-84%, p<0 05) and LN (Mean 57±13%, Range 23-73%, p<0 05) by 4 weeks which often preceded clinical evidence of response, particularly in nodal masses. In 8/9 patients evaluated thus far at 20 weeks, a further reduction was seen in the primary (Mean 74±9%, Range 67-87%, p < 0 05)and LN (Mean 74±13%, Range 41-83%, p < 0 02) correlating with excellent clinical and CT response. The other pt with an SUV of 23.2 at baseline had an increase in SUV from 5.5 on the 4 week study to 15.5 at week 20, corresponding to clinical and CT relapse. These preliminary results indicate the potential of FDG-PET for early assessment of the efficacy of experimental treatment regimens even in dose escalation (phase I) trials

  16. Thermochemoradiotherapy for advanced or recurrent head and neck cancer. Analysis of clinical results and background variables

    Energy Technology Data Exchange (ETDEWEB)

    Hoshina, Hideyuki; Takagi, Ritsuo; Nagashima, Katsuhiro; Fujita, Hajime; Miyamoto, Takeshi; Sohma, Yoh; Fukuda, Jun-ichi; Imai, Nobuyuki; Nagata, Masaki [Niigata Univ. (Japan). Faculty of Dentistry

    2001-03-01

    Eighteen patients with 25 unresectable advanced or recurrent head and neck cancers (squamous cell carcinomas) received thermochemotherapy in combination with radiotherapy. The total radiation dose ranged from 50 to 82 Gy (mean, 65.6 Gy). Patients received thermochemotherapy twice a week, for a total number of 8.8 sessions, on average. The temperature in the tumor, as a result of the hyperthermia, was over 42 deg C in 185 (84.5%) of the 219 treatments. Three kinds of heating systems were used: a 13.56-MHz radiofrequency system, a 2450-MHz microwave system, and a radiofrequency interstitial system. The total amount of administered CDDP ranged from 40 to 300 mg (mean, 110 mg), combined with PEP and/or 5FU. Background factors (tumor factors and treatment factors) were investigated in detail, and the clinical results (tumor response and the 5-year cumulative focal control rate) were evaluated. The relationship between these two results was then analyzed using univariate and multivariate statistics. The clinical results of patients with a WHO histological classification of grade 3 were poor compared with patients with a classification of grade 1 or 2. The difference between these two results was significant when analyzed using univariate statistics, but not significant when analyzed using multivariate statistics. The clinical results of patients with primary lesions surrounded by bony tissues were slightly poor compared with those of patients whose lesions were surrounded by soft tissues, but the difference between these two results was not significant. Successful treatment of refractory recurrent tumors, large tumor masses, and diffuse invasive carcinomas was not affected by the treatment factors (heating systems, heating sessions, radiation dose, and CDDP dose and drug combination). These results suggest that refractory recurrence, proximity to bony tissues, tumor size, and histological malignancy might not be prognostic variables for thermochemoradiotherapy strategy

  17. A phase II study using vinorelbine and continuous 5-fluorouracil in patients with advanced head and neck cancer

    DEFF Research Database (Denmark)

    Larsen, Susanne; Serup-Hansen, Eva; Andersen, Lisbeth J;

    2007-01-01

    Seventy patients with advanced head and neck cancer were treated with vinorelbine and continuous 5-FU administered in a central venous catheter. Over all response was 36% with 9% complete responses. The most common grade 3 and 4 toxicities were stomatitis (13), infection (5), pain related to vino...

  18. Treatment results of preoperative radiotherapy for advanced head and neck cancers

    International Nuclear Information System (INIS)

    One hundred and nine patients with advanced head and neck cancers (oral cavity: 50, oropharynx: 11, hypopharynx: 18, larynx: 30) received preoperative radiotherapy from 1987 through 1997 in our institute. The median age was 66 years (20-83). Almost all patients had advanced disease (stage II: 17, III: 34, IV: 58). The median dose of preoperative radiotherapy was 40 Gy (20-50). Seventy patients received chemotherapy. The median follow-up time was 30 months. The 5-year overall and disease-free survival rates of all patients were 66% and 56%, respectively. The 5-year locoregional and distant failure rates were 36% and 10%, respectively. The locoregional failure rate of oral cavity cancer (54%) was worse than those of other sites (13-28%) (p=0.0015). The locoregional failure rates of oral cavity cancers according to clinical stage were 59% (II), 57% (III) and 48% (IV), respectively. Incidentally those of other sites were 0% (II), 16% (III) and 30% (IV), respectively. Thirty-eight patients had major complication after surgery. The locoregional failure rates of preoperative radiotherapy following surgery for oral cavity cancers of all stages and other sites of stage IV were high. Preoperative radiotherapy should be stopped and postoperative radiotherapy for these patients should be considered. (author)

  19. Boron neutron capture therapy outcomes for advanced or recurrent head and neck cancer

    International Nuclear Information System (INIS)

    We retrospectively review outcomes of applying boron neutron capture therapy (BNCT) to unresectable advanced or recurrent head and neck cancers. Patients who were treated with BNCT for either local recurrent or newly diagnosed unresectable head or neck cancers between December 2001 and September 2007 were included. Clinicopathological characteristics and clinical outcomes were retrieved from hospital records. Either a combination of borocaptate sodium and boronophenylalanine (BPA) or BPA alone were used as boron compounds. In all the treatment cases, the dose constraint was set to deliver a dose <10–12 Gy-eq to the skin or oral mucosa. There was a patient cohort of 62, with a median follow-up of 18.7 months (range, 0.7–40.8). A total of 87 BNCT procedures were performed. The overall response rate was 58% within 6 months after BNCT. The median survival time was 10.1 months from the time of BNCT. The 1- and 2-year overall survival (OS) rates were 43.1% and 24.2%, respectively. The major acute Grade 3 or 4 toxicities were hyperamylasemia (38.6%), fatigue (6.5%), mucositis/stomatitis (9.7%) and pain (9.7%), all of which were manageable. Three patients died of treatment-related toxicity. Three patients experienced carotid artery hemorrhage, two of whom had coexistent infection of the carotid artery. This study confirmed the feasibility of our dose-estimation method and that controlled trials are warranted. (author)

  20. [Sequential Chemoradiotherapy for Advanced Head and Neck Cancer: A Clinical Study with 33 Cases].

    Science.gov (United States)

    Takahashi, Katsumasa; Nakajima, Kyoko; Murata, Takaaki; Shino, Masato; Nikkuni, Osamu; Toyoda, Minoru; Takayasu, Yukihiro; Chikamatsu, Kazuaki

    2016-05-01

    A total of 33 patients with advanced head and neck cancer (AHNC) treated with sequential chemoradiotherapy (SCRT) were retrospectively evaluated at Gunma University Hospital between 2009 and 2011. The regimen of SCRT was docetaxel, cisplatin, and fluorouracil (TPF)-based induction chemotherapy (ICT), accompanied by docetaxel and cisplatin-based concurrent chemoradiotherapy (CCRT), and oral administration of TS-1 after that. The response rate was 61%, the 3-year overall survival rate was 42%, the non-tumor-bearing survival rate was 27%, and the tumor-bearing survival rate was 15%. Fourteen of 33 patients were tumor-free, and their 3-year overall survival rate was surprisingly 86%. On the other hand, 3-year overall survival rate in the remaining 19 patients was significantly low. To select good response cases for ICT was important. In such cases, TPF should be applied repeatedly, which achieved a 61% response rate even in AHNC. A long-term TS-1 oral medication suppressed cancer regrowth and contributed to long-term survival. PMID:27459819

  1. Concurrent Cisplatin and Radiation Versus Cetuximab and Radiation for Locally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: To compare concurrent cisplatin (CDDP) and radiation (RT) with cetuximab (C225) and RT for locally advanced head-and-neck cancer (LAHNC). Methods and Materials: This study retrospectively compared 174 consecutive, newly diagnosed LAHNC patients definitively treated from March 1, 2006, to April 1, 2008, with single-agent CDDP/RT (n = 125) or C225/RT (n = 49). We excluded patients who received additional concurrent, induction, or adjuvant systemic therapy; weekly cisplatin; prior head-and-neck radiotherapy; or primary surgical resection. Outcomes were analyzed by the Kaplan-Meier method, Cox model, and competing-risks analysis tools. Results: The C225/RT patients were older and had decreased creatinine clearance. At a median follow-up of 22.5 months for living patients, the 2-year locoregional failure rate was 5.7% for CDDP/RT and 39.9% for C225/RT (p < 0.0001). The 2-year failure-free survival (FFS) and overall survival (OS) rates were 87.4% vs. 44.5% (p < 0.0001) and 92.8% vs. 66.6% (p = 0.0003), respectively, in favor of CDDP/RT. When the Cox proportional hazards model was used for multivariate analysis, treatment with CDDP/RT predicted for improved locoregional control (p < 0.0001), FFS (p < 0.0001), and OS (p = 0.01). Late Grade 3 or 4 toxicity or feeding tube dependence 9 months after completion of RT was observed in 21% of patients in the CDDP/RT cohort and 24% in the C225/RT cohort (p = 0.66). Conclusions: In this study of LAHNC patients, CDDP/RT achieved better locoregional control, FFS, and OS than C225/RT. Although the results were upheld on multivariate analysis, they must be interpreted cautiously because of the retrospective nature of the study and significant differences in patient selection. There was no statistically significant difference in late Grade 3 or 4 effects or feeding tube dependence.

  2. Concurrent Cisplatin and Radiation Versus Cetuximab and Radiation for Locally Advanced Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Koutcher, Lawrence, E-mail: Koutchel@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Sherman, Eric; Fury, Matthew [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Wolden, Suzanne [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Zhang Zhigang; Mo Qianxing [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Stewart, Laschelle; Schupak, Karen; Gelblum, Daphna [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Wong, Richard; Kraus, Dennis; Shah, Jatin [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Zelefsky, Michael [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Pfister, David [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Lee, Nancy [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2011-11-15

    Purpose: To compare concurrent cisplatin (CDDP) and radiation (RT) with cetuximab (C225) and RT for locally advanced head-and-neck cancer (LAHNC). Methods and Materials: This study retrospectively compared 174 consecutive, newly diagnosed LAHNC patients definitively treated from March 1, 2006, to April 1, 2008, with single-agent CDDP/RT (n = 125) or C225/RT (n = 49). We excluded patients who received additional concurrent, induction, or adjuvant systemic therapy; weekly cisplatin; prior head-and-neck radiotherapy; or primary surgical resection. Outcomes were analyzed by the Kaplan-Meier method, Cox model, and competing-risks analysis tools. Results: The C225/RT patients were older and had decreased creatinine clearance. At a median follow-up of 22.5 months for living patients, the 2-year locoregional failure rate was 5.7% for CDDP/RT and 39.9% for C225/RT (p < 0.0001). The 2-year failure-free survival (FFS) and overall survival (OS) rates were 87.4% vs. 44.5% (p < 0.0001) and 92.8% vs. 66.6% (p = 0.0003), respectively, in favor of CDDP/RT. When the Cox proportional hazards model was used for multivariate analysis, treatment with CDDP/RT predicted for improved locoregional control (p < 0.0001), FFS (p < 0.0001), and OS (p = 0.01). Late Grade 3 or 4 toxicity or feeding tube dependence 9 months after completion of RT was observed in 21% of patients in the CDDP/RT cohort and 24% in the C225/RT cohort (p = 0.66). Conclusions: In this study of LAHNC patients, CDDP/RT achieved better locoregional control, FFS, and OS than C225/RT. Although the results were upheld on multivariate analysis, they must be interpreted cautiously because of the retrospective nature of the study and significant differences in patient selection. There was no statistically significant difference in late Grade 3 or 4 effects or feeding tube dependence.

  3. Adjuvant chemotherapy prior to postoperative concurrent chemoradiotherapy for locoregionally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Background and purpose: Induction chemotherapy prior to definitive concurrent chemoradiotherapy (CCRT) is a promising treatment option for unresectable head and neck cancer (HNC). In the postoperative setting, the efficacy of such an approach with adjuvant chemotherapy (AdjCT) followed by postoperative CCRT is unclear. Materials and methods: Forty-one postoperative patients with stage III-IV (M0) HNC enrolled on 3 consecutive phase II clinical trials were retrospectively analyzed. Twenty-five of the patients were treated on a protocol which included AdjCT with carboplatin and paclitaxel prior to postoperative CCRT (AdjCT group). Sixteen were treated on protocols with similar postoperative CCRT but without AdjCT (control group). CCRT consisted of paclitaxel, 5-fluorouracil, hydroxyurea, and twice-daily radiotherapy. Results: After a median follow-up of 72 months, there were no locoregional failures (LRF) or distant metastases (DM) in the AdjCT group. In the control group, there were 2 LRF and 2 DM. The 5-year risk of disease recurrence was 0% in the AdjCT group, compared to 28.9% in the control group (p = 0.0074). No patients had disease progression during AdjCT, and all proceeded to postoperative CCRT without delay. Conclusions: Adjuvant chemotherapy after surgery followed by CCRT may be a treatment strategy associated with favorable disease outcomes in locoregionally advanced HNC. These results pose a hypothesis which warrants further investigation.

  4. Simultaneous radiochemotherapy versus concomitant boost radiation for advanced inoperable head and neck cancer

    International Nuclear Information System (INIS)

    In this prospective, non-randomized study we compare the results of simultaneous radiochemotherapy (RCT) with those of concomitant boost treatment (CBT) in advanced head and neck cancer. From January 1993 to March 1999, 77 patients were treated with cisplatin, 5-FU, and 70.2 Gy (accelerated split-course); from January 1995 to March 1999, a further 33 patients received CBT to a total dose of 72 Gy. Toxicities were prospectively recorded according to RTOG/EORTC criteria. Acute and subacute reactions did not differ significantly. Severe late effects (III/IV) remained anecdotal (one fistula). Therapy-associated mortalities were 3%(RCT) vs. 0% (CBT), most tumors responding well to therapy (CR + PR: RCT: 72%, CBT: 63%). The 2-year probabilities for freedom from locoregional progression amounted to 42% (RCT) and 31% (CBT); p > 0.05. Tumor-specific 2-year survival amounted to 40% (RCT) and 34% (CBT); p > 0.05. Both of the treatment concepts yield high remission rates with moderate toxicities. Nevertheless, median time to recurrence is still fairly short. We could not find any differences for local control and survival. For patients who are not able to complete the full three courses of radiochemotherapy, the concomitant boost schedule presents a good alternative

  5. Superselective arterial infusion and concomitant radiotherapy for advanced head and neck cancer

    International Nuclear Information System (INIS)

    Superselective arterial infusion for patients with advanced head and neck cancer has increasingly been applied in Japan. We analyzed our experiences and evaluated the efficacy and safety of this treatment. Forty-four patients, who were considered contraindicated for surgery or rejected radical surgery, received superselective intra-arterial infusion therapy of cisplatin (100-120 mg/m2/week) with simultaneous intravenous infusion of thiosulfate to neutralize cisplatin toxicity, and conventional concomitant extrabeam radiotherapy (65 Gy/26 f/6.5 weeks). During the median follow-up period of 17 months, 2-year progression-free survival rate of primary lesion was 66.9%, and that of patients with T4b diseases 57%. The 2-year overall survival rate was 52.4%. Although acute toxic effects were considered acceptable, severe toxic events occurred in some cases, namely, cranial nerve palsy, Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia, sepsis, and osteoradionecrosis. We confirmed the high effectiveness of superselective arterial infusion and concomitant radiotherapy, which can concentrate the attack of decadose cisplatin on locoregional disease. Moreover, even patients with unresectable disease can be cured. We must clarify the treatment results and late side effects, and establish the indications for this treatment. (author)

  6. Drugs Approved for Head and Neck Cancer

    Science.gov (United States)

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for head and neck cancer. The list includes generic names and brand names. The drug names link to NCI’s Cancer Drug Information summaries.

  7. Head and Neck Cancer Stem Cells

    OpenAIRE

    Krishnamurthy, S.; Nör, J.E.

    2012-01-01

    Most cancers contain a small sub-population of cells that are endowed with self-renewal, multipotency, and a unique potential for tumor initiation. These properties are considered hallmarks of cancer stem cells. Here, we provide an overview of the field of cancer stem cells with a focus on head and neck cancers. Cancer stem cells are located in the invasive fronts of head and neck squamous cell carcinomas (HNSCC) close to blood vessels (perivascular niche). Endothelial cell-initiated signalin...

  8. Combination of Taxanes, Cisplatin and Fluorouracil as Induction Chemotherapy for Locally Advanced Head and Neck Cancer: A Meta-Analysis

    OpenAIRE

    Hao Qin; Jie Luo; Yuan-Ping Zhu; Hai-Li Xie; Wei-Qiang Yang; Wen-Bin Lei

    2012-01-01

    BACKGROUND: Some investigations have suggested that induction chemotherapy with a combination of taxanes, cisplatin and fluorouracil (TPF) is effective in locally advanced head and neck cancer. However, other trials have indicated that TPF does not improve outcomes. The objective of this study was to compare the efficacy and safety of TPF with a cisplatin and fluorouracil (PF) regimen through a meta-analysis. METHODS: Four randomized clinical trials were identified, which included 1,552 patie...

  9. Roles of chemoradio therapy for stage III or IV advanced head and neck cancers

    Energy Technology Data Exchange (ETDEWEB)

    Tachikawa, Takuya; Iwai, Hiroshi; Tsuji, Hiroyuki; Minamino, Masayuki; Yamamoto, Takashi; Yukawa, Hisaya; Inoue, Toshiya; Yamashita, Toshio [Kansai Medical School, Moriguchi, Osaka (Japan)

    2002-03-01

    The effectiveness of chemoradio therapy (CRT), which was performed on 31 patients with advanced head and neck cancers of stage III or IV at Kansai Medical University between September 1999 and December 2000, was examined. The CRT consisted of continuous infusion of 5FU (500 mg/m{sup 2}) for 120 hours, prior to drip infusion of CDDP (50 mg/m{sup 2}) for 2 hours and conventional radiotherapy (2 Gy/day, 5 days/w). The 31 patients with these cancers were divided into two groups; a non-operative group (16 patients) and an operative group (15 patients). The patients in the non-operative group (16 patients) and an operative group (15 patients). The patients in the non-operative group underwent CRT (60-70 Gy of total radiation dose and two courses of chemotherapy) without surgery. The patients in the operative group received surgical treatment followed by CRT (40 Gy of total radiation dose and one course of chemotherapy). The results of CRT indicated 87.1% of the response rate (RR), and 29.0% of the complete response rate (CR) in the group. The CR rate was lower than in other reports. However, the combination of CRT and the subsequent operation indicated a disease-free survival rate of 61.3% and reduction of the recurrence rate to 17.4%. Eight of 9 patients of CR after CRT without surgery revealed NED. On the other hand, the results indicated that all 10 patients of PR after CRT showed tumor residue, 9 of 10 patients of PR showed NED after additional surgery. Therefore, it is likely that the patients of CR do not need the additional surgery, however, the patients of PR are strongly recommended the surgery to improve the local control rate as well as survival rate. Although adverse reactions of CRT on patients included mucositis, leucopenia, thrombopenia and dermatitis, the symptoms ranged within grade 3. (author)

  10. Long-term results of accelerated radiation treatment for advanced head and neck cancer

    International Nuclear Information System (INIS)

    Background and purpose: This report presents long-term follow-up data from a prospective but unrandomized trial of a continuous 3.5-week course of accelerated radiation treatment (ART) used as primary treatment for patients with loco-regionally advanced head and neck cancer. Materials and methods: Ninety-three patients in three centres in New Zealand and Australia were treated with ART (59.40 Gy in 33 fractions over 24-25 days). Their disease originated from three anatomical regions (oral cavity, 35 patients; pharynx, 31 patients; larynx, 27 patients). Seventy-nine of these patients had stage III or IV cancers. Results: Follow-up ranged from 68 to 203 months (median 139 months). Loco-regional (LR) failure occurred in 52 patients leading to a 10-year actuarial expectation of LR control of 38%. The actuarial expectation of LR control at 10 years was highly dependent on stage and for stage III, IVA and IVB patients it was 57±8.1%, 32±1.7% and 7±0.5%, respectively. Multivariate analysis could not confirm an independent impact of primary site or histological differentiation on LR failure. Two patients died of acute toxicity of treatment and six patients developed grade 3/4 late complications affecting soft tissues only, yielding an actuarial expectation of complications of this severity at 5 years of 9%. No cases of osteoradionecrosis or myelitis were observed. Conclusion: This ART, which has proved easy to use at a number of large and small centres, has produced encouraging long-term LR control at a cost of limited soft tissue morbidity. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  11. Sequential chemoradiation in locally advanced head and neck cancer after induction chemotherapy: an induction chemotherapy schedule more suited to a limited resource setting

    OpenAIRE

    Gangopadhyay, Aparna; Nath, Partha; Biswas, Jaydip

    2015-01-01

    Background In our experience, induction docetaxel, platinum, and fluorouracil (TPF) chemotherapy and sequential chemoradiation in locally advanced head and neck cancer lowers compliance owing to their considerable toxicity. Most of our head and neck cancer patients have locally advanced disease at presentation. Physicians frequently prefer paclitaxel–cisplatin induction chemotherapy instead, because of better patient tolerance. Materials and methods A total of 207 locally advanced head and ne...

  12. Adjuvant chemotherapy (Nedaplatin/UFT) after radiotherapy for locallu advanced head and neck cancer

    International Nuclear Information System (INIS)

    To evaluate the toxicity and efficacy of adjuvant chemotherapy after radiotherapy for patients with locally advanced head and neck squamous cancer, 40 patients, previously untreated (6 with stage III and 34 with stage IV; 26 with resectable, 10 with unresectable and 4 patients with inoperable) were treated with radiotherapy followed by adjuvant chemotherapy (Nedaplatin /tegafur-uracil (UFT)) at our outpatient clinic. The primary site was identified in the larynx or hypopharynx in 15, oral cavity or oropharynx in 11, sinuses in 6, nasopharynx in 4, unknown primary in 3, and parotis in 1 patient. Treatment consisted of 6 courses of Nedaplatin 80 mg/m2 repeated at 4 weeks intervals, and one-year oral administration of UFTE 400mg/day, after radiotherapy. Toxicities included leukopenia (grade 3, 20.5%, grade 4, 2.6%), thrombocytopenia (grade 3, 7.7%). There was one death due to gastric ulcer. Twenty-five patients (62.5%) received 6 courses of adjuvant chemotherapy. Two-year overall survival rate was 100% for stage III and 61.1% for stage IV. Over the same period, the progression-free survival rate was 83.3% for stage III and 46.1% for stage IV. 85.7% of complete response (CR) (12/14 patients) and 63.6% of partial response (PR) (14/22 patients) to radiotherapy showed that the effect of radiotherapy was maintained during adjuvant chemotherapy. If the effect of radiotherapy was maintained during adjuvant chemotherapy, the two-year progression free survival rate was not different between 81.8% for CR to radiotherapy and 81.3% for PR. The rate of distant failure was 2.5%, which was lower than that citedin previous reports. This adjuvant chemotherapy regimen is tolerable at outpatient clinics and might suppress distant metastasis after radiotherapy. (author)

  13. Weekly chemotherapy as Induction chemotherapy in locally advanced head and neck cancer for patients ineligible for 3 weekly maximum tolerable dose chemotherapy

    OpenAIRE

    Vijay Maruti Patil; Vanita Noronha; Amit Joshi; Vamshi Krishna Muddu; Sachin Dhumal; Supreeta Arya; Shashikant Juvekar; P Pai; Pankaj Chatturvedi; Arvind Chaukar Devendra; Sarbani Ghosh; Anil D′cruz; Prabhash Kumar

    2014-01-01

    Objective: To study the safety and efficacy of weekly chemotherapy as part of induction chemotherapy, in locally advanced head and neck cancer for patients, who are unfit for upfront radical treatment. Materials and Methods: It is a retrospective analysis of on-use weekly chemotherapy as Induction chemotherapy in locally advanced head and neck cancer, who are technically unresectable are unfit for upfront radical treatment. Induction chemotherapy given was a 2 drug combination of paclitaxel (...

  14. Head and neck cancer imaging. 2. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Hermans, Robert (ed.) [University Hospital Leuven (Belgium). Dept. of Radiology

    2008-07-01

    This book provides a comprehensive review of state-of-the-art imaging in head and neck cancer. Precise determination of tumor extent is of the utmost importance in these neoplasms, as it has important consequences for staging of disease, prediction of outcome and choice of treatment. Only the radiologist can fully appreciate submucosal, perineural, and perivascular tumor spread and detect metastatic disease at an early stage. Imaging is also of considerable benefit for patient surveillance after treatment. All imaging modalities currently used in the management of head and neck neoplasms are considered in depth, and in addition newer techniques such as PET-CT and diffusion-weighted MRI are discussed. This book will help the reader to recommend, execute and report head and neck imaging studies at a high level of sophistication and thereby to become a respected member of the team managing head and neck cancer. (orig.)

  15. Role of Met Axis in Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Yiru, E-mail: xuyiru@umich.edu; Fisher, Gary J., E-mail: xuyiru@umich.edu [Department of Dermatology, University of Michigan, Ann Arbor, MI 48109 (United States)

    2013-11-26

    Head and neck cancer is the sixth most common type of cancer worldwide. Despite advances in aggressive multidisciplinary treatments, the 5-year survival rate for this dreadful disease is only 50%, mostly due to high rate of recurrence and early involvement of regional lymph nodes and subsequent metastasis. Understanding the molecular mechanisms responsible for invasion and metastasis is one of the most pressing goals in the field of head and neck cancer. Met, also known as hepatocyte growth factor receptor (HGFR), is a member of the receptor protein tyrosine kinase (RPTK) family. There is compelling evidence that Met axis is dysregulated and plays important roles in tumorigenesis, progression, metastasis, angiogenesis, and drug resistance in head and neck cancer. We describe in this review current understanding of Met axis in head and neck cancer biology and development of therapeutic inhibitors targeting Met axis.

  16. Revisiting radiotherapy in head and neck cancers

    International Nuclear Information System (INIS)

    Head and neck cancers form 20% of the total cancers in India. It comprise of soft tissue neoplasms of oral/nasal cavity and paranasal sinuses/pharynx/larynx and salivary glands. Majority of them are squamous cell carcinomas, which shows a higher prevalence among rural population in the 4th decade of life with an equal male-female ratio. Buccal mucosa is the commonest site followed by tongue. Tobacco/related products and alcohol are its major causative factors. Though surgical resection is the main treatment modality; patients in the advanced stages of disease or those with multiple/extensive lymph node involvement are done through a multi-disciplinary approach involving radiation therapy. Typical doses of 60Cobalt irradiation are from 30-72 Grays (Gy). Overall treatment is from 15 to 80 days with a dose per fraction ranging from 1.8-6 Gy. High doses cause mouth sores/dry mouth/dysphagia/dysgeusia/jaw stiffness. However, modern radiation protocols considerably minimize exposure to healthy tissues. This paper evaluates the radiotherapy systems for head and neck cancers in the contemporary and future domains. (author)

  17. Acute mucosal reactions in patients with advanced head and neck cancer treated with concurrent chemoradiotherapy

    International Nuclear Information System (INIS)

    We conducted a clinical study to analyze the acute reactions in the oral cavity and the oropharyngeal (OCOPH) mucosa in patients with advanced head and neck cancer (HNC) undergoing a definitive treatment consisted of 3-D conformal radiotherapy combined with concomitant chemotherapy. Twenty nine patients with HNC who were treated between February 2008 and October 2009 were included in the study. The median age was 55 years (range 29-70). The site distribution was as follows: oropharynx, 20.7%; hypopharynx, 41.4%; larynx, 37.9%. The radiation technique used for 3-D conformal radiotherapy was named 'oblique photon fields' technique. The OCOPH mucosa as a critical normal tissue was delineated in every patient. Extraction of planning target volume (PTV50) from the volume of OCOPH mucosa led to formation of an OCOPH mucosa with extracted PTV50 (OCOPHEx mucosa). Acute mucosal reactions were recorded using Radiation Therapy Oncology Group (RTOG) grading system. The duration of a maximum grade of reaction was also recorded. A time intensity parameter, so-called Severity-Time Units (STU), quantifying the area under the acute reaction curve, was used to express the intensity of mucositis over time in every patient. Grade 3 acute mucosal reaction was manifested in 19 patients (65.5%). The median duration of confluent mucositis was 21 days (range 14-35). The STU less than 1000 mm2 and the STU more than 1500 mm2 was calculated in equal number of patients (9 patients, or 31.0%). Statistically significant difference in the distribution of the grade 3 reaction was found among patients with different site of the primary tumor (p = 0.003). Statistically significant difference was found between the grade of the acute mucositis and the volume of OCOPHEx mucosa, the dose in 50% of the volume of OCOPHEx (D50%, OCOPHEx) mucosa, and the mean dose to OCOPHEx mucosa (p = 0.02, p = 0.0002, p = 0.00001, respectively). The tested relation between STU and delineated volumes (PTV50 and OCOPHEx

  18. Is there room for combined modality treatments? Dosimetric comparison of boost strategies for advanced head and neck and prostate cancer

    OpenAIRE

    Góra, Joanna; Hopfgartner, Johannes; Kuess, Peter; Paskeviciute, Brigita; Georg, Dietmar

    2013-01-01

    The purpose of the study was to determine the dosimetric difference between three emerging treatment modalities—volumetric-modulated arc therapy (VMAT), intensity-modulated proton beam therapy (IMPT) and intensity-modulated carbon ion beam therapy (IMIT)—for two tumour sites where selective boosting of the tumour is applied. For 10 patients with locally advanced head and neck (H&N) cancer and 10 with high-risk prostate cancer (PC) a VMAT plan was generated for PTVinitial that included lymph n...

  19. Combination of taxanes, cisplatin and fluorouracil as induction chemotherapy for locally advanced head and neck cancer: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Hao Qin

    Full Text Available BACKGROUND: Some investigations have suggested that induction chemotherapy with a combination of taxanes, cisplatin and fluorouracil (TPF is effective in locally advanced head and neck cancer. However, other trials have indicated that TPF does not improve outcomes. The objective of this study was to compare the efficacy and safety of TPF with a cisplatin and fluorouracil (PF regimen through a meta-analysis. METHODS: Four randomized clinical trials were identified, which included 1,552 patients with locally advanced head and neck cancer who underwent induction chemotherapy with either a TPF or PF protocol. The outcomes included the 3-year survival rate, overall response rate and different types of adverse events. Risk ratios (RRs and their 95% confidence intervals (CIs were pooled using RevMan 5.1 software. RESULTS: The 3-year survival rate (51.0% vs. 42.4%; p = 0.002, 3-year progression-free survival rate (35.9% vs. 27.2%; p = 0.007 and overall response to chemotherapy (72.9% vs. 62.1%; p<0.00001 of the patients in the TPF group was statistically superior to those in the PF group. In terms of toxicities, the incidence of febrile neutropenia (7.0% vs. 3.2%; p = 0.001 and alopecia (10.8% vs. 1.1%; p<0.00001 was higher in the TPF group. CONCLUSION: The TPF induction chemotherapy regimen leads to a significant survival advantage with acceptable toxicity rates for patients with locally advanced head and neck cancer compared with the PF regimen.

  20. Comparison of postoperative complications in advanced head and neck cancer patients receiving neoadjuvant chemotherapy followed by surgery versus surgery alone

    Science.gov (United States)

    Joshi, Poonam; Joshi, Amit; Prabhash, Kumar; Noronha, Vanita; Chaturvedi, Pankaj

    2015-01-01

    Background: Head and neck cancer is the third most common cancer in India with 60% presenting in advanced stages. There is the emerging role of neoadjuvant chemotherapy (NACT) in the management of these advanced cancers. There is a general perception that complication rates are higher with the use of NACT. Materials and Methods: This is a retrospectively collected data of head and neck cancer patients operated at our hospital from March 2013 to September 2014. A total of 205 patients were included in the study. These patients were studied in two groups. Group 1 included 153 patients who underwent surgery alone, and Group 2 included 52 patients who received 2-3 cycles of NACT followed by surgery. Results: The mean age of the population was 51 years in the Group 1 and 45 years in Group 2. The hospital stay and readmissions in postoperative period were similar in the two groups. In this study, the complication rate was 37.9% in the surgery patients and 30.8% in the NACT patients (P = 0.424). Conclusion: The postoperative complication rates in patients who received NACT followed by surgery were not significantly different from those who underwent surgery. PMID:26811595

  1. Comparison of postoperative complications in advanced head and neck cancer patients receiving neoadjuvant chemotherapy followed by surgery versus surgery alone

    Directory of Open Access Journals (Sweden)

    Poonam Joshi

    2015-01-01

    Full Text Available Background: Head and neck cancer is the third most common cancer in India with 60% presenting in advanced stages. There is the emerging role of neoadjuvant chemotherapy (NACT in the management of these advanced cancers. There is a general perception that complication rates are higher with the use of NACT. Materials and Methods: This is a retrospectively collected data of head and neck cancer patients operated at our hospital from March 2013 to September 2014. A total of 205 patients were included in the study. These patients were studied in two groups. Group 1 included 153 patients who underwent surgery alone, and Group 2 included 52 patients who received 2-3 cycles of NACT followed by surgery. Results: The mean age of the population was 51 years in the Group 1 and 45 years in Group 2. The hospital stay and readmissions in postoperative period were similar in the two groups. In this study, the complication rate was 37.9% in the surgery patients and 30.8% in the NACT patients (P = 0.424. Conclusion: The postoperative complication rates in patients who received NACT followed by surgery were not significantly different from those who underwent surgery.

  2. Clinical Practice Guidance for Radiotherapy Planning After Induction Chemotherapy in Locoregionally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: The use of induction chemotherapy (IC) for locoregionally advanced head-and-neck cancer is increasing. The response to IC often causes significant alterations in tumor volume and location and shifts in normal anatomy. Proper determination of the radiotherapy (RT) targets after IC becomes challenging, especially with the use of conformal and precision RT techniques. Therefore, a consensus conference was convened to discuss issues related to RT planning and coordination of care for patients receiving IC. Methods and Materials: Ten participants with special expertise in the various aspects of integration of IC and RT for the treatment of locoregionally advanced head-and-neck cancer, including radiation oncologists, medical oncologists, and a medical physicist, participated. The individual members were assigned topics for focused, didactic presentations. Discussion was encouraged after each presentation, and recommendations were formulated. Results: Recommendations and guidelines emerged that emphasize up-front evaluation by all members of the head-and-neck management team, high-quality baseline and postinduction planning scans with the patient in the treatment position, the use of preinduction target volumes, and the use of full-dose RT, even in the face of a complete response. Conclusion: A multidisciplinary approach is strongly encouraged. Although these recommendations were provided primarily for patients treated with IC, many of these same principles apply to concurrent chemoradiotherapy without IC. A rapid response during RT is quite common, requiring the development of two or more plans in a sizeable fraction of patients, and suggesting the need for similar guidance in the rapidly evolving area of adaptive RT.

  3. Definitive radiochemotherapy of advanced head and neck cancer with carboplatin and paclitaxel. A phase II study

    Energy Technology Data Exchange (ETDEWEB)

    Semrau, Robert; Temming, Susanne; Mueller, Rolf-Peter [Cologne Univ., Koeln (Germany). Dept. of Radiation Oncology; Preuss, Simon Florian [Cologne Univ., Koeln (Germany). Dept. of Otorhinolaryngology, Head and Neck Surgery; Klussmann, Jens Peter [Giessen Univ. (Germany). Dept. of Otorhinolaryngology and Head and Neck Surgery; Guntinas-Lichius, Orlando [Friedrich-Schiller Univ. Jena (Germany). Dept. of Otorhinolaryngology and Head and Neck Surgery

    2011-10-15

    To report outcome and toxicity of concurrent radiochemotherapy with carboplatin and paclitaxel in advanced squamous cell carcinomas of the oropharynx and hypopharynx. Advanced inoperable carcinomas of the oropharynx and hypopharynx were treated with either hyper-fractionated, accelerated radiotherapy (50.0 Gy/2.0 with concomitant boost to 69.2 Gy/1.6) or conventional fractionated radiotherapy (70.2-72 Gy/1.8) concurrent with paclitaxel 40 mg/m{sup 2} and carboplatin AUC 1 weekly for 6 weeks. Acute and long-term toxicity was measured according to WHO- and CTC-criteria. A total of 84 patients were included between 2000 and 2008. Median follow-up time of patients alive was 36 months. Conventionally fractionated radiotherapy was given to 16 patients, while 68 patients were treated with concomitant boost. Finally, 88.1% of patients received full dose paclitaxel. Acute mucositis {>=} grade 3 was present in 51.2% of patients, while 6% of patients experienced {>=} grade 3 leucopenia and thrombopenia. A supportive gastric feeding tube was implanted in 89.1% of patients. Overall survival after 2 years was 46.3%, progression-free survival after 2 years was 41.0%. There was no significant survival difference between the different radiotherapy protocols. Concomitant carboplatin and paclitaxel is feasible and effective in advanced carcinomas of the head and neck.

  4. [Photodynamic therapy for head and neck cancer

    DEFF Research Database (Denmark)

    Lajer, C.B.; Specht, Lena; Kirkegaard, J.;

    2006-01-01

    Photodynamic therapy (PDT) is a new treatment for head and neck cancer. The principle of the treatment is a photochemical reaction initiated by light activation of a photosensitizer, which causes the death of the exposed tissue. This article presents the modes of action of PDT and the techniques as...... well as the clinical procedure. A critical review of the literature is also presented, regarding treatment results of the different techniques and indications for treatments. The possibilities for PDT for head and neck cancer in Denmark are mentioned Udgivelsesdato: 2006/6/5...

  5. Head and neck cancer stem cells.

    Science.gov (United States)

    Krishnamurthy, S; Nör, J E

    2012-04-01

    Most cancers contain a small sub-population of cells that are endowed with self-renewal, multipotency, and a unique potential for tumor initiation. These properties are considered hallmarks of cancer stem cells. Here, we provide an overview of the field of cancer stem cells with a focus on head and neck cancers. Cancer stem cells are located in the invasive fronts of head and neck squamous cell carcinomas (HNSCC) close to blood vessels (perivascular niche). Endothelial cell-initiated signaling events are critical for the survival and self-renewal of these stem cells. Markers such as aldehyde dehydrogenase (ALDH), CD133, and CD44 have been successfully used to identify highly tumorigenic cancer stem cells in HNSCC. This review briefly describes the orosphere assay, a method for in vitro culture of undifferentiated head and neck cancer stem cells under low attachment conditions. Notably, recent evidence suggests that cancer stem cells are exquisitely resistant to conventional therapy and are the "drivers" of local recurrence and metastatic spread. The emerging understanding of the role of cancer stem cells in the pathobiology of head and neck squamous cell carcinomas might have a profound impact on the treatment paradigms for this malignancy. PMID:21933937

  6. Mutli-disciplinary treatment of advanced cancer of the head and neck

    International Nuclear Information System (INIS)

    Twenty-six cases, consisting of 18 primary and 8 secondary cases, of head and neck cancer were treated with combinations of radiation, B-M therapy and/or operation or immunotherapy at Department of Radiology, Tokushima University Hospital from 1977 through 1979. Secondary cases were recurrent developing from irradiated and/or surgical scars. These histological types are 24 squamous cell carcinoma and 2 anaplastic carcinoma. Most of them were received over 5,000 rad by external irradiation and interstitial irradiation. B-M therapy, Bleomycin 5 mg intramuscularly (IM) daily 7 days and next eighth day Mitomycin-C 10 mg intravenously (IV) was employed 1 -- 4 cycles simultaneously or after irradiation. Fourteen patients (54%) experienced complete remission in the locally treated area by irradiation and B-M therapy. There are 8/26 patients (31%) who are alive without any current evidence of disease from 3 to 23 months, and 3/26 patients (12%) who are alive with disease from 7 to 15 months. The major toxicities encountered were mucositis, leukopenia and thrombocytopenia. (author)

  7. Low dose rate irradiation of advanced head and neck cancers: present status

    International Nuclear Information System (INIS)

    A total of 46 patients with advanced epidermoid carcinomas of the head and neck were treated with semi-continuous low dose rate cobalt teletherapy with curative intent. The dose rate was 90 to 130 rad per hr, the patients were treated 6 to 8 hr per day, and received total doses of 6500 to 7000 rad in either single or split courses. Thirty-four of these patients had a minimum follow-up of one year and form the basis of this report. While the survival of these patients was poor (22% at 3 years), the local control rate of 58% was encouraging. The immediate tolerance of the mucosa frequently was exceeded in a single course treatment; furthermore, there was a high necrosis rate. Skin reactions, however, remained characteristically mild. Split course treatment succeeded in reducing mucosal reactions to a tolerable level without decreasing local control, but it did not reduce the high risk of necrosis (actually greater than 50% at 2 years). Residual tumor at 3 months carried a grave prognosis. All non-sterilizations and recurrences within the low dose rate treated volumes occurred with tumors 5 cm or more in greatest dimension; local control was obtained in all 10 patients who had less extensive primary lesions. Necroses occurred with equal frequencies in both the larger and relatively smaller tumors. Low dose rate treatment has been proven feasible and currently is being used in a randomized prospective trial to test its possible superiority over conventional fractionation

  8. 50 Facts about Oral, Head and Neck Cancer

    Science.gov (United States)

    ... You 50 Facts about Oral, Head and Neck Cancer 50 Facts about Oral, Head and Neck Cancer Patient Health Information News ... particular strain of HPV. 66% of the time, oral cancers will be found as late stage three and ...

  9. Long-term outcome and patterns of failure in patients with advanced head and neck cancer

    International Nuclear Information System (INIS)

    To access the long-time outcome and patterns of failure in patients with advanced head and neck squamous cell carcinoma (HNSCC). Between 1992 and 2005 127 patients (median age 55 years, UICC stage III n = 6, stage IV n = 121) with primarily inoperable, advanced HNSCC were treated with definite platinum-based radiochemotherapy (median dose 66.4 Gy). Analysed end-points were overall survival (OS), disease-free survival (DFS), loco-regional progression-free survival (LPFS), development of distant metastases (DM), prognostic factors and causes of death. The mean follow-up time was 34 months (range, 3-156 months), the 3-, 5- and 10-year OS rates were 39%, 28% and 14%, respectively. The median OS was 23 months. Forty-seven patients achieved a complete remission and 78 patients a partial remission. The median LPFS was 17 months, the 3-, 5- and 10-year LPFS rates were 41%, 33% and 30%, respectively. The LPFS was dependent on the nodal stage (p = 0.029). The median DFS was 11 months (range, 2-156 months), the 3-, 5- and 10-year DFS rates were 30%, 24% and 22%, respectively. Prognostic factors in univariate analyses were alcohol abuse (n = 102, p = 0.015), complete remission (n = 47, p < 0.001), local recurrence (n = 71, p < 0.001), development of DM (n = 45, p < 0.001; median OS 16 months) and borderline significance in nodal stage N2 versus N3 (p = 0.06). Median OS was 26 months with lung metastases (n = 17). Nodal stage was a predictive factor for the development of DM (p = 0.025). Cause of death was most commonly tumor progression. In stage IV HNSCC long-term survival is rare and DM is a significant predictor for mortality. If patients developed DM, lung metastases had the most favourable prognosis, so intensified palliative treatment might be justified in DM limited to the lungs

  10. The Saudi experience with neutron therapy in locally advanced head and neck cancers

    International Nuclear Information System (INIS)

    The neutron therapy program at King Faisal Specialist Hospital and Research Center conducted a phase II study to evaluate the toxicity and efficacy of neutrons against conventional external megavoltage irradiation in patients with locally advanced head and neck malignancy. One hundred and nineteen patients were allocated to receive either photons (46/119) or neutrons (73/119). Radiation effects were scored according to the EORTC/RTOG criteria; data was collected weekly during treatment, once a month for the first year and at 6-month intervals subsequently. While acute effects were scored in all patients, only 59 were evaluable for late effects and locoregional control. A composite of the average reaction results were obtained using this information, to compare them in time, for acute and late effects in both arms of the study. The maximum acute reactions in the two groups were similar. In the majority of the patients (80 %) acute skin and mucosal reactions occurred during the last week of treatment. The changes in the subcutaneous tissues and salivary glands became clinically apparent at 3 months or later. Salivary gland toxicity was more severe in the photon arm and the difference was statistically significant at 3 months (P + 0.04) but this was lost at 12 months. Late effects for skin and subcutaneous tissues were significantly more severe in the neutron arm with P values of 0.04 and 0.01 respectively. Three patients in the neutron arm died of grade 4 radiation complications. The local control and survival were similar in both groups. (author)

  11. Skin Cancer of the Head and Neck

    OpenAIRE

    Ouyang, Yun-Hsuan

    2010-01-01

    The majority of skin cancers of the head and neck are nonmelanoma skin cancers (NMSC). Basal cell carcinoma and squamous cell carcinoma are the most frequent types of NMSC. Malignant melanoma is an aggressive neoplasm of skin, and the ideal adjuvant therapy has not yet been found, although various options for treatment of skin cancer are available to the patient and physician, allowing high cure rate and excellent functional and cosmetic outcomes. Sunscreen protection and early evaluation of ...

  12. Disseminated Mycobacterium chelonae Infection in a Patient Receiving an Epidermal Growth Factor Receptor Inhibitor for Advanced Head and Neck Cancer

    OpenAIRE

    Bark, Charles M.; Traboulsi, Rana S.; Honda, Kord; Starnes, Autumn M.; Jacobs, Michael R.; Rodriguez, Benigno

    2012-01-01

    We report a case of disseminated cutaneous Mycobacterium chelonae infection in a patient with head and neck cancer on salvage chemotherapy, including the epidermal growth factor receptor inhibitor cetuximab. Mycobacterium chelonae should be considered in the differential diagnosis of cutaneous infections in cancer patients receiving epidermal growth factor receptor inhibitors.

  13. Concurrent platinum-based chemotherapy and hyperfractionated radiotherapy with late intensification in advanced head and neck cancer

    International Nuclear Information System (INIS)

    months), disease-specific survival is 63%. The actuarial survival for all patients is 51%. Patients with pathological CR after initial treatment have disease specific survival of 73% at 4 years vs. 48% of patients with partial response (PR) only. Conclusion: This study, developed on the basis of radiobiological and cell kinetic precepts, produced results that compare favorably with other reports of management of patients with advanced head and neck cancer. In comparison with our previous study, these results are comparable, not impressively better. The associated morbidity was somewhat worse

  14. Head and Neck Cancer Treatment

    Science.gov (United States)

    ... lessening (palliation) of symptoms associated with an incurable cancer. If cure is unlikely, then potential risks associated with treatment ... plan is modified. However, if the likelihood of cure is significantly greater than the risk ... To detect recurrent cancer and possibly try further treatment, such as an ...

  15. Regional myocutaneous flaps for head and neck reconstruction: Experience of a head and neck cancer unit

    Directory of Open Access Journals (Sweden)

    Eyituoyo Okoturo

    2015-01-01

    Full Text Available Background: Pectoralis major myocutaneous pedicle flap and other regional myocutaneous pedicle flaps (RMF, despite the superiority shown by free flaps, have remained relevant in the reconstruction of major head and neck oncologic defects. It has continued to find relevance as the preferred reconstruction of choice in some general head and neck reconstructive applications. While its role has been defined in developed environment, the same cannot be said for developing environment. The aim thus, was to review our experiences with RMFs in head and neck reconstructions, with a view to evaluating the indications and outcomes in a limited opportunity environment with some free flaps expertise. Materials and Methods: This was a retrospective cohort study from records of RMF cases performed for head and neck reconstruction, at the study institution. Eligibility for study inclusion comprised case cohorts with advanced head and neck diseases requiring ablative surgery and reconstruction with pectoralis major flaps and other RMFs. Results: A total of 17 cases were treated with RMFs. 10 were pectoralis major flaps while 7 were other RMFs. The main indications were failed free flaps and financial constraints. No regional pedicle flap failure was recorded; however, complication rate was 35.5% (6/17. Conclusion: Pectoralis major flaps and other RMFs were very reliable option for head and neck reconstruction. Free flap failure and financial constraints were the main indications for RMF reconstruction indications in head and neck reconstruction in a developing environment with some free flap expertise.

  16. Two-year results of a prospective preventive swallowing rehabilitation trial in patients treated with chemoradiation for advanced head and neck cancer

    NARCIS (Netherlands)

    L. van der Molen; M. van Rossum; C.R.N. Rasch; L.E. Smeele; F.J.M. Hilgers

    2013-01-01

    The objective of the study was the assessment of the results of a prospective clinical trial with two preventive swallowing rehabilitation programs on the long-term side effects of chemoradiotherapy (CCRT) in advanced head and neck cancer patients. The study cohort consisted of 29 patients, randomiz

  17. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises

    NARCIS (Netherlands)

    S.A.C. Kraaijenga; L. van der Molen; I. Jacobi; O. Hamming-Vrieze; F.J.M. Hilgers; M.W.M. van den Brekel

    2014-01-01

    Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in

  18. Cancer stem cells in head and neck cancer

    OpenAIRE

    Trapasso S; Allegra E

    2012-01-01

    Eugenia Allegra, Serena TrapassoOtolaryngology – Head and Neck Surgery, University Magna Graecia of Catanzaro, Catanzaro, ItalyAbstract: Cancer stem cells (CSCs), also called "cells that start the tumor," represent in themselves one of the most topical and controversial issues in the field of cancer research. Tumor stem cells are able to self-propagate in vitro (self-renewal), giving rise both to other tumor stem cells and most advanced cells in the line of differe...

  19. Stereotactic irradiation for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yokouchi, Junichi; Satani, Kenichiro; Kanesaka, Naoto; Abe, Kimihiko [Tokyo Medical Coll. (Japan); Tsumuraya, Akio; Saitoh, Kazuhiro; Kotake, Fumio [Tokyo Medical Coll., Ami, Ibaraki (Japan). Kasumigaura Hospital

    2003-03-01

    We performed stereotactic irradiation (STI) for head and neck cancer. Numbers of patients with nasopharyngeal cancer, oral/oropharyngeal cancer, malignant melanoma of sinus, orbital metastasis, choroidal metastasis were 10, 4, 1, 1, 1 respectively. STI was performed as an initial treatment in 5 patients. Local control was achieved in 4 of them. SRT (stereotactic radiotherapy) was given to 10 patients with local recurrent tumors. Local control could be achieved in 8 of them, but 2 patients died because of the underlying disease. SRS (stereotactic radiosurgery) was performed in two patients with distant metastasis and they were controlled. (author)

  20. Phase Ib Study of BKM120 With Cisplatin and XRT in High Risk Locally Advanced Squamous Cell Cancer of Head and Neck

    Science.gov (United States)

    2015-12-08

    Carcinoma, Squamous Cell of Head and Neck; HPV Positive Oropharyngeal Squamous Cell Carcinoma; Hypopharyngeal Cancer; Early Invasive Cervical Squamous Cell Carcinoma; Carcinoma of Larynx; Cancer of Nasopharynx

  1. Lenalidomide and Cetuximab in Treating Patients With Advanced Colorectal Cancer or Head and Neck Cancer

    Science.gov (United States)

    2016-02-03

    Recurrent Colon Carcinoma; Recurrent Hypopharyngeal Squamous Cell Carcinoma; Recurrent Laryngeal Squamous Cell Carcinoma; Recurrent Laryngeal Verrucous Carcinoma; Recurrent Lip and Oral Cavity Squamous Cell Carcinoma; Recurrent Metastatic Squamous Cell Carcinoma in the Neck With Occult Primary; Recurrent Nasal Cavity and Paranasal Sinus Squamous Cell Carcinoma; Recurrent Nasopharyngeal Keratinizing Squamous Cell Carcinoma; Recurrent Oral Cavity Verrucous Carcinoma; Recurrent Oropharyngeal Squamous Cell Carcinoma; Recurrent Rectal Carcinoma; Recurrent Salivary Gland Carcinoma; Salivary Gland Squamous Cell Carcinoma; Squamous Cell Carcinoma Metastatic in the Neck With Occult Primary; Stage IV Hypopharyngeal Squamous Cell Carcinoma; Stage IV Nasopharyngeal Keratinizing Squamous Cell Carcinoma; Stage IVA Colon Cancer; Stage IVA Laryngeal Squamous Cell Carcinoma; Stage IVA Laryngeal Verrucous Carcinoma; Stage IVA Lip and Oral Cavity Squamous Cell Carcinoma; Stage IVA Major Salivary Gland Carcinoma; Stage IVA Nasal Cavity and Paranasal Sinus Squamous Cell Carcinoma; Stage IVA Oral Cavity Verrucous Carcinoma; Stage IVA Oropharyngeal Squamous Cell Carcinoma; Stage IVA Rectal Cancer; Stage IVB Colon Cancer; Stage IVB Laryngeal Squamous Cell Carcinoma; Stage IVB Laryngeal Verrucous Carcinoma; Stage IVB Lip and Oral Cavity Squamous Cell Carcinoma; Stage IVB Major Salivary Gland Carcinoma; Stage IVB Nasal Cavity and Paranasal Sinus Squamous Cell Carcinoma; Stage IVB Oral Cavity Verrucous Carcinoma; Stage IVB Oropharyngeal Squamous Cell Carcinoma; Stage IVB Rectal Cancer; Stage IVC Laryngeal Squamous Cell Carcinoma; Stage IVC Laryngeal Verrucous Carcinoma; Stage IVC Lip and Oral Cavity Squamous Cell Carcinoma; Stage IVC Major Salivary Gland Carcinoma; Stage IVC Nasal Cavity and Paranasal Sinus Squamous Cell Carcinoma; Stage IVC Oral Cavity Verrucous Carcinoma; Stage IVC Oropharyngeal Squamous Cell Carcinoma; Tongue Carcinoma; Untreated Metastatic Squamous Cell Carcinoma to Neck

  2. Tumor regression and other prognosticators in advanced head and neck cancers: a sequel to the RTOG methotrexate study

    International Nuclear Information System (INIS)

    The randomized Radiation Therapy Oncology Group (RTOG) Methotrexate trial in advanced squamous cancers of the head and neck has reported no control or survival benefits when the chemotherapy adjuvant was administered to patients just prior to definitive irradiation. The required data collection and outcome reporting among 146 patients bearing oral cavity primaries and 354 patients with oropharyngeal cancers has allowed a multi-variate approach seeking answers to many unresolved questions. As anticipated, the ability to control these squamous cancers is largely a function of size (T and N stage) with a superior clearance among T3-4 primaries of the oropharynx (66%) contrasted to identically staged oral cavity tumors (48%). Lymph node deposits also impact upon survival, especially among oropharynx patients where the 17.6 month adjusted median survival among N0 patients declines to 11.0 months when the primaries are associated with N3 nodes. Finally, the association of T and N-stage upon distant metastases was investigated, with the surprising conclusion that neither initial T nor N-stage exerts any apparent influence on the observed 10 to 12% occurrence. The interrelationship of these various prognostic variables is explored using the Cox and logistic models

  3. Radical Radiotherapy of Head and Neck Cancer

    International Nuclear Information System (INIS)

    Sixty patients with head and neck carcinoma were studied retrospectively to assess the impact of treatment on survival and local control rate by stage in the Dept of Radiation Therapy, Korea University Had Wha Hospital between March 1981 and March 1986. Prior to definite radiotherapy, patients were evaluated by physical examination and radiologic studies including heart, paryngogram and CT scan and then these patients were grouped according to the American Joint Committee(AJC) staging system. They were Treated with RT alone or postoperative irradiation to the dose of 7,200 cGy/8 weeks and 6,000 cGy/7 weeks respectively. The results were obtained and as follows; 1. overall male to female sex ratio was 3.6:1. The peak age of patients with head and neck cancer was 6th decade. 2. In all patients treated by RT, the ratio of squamous cell carcinoma to non-squamous cell carcinoma was 3.5:1 (60/77 patients). 3. The incidence according to the anatomic site of primary tumor was 22 cases in the larynx, 12 cases in PNS, 7 cases in nasopharynx, 6 cases in oropharynx, and 3 cases in hypopharynx. 4. According to AJC staging system, 4 cases were Stage I, 7 in Stage II, 19 in Stage III and 27 in Stage IV. 5. The overall incidence of cervical lymph node metastases was 43% and subdigatric and submaxillary triangle lymph nodes were the most frequent site of metastases. 6. Local control was achieved in 48% of patients treated by radio-therapy. 7. The lung was the most common site for distant metastases, comprising 4 cases among 7 cases in which distant metastases occurred. 8. The overall estimated 5-year survival rate was 43% in the head and neck cancer treated with radiotherapy by life-table analysis

  4. Recombinant Interleukin-15 in Treating Patients With Advanced Melanoma, Kidney Cancer, Non-small Cell Lung Cancer, or Squamous Cell Head and Neck Cancer

    Science.gov (United States)

    2016-05-05

    Head and Neck Squamous Cell Carcinoma; Recurrent Head and Neck Carcinoma; Recurrent Non-Small Cell Lung Carcinoma; Recurrent Renal Cell Carcinoma; Recurrent Skin Carcinoma; Stage III Renal Cell Cancer; Stage IIIA Non-Small Cell Lung Cancer; Stage IIIA Skin Melanoma; Stage IIIB Non-Small Cell Lung Cancer; Stage IIIB Skin Melanoma; Stage IIIC Skin Melanoma; Stage IV Non-Small Cell Lung Cancer; Stage IV Renal Cell Cancer; Stage IV Skin Melanoma

  5. Palliative radiotherapy in head and neck cancers: Evidence based review

    Directory of Open Access Journals (Sweden)

    Talapatra Kaustav

    2006-01-01

    Full Text Available Squamous cell carcinoma of head and neck (SCCHN is one of the commonest cancers seen in India, constituting up to 25% of their overall cancer burden. Advanced SCCHN is a bad disease with a poor prognosis and patients usually die of uncontrolled loco-regional disease. Curative intent management of loco-regionally advanced SCCHN has become more evidence-based with active clinical research in the form of large prospective randomized controlled trials and meta-analyses. However, little has been written about palliative radiotherapy (PRT in head and neck cancers. It is widely recognized that PRT provides effective palliation and improved quality-of-life in advanced incurable malignancies. It is in this context that this study proposes to review the existing literature on palliative radiotherapy in advanced incurable SCCHN to help formulate consensus guidelines and recommendations.

  6. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer

    International Nuclear Information System (INIS)

    , PORT in patients with advanced head-and-neck squamous cell cancer in a prospective, multi-institutional setting. It also revealed the impact of the overall treatment time in the combination of surgery and PORT on the outcome in high-risk patients and showed that PORT acceleration without a reduction in dose by a concomitant boost regimen did not increase the late complication rate. These findings emphasize the importance of coordinated interdisciplinary care in the delivery of combined surgery and RT

  7. Prognostic significance of radiation therapy delay in advanced head and neck cancer patients who completed induction chemotherapy

    International Nuclear Information System (INIS)

    This paper evaluates the prognostic significance of radiation therapy (RT) delay in patients with advanced head and neck cancer who completed induction chemotherapy (IC). The authors retrospectively reviewed 67 patients who received radical RT after IC between 1978 and 1987. The time interval between the completion of IC and the initiation of RT was documented, and the reasons for delay were recorded. Approximately equal numbers of patients initiated RT within and beyond 30 days. In 24 patients who survived 9-79 months (median, 34 months) after IC and RT, 15/24 (62%) began RT within 30 days of IC, while only 9/24 (37%) survived if RT began beyond 30 days. Among these 24 patients, seven underwent salvage surgery. Five of seven began RT beyond 30 days. Without the surgically salvaged patients, the difference was more striking; 13/17 (76%) survived if RT was initiated within 30 days versus 4/17 (23%) if RT was initiated beyond 30 days

  8. Advanced and rapidly progressing head and neck cancer: good palliation following intralesional bleomycin.

    LENUS (Irish Health Repository)

    Quintyne, Keith Ian

    2011-09-01

    The authors herein report the case of a 61-year-old man undergoing adjuvant therapy for locally advanced laryngeal cancer, who developed parastomal recurrence in his radiation field around his tracheotomy site, while he was undergoing radiation therapy, and compromised the secure placement of his tracheotomy tube and maintenance of his upper airway. MRI restaging and biopsy confirmed recurrence and progressive disease in his mediastinum. He underwent local therapy with intralesional bleomycin with good palliation, and ability to maintain the patency of his upper airway.

  9. Gene therapy in head and neck cancer: a review

    OpenAIRE

    Chisholm, E; Bapat, U.; Chisholm, C; Alusi, G.; Vassaux, G

    2007-01-01

    Gene therapy for cancer is a rapidly evolving field with head and neck squamous cell cancer being one of the more frequently targeted cancer types. The number of clinical trials in the UK is growing and there is already a commercially available agent in China. Various gene therapy strategies along with delivery mechanisms for targeting head and neck cancer are reviewed.

  10. Fractionation schedules for cancers of the head and neck

    International Nuclear Information System (INIS)

    Purpose/Objective: This refresher course reviews current research activity and treatment results in the field of radiation therapy fractionation. The presentation emphasizes worldwide studies of altered fractionation, highlighting head and neck cancer as the primary teaching model. Basic radiobiological principles guiding the development of altered fractionation regimens, and advancing the understanding of fractionation effects on normal and tumor tissue are reviewed. A 'standard' prescription of 2 Gy x 35 fractions = 70 Gy may not provide the optimal balance between primary tumor control and late normal tissue effects for all patients with squamous cell carcinoma of the head and neck. The last decade has witnessed the treatment of thousands of head and neck cancer patients with curative radiotherapy using altered fractination schedules designed to improve overall treatment results. Although the number of different fractionation regimens currently being investigated continues to increase, the common guiding principles behind their design are relatively simple. Common fractionation terminology (i.e., accelerated hyperfractionation) will be reviewed, as well as a brief summary of radiobiological concepts pertaining to tumor potential doubling time, tumor proliferation kinetics, overall treatment time and fraction size-dependence of acute and late tissue effects. Several well known head and neck fractionation schedules from around the world (Manchester Christie Hospital-United Kingdom, Princess Margaret Hospital-Canada, Massachusetts General Hospital-USA, MD Anderson Hospital-USA, University of Florida-USA, Mount Vernon Hospital CHART-United Kingdom, RTOG and EORTC trials-USA and Europe) will be summarized with regard to design-rationale, treatment technique and results. The design of several current cooperative group trials investigating altered head and neck fractionation will be presented, as well as concepts prompting the pilot evaluation of several brand new

  11. Symptom burden and quality of life in advanced head and neck cancer patients: AIIMS study of 100 patients

    Directory of Open Access Journals (Sweden)

    Ajeet Kumar Gandhi

    2014-01-01

    Full Text Available Aim: Head and neck cancers (HNCa are the most common cancers among males in India and 70-80% present in advanced stage. The study aims to assess symptom burden and quality of life (QOL in advanced incurable HNCa patients at presentation. Materials and Methods: One hundred patients were asked to fill EORTC QLQ-C15-PAL questionnaire, which consisted of Global QOL, physical functioning (PF, emotional functioning (EF, fatigue (FA, nausea-vomiting (NV, pain (PA, dyspnea (DY, sleep (SL, appetite (AP, and constipation (CO. Additional questions pertaining to swallowing (SW, hoarseness (HO, cough (CG, weight loss (WL, using pain killers (PK, taste (TA, bleeding (BL, hearing (HE, pain in neck lump (PALMP, opening mouth (OM, and oral secretions (OS were asked based on a modified EORTC-HN35 questionnaire. Scoring was according to EORTC scoring manual. Mean, median and range were calculated for each item for the entire cohort. Results: The female:male ratio was 17:83.42% of them were ≥60 years of age. Sixty-six patients had T4, 25 had T3, 36 had N2, and 33 had N3 disease. Median QOL was 50 (range 0-83.33 and PF was 77.78 (0-100. Median score for EF and FA was 50. Median score for PA, PK, and SL was 66.67 while that for AP was 33.33. Median value for SW, HO, WL, BL, PALMP, OM, and OS was 33.33 (100-0 while TA, CG, NV, DY, and HE had a median score of 0.00. Conclusion: Advanced HNCa has a significant burden of symptoms. These results would help in giving patients better symptom directed therapies and improve their QOL.

  12. A randomized study of accelerated fractionation radiotherapy with and without mitomycin C in the treatment of locally advanced head and neck cancer

    DEFF Research Database (Denmark)

    Ezzat, M.; Shouman, T.; Zaza, K.;

    2005-01-01

    Objectives: This single-institution study evaluates the feasibility of accelerated fractionation radiotherapy (AF) with and without mitomycin C (MMC) in the treatment of locally advanced head and neck cancer. Patients and Methods: Between May 1998 and October 2001, sixty patients with locally...... advanced stage III and IV of head and neck cancer were randomized into three treatment arms: (1) conventional fractionation radiotherapy (CF) (5 fractions per week); (2) accelerated fractionation radiotherapy (AF) (6 fractions per week); and (3) AF plus Mitomycin C (MMC). Results: The 2-year overall...... survival (OS) of the whole group was 21%. The OS according to treatment arm was 23%, 20%, and 28% in CF, AF, and AF+MMC arms respectively (p<0.19). The 2-year loco-regional control (LC) rate was 22% for the whole group of patients. The LC was 10%, 25%, and 30% for the CF, AF, and AF+MMC respectively (p=0...

  13. Radiochemotherapy With Cetuximab, Cisplatin, and Amifostine for Locally Advanced Head and Neck Cancer: A Feasibility Study

    International Nuclear Information System (INIS)

    Purpose: Radiotherapy (RT) combined with cisplatin or cetuximab is the standard of care for patients with locally advanced head/neck cancer (LA-HNC). The feasibility of radiochemotherapy with cisplatin and cetuximab, supported with amifostine, was herein investigated. Methods and Materials: Forty-three patients with LA-HNC were recruited. Conformal hypofractionated/accelerated RT with amifostine cytoprotection (2.7 Gy/fraction, 21 fractions in 4 weeks) was combined with cisplatin (30 mg/m2/week) and cetuximab (standard weekly regimen) therapy. The dose of amifostine was individualized according to tolerance. Results: A high daily amifostine dose (750-1,000 mg) was tolerated by 41.8% of patients, and a standard dose (500 mg) was tolerated by 34.9% of patients. A high amifostine dose was linked to reduced RT delays (p = 0.0003). Grade 3 to 4 (3-4) mucositis occurred in 7/43 (16.2%) patients, and fungal infections occurred in 18/43 (41.8%) patients. Radiation dermatitis was not aggravated. Interruption of cetuximab due to acneiform rash was necessary in 23.3% of patients, while amifostine-related fever and rash were not observed. Severe late radiation sequelae consisted of laryngeal edema (9% laryngeal cases) and cervical strictures (33% of hypopharyngeal cases). Good salivary function was preserved in 6/11 (54.5%) nasopharyngeal cancer patients. The complete response rate was 68.5%, reaching 77.2% in patients with minor radiotherapy delays. The 24-month local control and survival rates were 72.3% and 91%, respectively (median follow-up was 13 months.). Conclusions: In this feasibility study, weekly administration of cisplatin and cetuximab was safely combined with accelerated RT, supported with amifostine, at the cost of a high incidence of acneiform rash but a reduced incidence of amifostine-related fever/rash. A high daily dose of amifostine allows completion of therapy with minor delays.

  14. Reirradiation of recurrent head and neck cancers

    Energy Technology Data Exchange (ETDEWEB)

    Emami, B.; Bignardi, M.; Spector, G.J.; Devineni, V.R.; Hederman, M.A.

    1987-01-01

    Ninety-nine patients with recurrent cancers of the head and neck region were treated with surgery, radiation therapy, or combination therapy. The follow-up period ranged from 18 months to 18 years. An initial overall complete response rate of 67% and a partial response rate of 7% (overall response rate-74%) were achieved. The eventual tumor control rate was 15%. Although equal initial response rates were achieved in recurrences at the primary site and the cervical nodes, the eventual local control was better for the former (21% vs. 10%). Patients receiving less than 5,000 rad radiotherapy had a 44% complete response and an 11% eventual tumor control. Patients receiving over 5,000 rad had an 80% complete response and a 25% eventual tumor control.

  15. Reirradiation of recurrent head and neck cancers

    International Nuclear Information System (INIS)

    Ninety-nine patients with recurrent cancers of the head and neck region were treated with surgery, radiation therapy, or combination therapy. The follow-up period ranged from 18 months to 18 years. An initial overall complete response rate of 67% and a partial response rate of 7% (overall response rate-74%) were achieved. The eventual tumor control rate was 15%. Although equal initial response rates were achieved in recurrences at the primary site and the cervical nodes, the eventual local control was better for the former (21% vs. 10%). Patients receiving less than 5,000 rad radiotherapy had a 44% complete response and an 11% eventual tumor control. Patients receiving over 5,000 rad had an 80% complete response and a 25% eventual tumor control

  16. Enteral Feeding During Chemoradiotherapy for Advanced Head-and-Neck Cancer: A Single-Institution Experience Using a Reactive Approach

    International Nuclear Information System (INIS)

    Purpose: The optimal method for providing enteral nutrition to patients with head-and-neck cancer is unclear. The purpose of the present study was to evaluate the safety and efficacy of our reactive policy, which consists of the installation of a nasogastric (NG) feeding tube only when required by the patient's nutritional status. Methods and Materials: The records of all patients with Stage III and IV head-and-neck cancer treated with concomitant chemotherapy and radiotherapy between January 2003 and December 2006 were reviewed. The overall and disease-free survival rates were estimated using the Kaplan-Meier method and compared with the log-rank test. Results: The present study included 253 patients, and the median follow-up was 33 months. At 3 years, the estimated overall survival and disease-free survival rate was 82.8% and 77.8%, respectively, for the whole population. No survival difference was observed when the patients were compared according to the presence and absence of a NG tube or stratified by weight loss quartile. The mean weight loss during treatment for all patients was 10.4%. The proportion of patients requiring a NG tube was 49.8%, and the NG tube remained in place for a median duration of 40 days. No major complications were associated with NG tube installation. Only 3% of the patients were still dependent on enteral feeding at 6 months. Conclusion: These results suggest that the use of a reactive NG tube with an interdisciplinary team approach is a safe and effective method to manage malnutrition in patients treated with concomitant chemotherapy and radiotherapy for head-and-neck cancer.

  17. Is there room for combined modality treatments? Dosimetric comparison of boost strategies for advanced head and neck and prostate cancer.

    Science.gov (United States)

    Góra, Joanna; Hopfgartner, Johannes; Kuess, Peter; Paskeviciute, Brigita; Georg, Dietmar

    2013-07-01

    The purpose of the study was to determine the dosimetric difference between three emerging treatment modalities--volumetric-modulated arc therapy (VMAT), intensity-modulated proton beam therapy (IMPT) and intensity-modulated carbon ion beam therapy (IMIT)--for two tumour sites where selective boosting of the tumour is applied. For 10 patients with locally advanced head and neck (H&N) cancer and 10 with high-risk prostate cancer (PC) a VMAT plan was generated for PTV initial that included lymph node regions, delivering 50 Gy (IsoE) for H&N and 50.4 Gy (IsoE) for PC patients. Furthermore, separate boost plans (VMAT, IMPT and IMIT) were created to boost PTV boost up to 70 Gy (IsoE) and 78 Gy (IsoE) for H&N and PC cases, respectively. Doses to brainstem, myelon, larynx and parotid glands were assessed for H&N cases. Additionally, various OARs (e.g. cochlea, middle ear, masticator space) were evaluated that are currently discussed with respect to quality of life after treatment. For PC cases, bladder, rectum and femoral heads were considered as OARs. For both tumour sites target goals were easily met. Looking at OAR sparing, generally VMAT + VMAT was worst. VMAT + IMIT had the potential to spare some structures in very close target vicinity (such as cochlea, middle ear, masticator space ) significantly better than VMAT + IMPT. Mean doses for rectal and bladder wall were on average 4 Gy (IsoE) and 1.5 Gy (IsoE) higher, respectively, compared to photons plus particles scenarios. Similar results were found for parotid glands and larynx. Concerning target coverage, no significant differences were observed between the three treatment concepts. Clear dosimetric benefits were observed for particle beam therapy as boost modality. However, the clinical benefit of combined modality treatments remains to be demonstrated. PMID:23824134

  18. Is there room for combined modality treatments? Dosimetric comparison of boost strategies for advanced head and neck and prostate cancer

    International Nuclear Information System (INIS)

    The purpose of the study was to determine the dosimetric difference between three emerging treatment modalities-volumetric-modulated arc therapy (VMAT), intensity-modulated proton beam therapy (IMPT) and intensity-modulated carbon ion beam therapy (IMIT)-for two tumour sites where selective boosting of the tumour is applied. For 10 patients with locally advanced head and neck (H and N) cancer and 10 with high-risk prostate cancer (PC) a VMAT plan was generated for PTVinitial that included lymph node regions, delivering 50 Gy (IsoE) for H and N and 50.4 Gy (IsoE) for PC patients. Furthermore, separate boost plans (VMAT, IMPT and IMIT) were created to boost PTVboost up to 70 Gy (IsoE) and 78 Gy (IsoE) for H and N and PC cases, respectively. Doses to brainstem, myelon, larynx and parotid glands were assessed for H and N cases. Additionally, various organs at risk (OARs) (e.g. cochlea, middle ear, masticator space) were evaluated that are currently discussed with respect to quality of life after treatment. For PC cases, bladder, rectum and femoral heads were considered as OARs. For both tumour sites target goals were easily met. Looking at OAR sparing, generally VMAT + VMAT was worst. VMAT + IMIT had the potential to spare some structures in very close target vicinity (such as cochlea, middle ear, masticator space) significantly better than VMAT + IMPT. Mean doses for rectal and bladder wall were on average 4 Gy (IsoE) and 1.5 Gy (IsoE) higher, respectively, compared to photons plus particles scenarios. Similar results were found for parotid glands and larynx. Concerning target coverage, no significant differences were observed between the three treatment concepts. Clear dosimetric benefits were observed for particle beam therapy as boost modality. However, the clinical benefit of combined modality treatments remains to be demonstrated. (author)

  19. Differentiation of irradiation and cetuximab induced skin reactions in patients with locally advanced head and neck cancer undergoing radioimmunotherapy: the HICARE protocol (Head and neck cancer: ImmunoChemo and Radiotherapy with Erbitux) – a multicenter phase IV trial

    International Nuclear Information System (INIS)

    In order to improve the clinical outcome of patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN) not being capable to receive platinum-based chemoradiation, radiotherapy can be intensified by addition of cetuximab, a monoclonal antibody that blocks the epidermal growth factor receptor (EGFR). The radioimmunotherapy with cetuximab is a feasible treatment option showing a favourable toxicity profile. The most frequent side effect of radiotherapy is radiation dermatitis, the most common side effect of treatment with cetuximab is acneiform rash. Incidence and severity of these frequent, often overlapping and sometimes limiting skin reactions, however, are not well explored. A clinical and molecular differentiation between radiogenic skin reactions and skin reactions caused by cetuximab which may correlate with outcome, have never been described before. The HICARE study is a national, multicenter, prospective phase IV study exploring the different types of skin reactions that occur in patients with LASCCHN undergoing radioimmun(chemo)therapy with the EGFR inhibitor cetuximab. 500 patients with LASCCHN will be enrolled in 40 participating sites in Germany. Primary endpoint is the rate of radiation dermatitis NCI CTCAE grade 3 and 4 (v. 4.02). Radioimmunotherapy will be applied according to SmPC, i.e. cetuximab will be administered as loading dose and then weekly during the radiotherapy. Irradiation will be applied as intensity-modulated radiation therapy (IMRT) or 3D-dimensional radiation therapy. The HICARE trial is expected to be one of the largest trials ever conducted in head and neck cancer patients. The goal of the HICARE trial is to differentiate skin reactions caused by radiation from those caused by the monoclonal antibody cetuximab, to evaluate the incidence and severity of these skin reactions and to correlate them with outcome parameters. Besides, the translational research program will help to identify and confirm novel

  20. Long-Term Outcomes and Toxicity of Concurrent Paclitaxel and Radiotherapy for Locally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: To report the long-term outcomes and toxicity of a regimen of infusion paclitaxel delivered concurrently with radiotherapy in patients with locally advanced squamous cell carcinoma of the head and neck. Patients and Methods: Between 1995 and 1999, 35 patients with nonmetastatic, Stage III or IV squamous cell carcinoma of the head and neck were treated with three cycles of paclitaxel as a 120-h continuous infusion beginning on Days 1, 21, and 42, concurrent with radiotherapy. The initial 16 patients received 105 mg/m2/cycle, and the subsequent 19 patients received 120 mg/m2/cycle. External beam radiotherapy was delivered to a dose of 70.2-72 Gy at five fractions weekly. Patients were followed to evaluate the disease outcomes and late toxicity of this regimen. Results: The median follow-up for all patients was 56.5 months. The median survival was 56.5 months, and the median time to local recurrence was not reached. Of the 35 patients, 15 (43%) developed hypothyroidism. Of the 33 patients who underwent percutaneous endoscopic gastrostomy tube placement, 11 were percutaneous endoscopic gastrostomy tube dependent until death or their last follow-up visit. Also, 5 patients (14%) required a tracheostomy until death, and 3 (9%) developed a severe esophageal stricture. All evaluated long-term survivors exhibited salivary hypofunction. Fibrosis in the radiation field occurred in 24 patients (69%). Conclusion: The results of our study have shown that concurrent chemoradiotherapy with a 120-h infusion of paclitaxel provides long-term local control and survival in patients with squamous cell carcinoma of the head and neck. Xerostomia, hypothyroidism, esophageal and pharyngeal complications, and subcutaneous fibrosis were common long-term toxicities; however, the vast majority of toxicities were grade 1 or 2.

  1. Bevacizumab, Fluorouracil, and Hydroxyurea Plus Radiation Therapy in Treating Patients With Advanced Head and Neck Cancer

    Science.gov (United States)

    2013-02-06

    Metastatic Squamous Neck Cancer With Occult Primary Squamous Cell Carcinoma; Recurrent Adenoid Cystic Carcinoma of the Oral Cavity; Recurrent Basal Cell Carcinoma of the Lip; Recurrent Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Recurrent Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Recurrent Lymphoepithelioma of the Nasopharynx; Recurrent Lymphoepithelioma of the Oropharynx; Recurrent Metastatic Squamous Neck Cancer With Occult Primary; Recurrent Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Recurrent Mucoepidermoid Carcinoma of the Oral Cavity; Recurrent Salivary Gland Cancer; Recurrent Squamous Cell Carcinoma of the Hypopharynx; Recurrent Squamous Cell Carcinoma of the Larynx; Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity; Recurrent Squamous Cell Carcinoma of the Nasopharynx; Recurrent Squamous Cell Carcinoma of the Oropharynx; Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Recurrent Verrucous Carcinoma of the Larynx; Recurrent Verrucous Carcinoma of the Oral Cavity; Stage III Adenoid Cystic Carcinoma of the Oral Cavity; Stage III Basal Cell Carcinoma of the Lip; Stage III Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Stage III Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Stage III Lymphoepithelioma of the Nasopharynx; Stage III Lymphoepithelioma of the Oropharynx; Stage III Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Stage III Mucoepidermoid Carcinoma of the Oral Cavity; Stage III Salivary Gland Cancer; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage III Verrucous Carcinoma of the Larynx; Stage III Verrucous

  2. Iodine-125 seed implantation as an adjunct to surgery in advanced recurrent squamous cell cancer of the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Park, R.I.; Liberman, F.Z.; Lee, D.J.; Goldsmith, M.M.; Price, J.C. (Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD (United States))

    1991-04-01

    Survival for extensive recurrent squamous cell carcinomas of the head and neck remains poor, with the major cause of death being local recurrence. Surgical implantation of iodine-125 interstitial seeds allows tumoricidal doses of radiation to be delivered to residual tumor while minimizing radiation doses to the surrounding tissues. From 1978 to 1988, 39 implantations were performed on 35 patients for extensive recurrent squamous cell carcinoma of the head and neck. The decision for implantation was based on positive margins or close to resection margins from frozen sections after salvage resection. The determinate 5-year disease-free survival was 41%, with both the overall and no evidence of disease 5-year survivals being 29%. Significant complications occurred in 36% of all cases. This figure increased to 56% when flap reconstruction was required. Possible reasons for this seemingly high complication rate are discussed. Considering the advanced nature of these recurrent carcinomas, surgical resection with iodine-125 seed implantation appears to be an effective method of managing disease that might otherwise be judged unresectable and treated for palliation only.

  3. Iodine-125 seed implantation as an adjunct to surgery in advanced recurrent squamous cell cancer of the head and neck

    International Nuclear Information System (INIS)

    Survival for extensive recurrent squamous cell carcinomas of the head and neck remains poor, with the major cause of death being local recurrence. Surgical implantation of iodine-125 interstitial seeds allows tumoricidal doses of radiation to be delivered to residual tumor while minimizing radiation doses to the surrounding tissues. From 1978 to 1988, 39 implantations were performed on 35 patients for extensive recurrent squamous cell carcinoma of the head and neck. The decision for implantation was based on positive margins or close to resection margins from frozen sections after salvage resection. The determinate 5-year disease-free survival was 41%, with both the overall and no evidence of disease 5-year survivals being 29%. Significant complications occurred in 36% of all cases. This figure increased to 56% when flap reconstruction was required. Possible reasons for this seemingly high complication rate are discussed. Considering the advanced nature of these recurrent carcinomas, surgical resection with iodine-125 seed implantation appears to be an effective method of managing disease that might otherwise be judged unresectable and treated for palliation only

  4. Cervicopectoral flap in head and neck cancer surgery

    Directory of Open Access Journals (Sweden)

    Sivrioglu Nazan S

    2003-12-01

    Full Text Available Abstract Background Reconstruction of the head and neck after adequate resection of primary tumor and neck dissection is a challenge. It should be performed at one sitting in advanced tumors. Defects caused by the resection should be closed with flaps which match in color, texture and hair bearing characteristics with the face. Cervicopectoral flap is a one such flap from chest and neck skin mainly used to cover the cheek defects. Methods This study included twelve patients presenting with cancer of the head and neck to Izmir Ataturk Training Hospital and Adnan Menderes University Hospital. Tumor resection and neck dissection was performed in one session by the same surgeon. A single incision was made and a medially based cervicopectoral fascio-cutaneous flap was used for surgical exposure in neck dissection and for closure of defects after tumor resection. Results There was no major complication. Two flaps had partial superficial epidermolysis at the suture line. Good aesthetic and functional results were achieved. Conclusion The cervicopectoral flap is an excellent alternative for the reconstruction of head and neck. Harvesting and application of the flap is rapid and safe. Only a single incision is sufficient for dissection and flap elevation. This flap achieves perfect surgical exposure, makes neck dissection easy and allows one to perform both tumor resection and neck dissection in one session.

  5. HPV Associated Head and Neck Cancer

    Science.gov (United States)

    Spence, Tara; Bruce, Jeff; Yip, Kenneth W.; Liu, Fei-Fei

    2016-01-01

    Head and neck cancers (HNCs) are a highly heterogeneous group of tumours that are associated with diverse clinical outcomes. Recent evidence has demonstrated that human papillomavirus (HPV) is involved in up to 25% of HNCs; particularly in the oropharyngeal carcinoma (OPC) subtype where it can account for up to 60% of such cases. HPVs are double-stranded DNA viruses that infect epithelial cells; numerous HPV subtypes, including 16, 18, 31, 33, and 35, drive epithelial cell transformation and tumourigenesis. HPV positive (HPV+) HNC represents a distinct molecular and clinical entity from HPV negative (HPV−) disease; the biological basis for which remains to be fully elucidated. HPV positivity is strongly correlated with a significantly superior outcome; indicating that such tumours should have a distinct management approach. This review focuses on the recent scientific and clinical investigation of HPV+ HNC. In particular, we discuss the importance of molecular and clinical evidence for defining the role of HPV in HNC, and the clinical impact of HPV status as a biomarker for HNC. PMID:27527216

  6. HPV Associated Head and Neck Cancer.

    Science.gov (United States)

    Spence, Tara; Bruce, Jeff; Yip, Kenneth W; Liu, Fei-Fei

    2016-01-01

    Head and neck cancers (HNCs) are a highly heterogeneous group of tumours that are associated with diverse clinical outcomes. Recent evidence has demonstrated that human papillomavirus (HPV) is involved in up to 25% of HNCs; particularly in the oropharyngeal carcinoma (OPC) subtype where it can account for up to 60% of such cases. HPVs are double-stranded DNA viruses that infect epithelial cells; numerous HPV subtypes, including 16, 18, 31, 33, and 35, drive epithelial cell transformation and tumourigenesis. HPV positive (HPV+) HNC represents a distinct molecular and clinical entity from HPV negative (HPV-) disease; the biological basis for which remains to be fully elucidated. HPV positivity is strongly correlated with a significantly superior outcome; indicating that such tumours should have a distinct management approach. This review focuses on the recent scientific and clinical investigation of HPV+ HNC. In particular, we discuss the importance of molecular and clinical evidence for defining the role of HPV in HNC, and the clinical impact of HPV status as a biomarker for HNC. PMID:27527216

  7. Preventive sparing of spinal cord and brain stem in the initial irradiation of locally advanced head and neck cancers.

    Science.gov (United States)

    Farace, Paolo; Piras, Sara; Porru, Sergio; Massazza, Federica; Fadda, Giuseppina; Solla, Ignazio; Piras, Denise; Deidda, Maria Assunta; Amichetti, Maurizio; Possanzini, Marco

    2014-01-01

    Since reirradiation in recurrent head and neck patients is limited by previous treatment, a marked reduction of maximum doses to spinal cord and brain stem was investigated in the initial irradiation of stage III/IV head and neck cancers. Eighteen patients were planned by simultaneous integrated boost, prescribing 69.3 Gy to PTV1 and 56.1 Gy to PTV2. Nine 6 MV coplanar photon beams at equispaced gantry angles were chosen for each patient. Step-and-shoot IMRT was calculated by direct machine parameter optimization, with the maximum number of segments limited to 80. In the standard plan, optimization considered organs at risk (OAR), dose conformity, maximum dose < 45 Gy to spinal cord and < 50 Gy to brain stem. In the sparing plans, a marked reduction to spinal cord and brain stem were investigated, with/without changes in dose conformity. In the sparing plans, the maximum doses to spinal cord and brain stem were reduced from the initial values (43.5 ± 2.2 Gy and 36.7 ± 14.0 Gy), without significant changes on the other OARs. A marked difference (-15.9 ± 1.9 Gy and -10.1 ± 5.7 Gy) was obtained at the expense of a small difference (-1.3% ± 0.9%) from initial PTV195% coverage (96.6% ± 0.9%). Similar difference (-15.7 ± 2.2 Gy and -10.2 ± 6.1 Gy) was obtained compromising dose conformity, but unaffecting PTV195% and with negligible decrease in PTV295% (-0.3% ± 0.3% from the initial 98.3% ± 0.8%). A marked spinal cord and brain stem preventive sparing was feasible at the expense of a decrease in dose conformity or slightly compromising target coverage. A sparing should be recommended in highly recurrent tumors, to make potential reirradiation safer. PMID:24423836

  8. Assessment of an advanced monoenergetic reconstruction technique in dual-energy computed tomography of head and neck cancer

    International Nuclear Information System (INIS)

    To define optimal keV settings for advanced monoenergetic (Mono+) dual-energy computed tomography (DECT) in patients with head and neck squamous cell carcinoma (SCC). DECT data of 44 patients (34 men, mean age 55.5 ± 16.0 years) with histopathologically confirmed SCC were reconstructed as 40, 55, 70 keV Mono + and M0.3 (30 % 80 kV) linearly blended series. Attenuation of tumour, sternocleidomastoid muscle, internal jugular vein, submandibular gland, and noise were measured. Three radiologists with >3 years of experience subjectively assessed image quality, lesion delineation, image sharpness, and noise. The highest lesion attenuation was shown for 40 keV series (248.1 ± 94.1 HU), followed by 55 keV (150.2 ± 55.5 HU; P = 0.001). Contrast-to-noise ratio (CNR) at 40 keV (19.09 ± 13.84) was significantly superior to all other reconstructions (55 keV, 10.25 ± 9.11; 70 keV, 7.68 ± 6.31; M0.3, 5.49 ± 3.28; all P < 0.005). Subjective image quality was highest for 55 keV images (4.53; κ = 0.38, P = 0.003), followed by 40 keV (4.14; κ = 0.43, P < 0.001) and 70 keV reconstructions (4.06; κ = 0.32, P = 0.005), all superior (P < 0.004) to linear blending M0.3 (3.81; κ = 0.280, P = 0.056). Mono + DECT at low keV levels significantly improves CNR and subjective image quality in patients with head and neck SCC, as tumour CNR peaks at 40 keV, and 55 keV images are preferred by observers. (orig.)

  9. Assessment of an advanced monoenergetic reconstruction technique in dual-energy computed tomography of head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Albrecht, Moritz H.; Scholtz, Jan-Erik; Kraft, Johannes; Bauer, Ralf W.; Kaup, Moritz; Dewes, Patricia; Bucher, Andreas M.; Burck, Iris; Lehnert, Thomas; Kerl, J.M.; Vogl, Thomas J. [University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt am Main (Germany); Wagenblast, Jens [University Hospital Frankfurt, Department of Otolaryngology, Head and Neck Surgery, Frankfurt am Main (Germany); Wichmann, Julian L. [University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt am Main (Germany); Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2015-08-15

    To define optimal keV settings for advanced monoenergetic (Mono+) dual-energy computed tomography (DECT) in patients with head and neck squamous cell carcinoma (SCC). DECT data of 44 patients (34 men, mean age 55.5 ± 16.0 years) with histopathologically confirmed SCC were reconstructed as 40, 55, 70 keV Mono + and M0.3 (30 % 80 kV) linearly blended series. Attenuation of tumour, sternocleidomastoid muscle, internal jugular vein, submandibular gland, and noise were measured. Three radiologists with >3 years of experience subjectively assessed image quality, lesion delineation, image sharpness, and noise. The highest lesion attenuation was shown for 40 keV series (248.1 ± 94.1 HU), followed by 55 keV (150.2 ± 55.5 HU; P = 0.001). Contrast-to-noise ratio (CNR) at 40 keV (19.09 ± 13.84) was significantly superior to all other reconstructions (55 keV, 10.25 ± 9.11; 70 keV, 7.68 ± 6.31; M0.3, 5.49 ± 3.28; all P < 0.005). Subjective image quality was highest for 55 keV images (4.53; κ = 0.38, P = 0.003), followed by 40 keV (4.14; κ = 0.43, P < 0.001) and 70 keV reconstructions (4.06; κ = 0.32, P = 0.005), all superior (P < 0.004) to linear blending M0.3 (3.81; κ = 0.280, P = 0.056). Mono + DECT at low keV levels significantly improves CNR and subjective image quality in patients with head and neck SCC, as tumour CNR peaks at 40 keV, and 55 keV images are preferred by observers. (orig.)

  10. Radiotherapy for head and neck cancer in elderly patients

    International Nuclear Information System (INIS)

    Background and purpose: Elderly patients with head and neck cancer may not be treated aggressively with radiotherapy, due to concerns regarding tolerance of treatment and toxicity. A retrospective study was undertaken of patients aged 80 years and over, treated by definitive radiotherapy for head and neck cancer. Material and methods: 98 patients aged 80-92 received radiotherapy for carcinoma of the head and neck between 1991 and 1995. All patients received beam directed radiotherapy with radical intent using an immobilisation shell. Results: Cancer specific survival was 59% and overall local control was 70% at 5 years. Both were significantly affected by T stage and site of disease. Cancer specific survival was comparable to that of patients aged below 80 years. Seven patients died within 6 months of the treatment. Three patients developed severe late toxicity. Metastatic disease occurred in eight patients. Conclusions: Radiotherapy is a beneficial and well tolerated treatment in elderly patients with carcinoma of the head and neck

  11. Three-dimensional conformal radiotherapy for locally advanced (Stage II and worse) head-and-neck cancer: Dosimetric and clinical evaluation

    International Nuclear Information System (INIS)

    Purpose: To evaluate the dosimetric parameters of three-dimensional conformal radiotherapy (3D-CRT) in locally advanced head-and-neck tumors (Stage II and above) and the effects on xerostomia. Methods and Materials: A total of 49 patients with histologically proven squamous cell cancer of the head and neck were consecutively treated with 3D-CRT using a one-point setup technique; 17 had larynx cancer, 12 oropharynx, 12 oral cavity, and 6 nasopharynx cancer; 2 had other sites of cancer. Of the 49 patients, 41 received postoperative RT and 8 definitive treatment. Also, 13 were treated with cisplatin-based chemotherapy before and during RT; in 6 cases, 5-fluorouracil was added. The follow-up time was 484-567 days (median, 530 days). Results: One-point setup can deliver 96% of the prescribed dose to the isocenter, to the whole planning target volume, including all node levels of the neck and without overdosages. The mean dose to the primary planning target volume was 49.54 ± 4.82 Gy (51.53 ± 5.47 Gy for larynx cases). The average dose to the contralateral parotid gland was approximately 38 Gy (30 Gy for larynx cases). The maximal dose to the spinal cord was 46 Gy. A Grade 0 Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer xerostomia score corresponded to a mean dose of 30 Gy to one parotid gland. A lower xerostomia score with a lower mean parotid dose and longer follow-up seemed to give rise to a sort of functional recovery phenomenon. Conclusion: Three dimensional-CRT in head-and-neck cancers permits good coverage of the planning target volume with about 10-11 segments and one isocenter. With a mean dose of approximately 30 Gy to the contralateral parotid, we observed no or mild xerostomia

  12. Cancer stem cells in head and neck cancer

    Directory of Open Access Journals (Sweden)

    Trapasso S

    2012-11-01

    Full Text Available Eugenia Allegra, Serena TrapassoOtolaryngology – Head and Neck Surgery, University Magna Graecia of Catanzaro, Catanzaro, ItalyAbstract: Cancer stem cells (CSCs, also called "cells that start the tumor," represent in themselves one of the most topical and controversial issues in the field of cancer research. Tumor stem cells are able to self-propagate in vitro (self-renewal, giving rise both to other tumor stem cells and most advanced cells in the line of differentiation (asymmetric division. A final characteristic is tumorigenicity, a fundamental property, which outlines the tumor stem cell as the only cell able to initiate the formation of a tumor when implanted in immune-deficient mice. The hypothesis of a hierarchical organization of tumor cells dates back more than 40 years, but only in 1997, thanks to the work of John Dick and Dominique Bonnet, was there the formal proof of such an organization in acute myeloid leukemia. Following this, many other research groups were able to isolate CSCs, by appropriate selection markers, in various malignancies, such as breast, brain, colon, pancreas, and liver cancers and in melanoma. To date, however, it is not possible to isolate stem cells from all types of neoplasia, particularly in solid tumors. From a therapeutic point of view, the concept of tumor stem cells implies a complete revision of conventional antineoplastic treatment. Conventional cytotoxic agents are designed to target actively proliferating cells. In the majority of cases, this is not sufficient to eliminate the CSCs, which thanks to their reduced proliferative activity and/or the presence of proteins capable of extruding chemotherapeutics from the cell are not targeted. Therefore, the theory of cancer stem cells can pose new paradigms in terms of cancer treatment. Potential approaches, even in the very early experimental stages, relate to the selective inhibition of pathways connected with self-renewal, or more specifically based on

  13. A cost-effectiveness analysis of a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy

    International Nuclear Information System (INIS)

    Concomitant chemo-radiotherapy (CCRT) has become an indispensable organ, but not always function preserving treatment modality for advanced head and neck cancer. To prevent/limit the functional side effects of CCRT, special exercise programs are increasingly explored. This study presents cost-effectiveness analyses of a preventive (swallowing) exercise program (PREP) compared to usual care (UC) from a health care perspective. A Markov decision model of PREP versus UC was developed for CCRT in advanced head and neck cancer. Main outcome variables were tube dependency at one-year and number of post-CCRT hospital admission days. Primary outcome was costs per quality adjusted life years (cost/QALY), with an incremental cost-effectiveness ratio (ICER) as outcome parameter. The Expected Value of Perfect Information (EVPI) was calculated to obtain the value of further research. PREP resulted in less tube dependency (3% and 25%, respectively), and in fewer hospital admission days than UC (3.2 and 4.5 days respectively). Total costs for UC amounted to €41,986 and for PREP to €42,271. Quality adjusted life years for UC amounted to 0.68 and for PREP to 0.77. Based on costs per QALY, PREP has a higher probability of being cost-effective as long as the willingness to pay threshold for 1 additional QALY is at least €3,200/QALY. At the prevailing threshold of €20,000/QALY the probability for PREP being cost-effective compared to UC was 83%. The EVPI demonstrated potential value in undertaking additional research to reduce the existing decision uncertainty. Based on current evidence, PREP for CCRT in advanced head and neck cancer has the higher probability of being cost-effective when compared to UC. Moreover, the majority of sensitivity analyses produced ICERs that are well below the prevailing willingness to pay threshold for an additional QALY (range from dominance till €45,906/QALY)

  14. PET-CT–Guided Surveillance of Head and Neck Cancers

    Science.gov (United States)

    Patients with advanced squamous cell carcinoma of the head and neck who underwent PET-CT–guided surveillance had fewer operations but similar overall survival rates to those of patients who underwent planned neck dissection.

  15. Radiation therapy for head and neck cancers

    International Nuclear Information System (INIS)

    Radiation therapy may be indicated for larger invasive tumors of the head and neck that may be difficult to surgically excise or for which surgery would be significantly disfiguring. Previous studies of oral squamous cell carcinomas indicate that it should be possible to control approximately 80% of all but the most advanced local or locoregional tumors. Aggressive radiation therapy to total doses of 56 Gy or greater may be required. That can be done by using smaller doses per fraction and gradually reducing the size of the field so that the highest dose is given only to the tumor with a relatively tight margin. Malignant melanomas can be controlled locally apparently with a few large fractions. Metastatic disease limits survival; therefore, some type of systemic therapy seems to be needed to improve survival of those patients. Canine oral fibrosarcomas require a very high dose for a reasonable probability of control. It seems that a dose of 56 Gy given in 3.3 Gy fractions might provide local control of 50% of the tumors. It is likely that a combination of surgery and radiation would significantly improve the probability for control. Oral squamous cell carcinomas of cats must also be treated very aggressively to improve local control. Tumors of the nasal cavity are usually very large and invasive at the time of diagnosis. Radiation therapy has been shown to be effective in some instances. It is possible that with better definition of the tumor through computerized tomography imaging and improved treatment planning, control of these difficult to manage nasal tumors can be improved

  16. Selective lymph node dissection following hyperfractionated accelerated radio-(chemo-)therapy for advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hehr, T.; Classen, J.; Schreck, U.; Glocker, S.; Bamberg, M.; Budach, W. [Dept. of Radiation Oncology, Eberhard-Karls Univ. of Tuebingen (Germany); Koitschev, A. [Dept. of Head and Neck Surgery, Eberhard-Karls Univ. of Tuebingen (Germany)

    2002-07-01

    -(chemo-)therapie is likely to contribute to loco-regional tumor control in advanced head and neck cancer. (orig.) [German] Hintergrund: Die multizentrische Phase-III-Studie (ARO 95-6) zur akzelerierten hyperfraktionierten Strahlentherapie {+-}5-Fluorouracil/Mitomycin C bei lokal fortgeschrittenen Kopf-Hals-Tumoren konnte nachweisen, dass die kombinierte Radiochemotherapie bezueglich lokaler Tumorkontrolle und Gesamtueberleben wirksamer ist als die alleinige Strahlentherapie. Wir untersuchten Haeufigkeit, histopathologisches Ergebnis und den Einfluss der selektiven Neck-Dissection auf die lokale Tumorkontrolle. Patienten und Methoden: Zwischen Februar 1996 und Oktober 2000 wurden in Tuebingen insgesamt 42 randomisierte und 45 nicht randomisierte Patienten mit fortgeschrittenen Kopf-Hals-Tumoren im Stadium III/IV MO nach diesem Protokoll behandelt. Nach Abschluss der akzelerierten hyperfraktionierten Strahlentherapie {+-}5-Fluorouracil/Mitomycin C wurde eine selektive Neck-Dissection bei kompletter Remission des Primaertumors und partieller Remission der Halslymphknotenmetastasen angestrebt. Bei 17 von 38 Patienten mit residuellen Halslymphknotenmetastasen wurde eine uni- oder bilaterale selektive Neck-Dissection durchgefuehrt. Bei 21 Patienten wurde die Neck-Dissection wegen partieller Remission des Primaertumors, klinischer Verschlechterung oder Ablehnung durch den Patienten nicht durchgefuehrt. Ergebnisse: Nach einem medianen Follow-up von 26 Monaten betrugen das 2-Jahres-Gesamtueberleben 49%, das krankheitsspezifische Ueberleben 64% und die lokoregionaere Tumorkontrolle 60% (Kaplan-Meier-Analyse). Fuer cT4-cNO-Tumoren betrug die lokoregionaere 2-Jahres-Tumorkontrolle 76% im Vergleich zu 57% bei cT2-4-cN1-3-Tumoren. Es bestand kein Unterschied bezueglich der lokoregionaeren Tumorkontrolle zwischen randomisierten und nicht randomisierten Patienten. Bei kompletter Remission des Primaertumors und der lokoregionaeren Lymphknoten betrug die 2-Jahres-Tumorkontrolle 74%, bei partieller

  17. Molecular mechanisms of radioresistance: applications for head and neck cancer

    International Nuclear Information System (INIS)

    A significant part of head and neck cancers is clinically radioresistant. The mechanisms of acquired or intrinsic radioresistance of head and neck tumors are still unclear. More recently molecular research focused on alterations in cell cycle control and resistance to programmed cell death in tumor cells as possible mechanisms of radioresistance. Some molecular targets of radiosensitivity or radioresistance (e.g. specific oncogenes or tumor suppressor genes) are known in specific tumor cells or tumor model systems. Such key targets for head and neck cancer cells are also emerging in in vitro studies. However, it is unclear so far if the modification of such molecular targets in vivo leads to an increased tumor selective radiosensitivity. Nevertheless, selected molecular targets could be potential novel tools for modifying radiosensitivity through gene therapy in patients with radioresistant head and neck cancers. (orig.)

  18. A comparative study of low dose weekly paclitaxel versus cisplatin with concurrent radiation in the treatment of locally advanced head and neck cancers

    Directory of Open Access Journals (Sweden)

    R K Jain

    2009-01-01

    Full Text Available Purpose: The purpose of this study was to compare low dose weekly paclitaxel versus cisplatin with concurrent radiation in locally advanced head and neck cancers. Materials and Methods: From August 2005 to July 2006, a total of 100 biopsy proven, locally advanced head and neck cancers were enrolled for the study. All the patients were stratified in two groups, study group A and control group B. Study group patients received injection Paclitaxel 20 mg/m 2 , I/V 1 hr infusion weekly for 6 weeks and control group patients received injection Cisplatin 30 mg/m 2 , I/V 2 hrs infusion weekly for 6 weeks. All patients received 66-70 Gy concurrent radiation at the rate of 2 Gy/day, 5 #/week, in 6-7 weeks by cobalt theratron phoenix - 80 teletherapy units. Result: Complete response achieved in 73% of patients in study group and 64% of patients in control group. There was no statistically significant difference observed between the study group and the control group (χ2 = 1.167, df = 1, level of significance 0.05. On 3-10 months of follow-up 59% of patients in the study group and 42% of patients in the control group are alive and disease free. Local toxicities including mucositis, dysphasia and skin reactions were more in the study group but tolerable. Conclusion: Efficacy of paclitaxel in low dose weekly schedule is comparable to cisplatin in locally advanced head and neck squamous cell carcinoma. Further analysis and follow-up are needed to evaluate if this benefit will translate into prolonged survival.

  19. Pretreatment anemia is correlated with the reduced effectiveness of radiation and concurrent chemotherapy in advanced head and neck cancer

    International Nuclear Information System (INIS)

    Purpose: Pretreatment anemia is an adverse prognostic variable in squamous cell head-and-neck cancer (HNC) patients treated with radiotherapy (RT) alone. Tumor hypoxia is an adverse parameter for treatment with RT alone or with RT and concurrent chemotherapy (CCT). Tumor hypoxia is more prevalent in patients who present with pretreatment hemoglobin (Hgb) concentrations less than 13 g/dL. RT/CCT improves survival over RT alone in advanced HNC, and its use is becoming more widespread. This study was performed to evaluate whether pretreatment Hgb less than 13 g/dL was correlated with treatment outcome in patients with advanced HNC treated with a uniform regimen of RT/CCT. Methods and materials: The study population consisted of patients with AJCC Stage III or IV, M0 HNC who were treated with 70 to 72.5 Gy accelerated hyperfractionated RT (1.25 Gy b.i.d.) and CCT consisting of 2 cycles of CDDP (12-20 mg/m2/d x 5 days) and continuous infusion 5-FU (600 mg/m2/d x 5 days) during Week 1 and Week 6. A planned break in RT occurred during Week 4. These patients were enrolled on the experimental arm of a prospective randomized trial that compared this regimen to hyperfractionated irradiation alone from 1990 to 1996. RT/CCT was delivered as standard therapy from 1996 to 2000. The primary endpoint was failure-free survival (FFS). Secondary endpoints included local-regional control and overall survival. Results: One hundred and fifty-nine patients were treated from 1990 to 2000. The median (25-75%) pretreatment Hgb was 13.6 (12.2-13.5) g/dL. Hgb was 13 g/dL or higher in 105 patients and less than 13 g/dL in 54 patients. Primary tumor sites included oropharynx (43%), hypopharynx/larynx (36%), oral cavity (9%), and nasopharynx (6%). Seventy-eight percent of the patients with Hgb 13 g/dL or higher and 92% of the patients with Hgb less than 13 g/dL had a primary tumor stage of T3 or T4 (p = 0.01). Node-positive disease was present in 74 of 105 (70%) of patients with Hgb 13 g/dL or

  20. The Tip of the Iceberg: Clinical Implications of Genomic Sequencing Projects in Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    Andrew C. Birkeland

    2015-10-01

    Full Text Available Recent genomic sequencing studies have provided valuable insight into genetic aberrations in head and neck squamous cell carcinoma. Despite these great advances, certain hurdles exist in translating genomic findings to clinical care. Further correlation of genetic findings to clinical outcomes, additional analyses of subgroups of head and neck cancers and follow-up investigation into genetic heterogeneity are needed. While the development of targeted therapy trials is of key importance, numerous challenges exist in establishing and optimizing such programs. This review discusses potential upcoming steps for further genetic evaluation of head and neck cancers and implementation of genetic findings into precision medicine trials.

  1. Prospective randomized trial to compare accelerated (six fractions a week radiotherapy against concurrent chemoradiotherapy (using conventional fractionation in locally advanced head and neck cancers

    Directory of Open Access Journals (Sweden)

    Manoj Gupta

    2015-01-01

    Full Text Available Background: Concurrent chemoradiation (CCRT is currently considered to be the standard of care in locally advanced head and neck cancer. The optimum radiotherapy schedule for best local control and acceptable toxicity is not yet clear. We aimed at shortening of treatment time by using accelerated radiation, thereby comparing the disease response, loco-regional tumor control and tolerability of accelerated radiation (six fractions per week against CCRT in locally advanced head and neck cancer. Materials and Methods: We conducted the prospective randomized study for a period of 2 years from June 2011 to May 2013 in 133 untreated patients of histologically confirmed squamous cell carcinoma of head and neck. Study group (66 patients received accelerated radiotherapy with 6 fractions per week (66Gy/33#/5½ weeks. Control group (67 patients received CCRT with 5 fractions per week radiation (66 Gy/33#/6½ weeks along with intravenous cisplatin 30 mg/m 2 weekly. Tumor control, survival, acute and late toxicities were assessed. Results: Median overall treatment time was 38 days and 45 days in the accelerated radiotherapy and concurrent chemoradiation arm, respectively. At a median follow up of 12 months, 41 patients (62.1% in the accelerated radiotherapy arm and 47 patients (70.1% in the CCRT arm were disease free (P = 0.402. Local disease control was comparable in both the arms. Acute toxicities were significantly higher in the CCRT arm as compared with accelerated radiotherapy arm. There was no difference in late toxicities between the two arms. Conclusion: We can achieve, same or near to the same local control, with lower toxicities with accelerated six fractions per week radiation compared with CCRT especially for Indian population.

  2. Clinicopathological correlates of pediatric head and neck cancer

    OpenAIRE

    Sengupta Subhabrata; Pal Ranabir

    2009-01-01

    Background : The spectrum of head and neck tumors in children continues to be the cause of diverse, diagnostically challenging issues. Aims : To demonstrate and compare the unique clinicopathological features in our study population and their correlations with the final histopathological diagnosis. Methods : Fifty-three children with head and neck cancer were examined thoroughly at the Otorhinolaryngology department in a tertiary care teaching hospital followed by histopathological studies...

  3. Prediction of clinical toxicity in locally advanced head and neck cancer patients by radio-induced apoptosis in peripheral blood lymphocytes (PBLs)

    International Nuclear Information System (INIS)

    in locally advanced head and neck cancer patients. Anyhow, prospective studies with different cancer types and higher number of patients are needed to validate these results

  4. Prognostic value of hemoglobin concentrations in patients with advanced head and neck cancer treated with combined radio-chemotherapy and surgery

    International Nuclear Information System (INIS)

    Purpose: Hemoglobin levels are currently the focus of interest as prognostic factors in patients with head and neck cancer. Most published clinical trials have confirmed hemoglobin to process a significant influence on survival in patients treated with radiotherapy. In our study we have investigated the prognostic value of hemoglobin in a combined modality schedule. Patients and Methods: Forty-three patients with advanced head and neck tumors were treated with combined radiochemotherapy. The therapy comprised 2 courses of induction chemotherapy with ifosfamide (1,500 mg/m2, day 1 to 5) and cisplatin (60 mg/m2, day 5) followed by hyperfractionated accelerated radiotherapy with a total dose of only 30 Gy. Surgery involved tumor resection and neck dissection. Results: The 1-year overall survival rate and the 2-year survival rate were 79% and 56%, respectively. The 1- and 2-year recurrence-free survival rates were 68% and 49%, respectively. Prognostic factors with an impact on survival were seen in tumor size (T3 vs T4, p=0.0088), response to radio-chemotherapy at the primary site (no vital tumor rest vs vital tumor rest, p=0.045), response to lymph node radio-chemotherapy (no vital tumor cells vs vital tumor cells, p=0.013) and level of hemoglobin after radio-chemotherapy (Hb≥11.5 g/dl vs <11.5 g/dl, p=0.0084). Conclusion: In our study hemoglobin level after radio-chemotherapy was identified for the first time to be also a significant prognostic factor (univariate analysis) in head and neck cancer patients who underwent combined radio-chemotherapy. Besides chemotherapy plus low-dose irradiation achieved similar results in comparison with radical resection and high-dose radiotherapy at least for the first 2 years after therapy. Relapsing disease could be treated with 1 additional course of radiotherapy which is supposed to be well tolerated. (orig.)

  5. Hyperfractionated Radiotherapy with Concurrent Cisplatin/5-Fluorouracil for Locoregional Advanced Head and Neck Cancer: Analysis of 105 Consecutive Patients

    Directory of Open Access Journals (Sweden)

    David Zaboli

    2012-01-01

    Full Text Available Objective. We reviewed a cohort of patients with previously untreated locoregional advanced head and neck squamous cell carcinoma (HNSCC who received a uniform chemoradiotherapy regimen. Methods. Retrospective review was performed of 105 patients with stage III or IV HNSCC treated at Greater Baltimore Medical Center from 2000 to 2007. Radiation included 125 cGy twice daily for a total 70 Gy to the primary site. Chemotherapy consisted of cisplatin (12 mg/m2/h daily for five days and 5-fluorouracil (600 mg/m2/20 h daily for five days, given with weeks one and six of radiation. All but seven patients with N2 or greater disease received planned neck dissection after chemoradiotherapy. Primary outcomes were overall survival (OS, locoregional control (LRC, and disease-free survival (DFS. Results. Median followup of surviving patients was 57.6 months. Five-year OS was 60%, LRC was 68%, and DFS was 56%. Predictors of increased mortality included age ≥55, female gender, hypopharyngeal primary, and T3/T4 stage. Twelve patients developed locoregional recurrences, and 16 patients developed distant metastases. Eighteen second primary malignancies were diagnosed in 17 patients. Conclusions. The CRT regimen resulted in favorable outcomes. However, locoregional and distant recurrences cause significant mortality and highlight the need for more effective therapies to prevent and manage these events.

  6. Cetuximab: its unique place in head and neck cancer treatment

    Directory of Open Access Journals (Sweden)

    Specenier P

    2013-04-01

    Full Text Available Pol Specenier, Jan B Vermorken Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium Abstract: Head and neck cancer is the sixth most common cancer worldwide. At present, globally about 650,000 new cases of squamous cell carcinoma of the head and neck (SCCHN are diagnosed each year. The epidermal growth factor receptor (EGFR is almost invariably expressed in SCCHN. Overexpression of the EGFR is a strong and independent unfavorable prognostic factor in SCCHN. Cetuximab is a chimeric monoclonal antibody, which binds with high affinity to the extracellular domain of the human EGFR, blocking ligand binding, resulting in inhibition of the receptor function. It also targets cytotoxic immune effector cells towards EGFR-expressing tumor cells (antibody dependent cell-mediated cytotoxicity. The addition of cetuximab to radiotherapy (RT improves locoregional control and survival when compared to RT alone. The addition of cetuximab to platinum-based chemoradiation (CRT is feasible but does not lead to an improved outcome. Cetuximab plus RT has never been compared prospectively to CRT, which therefore remains the standard treatment for patients with locoregionally advanced SCCHN for whom surgery is not considered the optimal treatment, provided they can tolerate CRT. The addition of cetuximab to platinum-based chemotherapy prolongs survival in patients with recurrent or metastatic SCCHN. The combination of a platinum-based regimen and cetuximab should be considered as the standard first line regimen for patients who can tolerate this treatment. Keywords: SCCHN, cetuximab, recurrent metastatic, locoregionally advanced, chemoradiation

  7. Radiation therapy and concurrent cisplatin administration in locally advanced head and neck cancer. A Hellenic co-operative oncology group study

    Energy Technology Data Exchange (ETDEWEB)

    Fountzilas, G. [AHEPA Hospital, Thessaloniki (Greece); Skarlos, D. [`Agii Anargyri` Cancer Hospital, Athens (Greece); Kosmidis, P. [`METAXA` Cancer Hospital, Piraeous (Greece); Samantas, E. [`Agii Anargyri` Cancer Hospital, Athens (Greece); Kalogera-Fountzila, A. [AHEPA Hospital, Thessaloniki (Greece); Papaspyrou, S. [`Evangelismos` Hospital, Athens (Greece); Tzitzikas, J. [AHEPA Hospital, Thessaloniki (Greece); Sridhar, K.S. [Sylvester Comprehensive Cancer Center, Miami, FL (United States); Makrantonakis, P. [AHEPA Hospital, Thessaloniki (Greece); Pantelakos, P. [`Agii Anargyri` Cancer Hospital, Athens (Greece); Nikolaou, A. [AHEPA Hospital, Thessaloniki (Greece); Bacoyiannis, H. [`METAXA` Cancer Hospital, Piraeous (Greece); Sinodinou, M. [`METAXA` Cancer Hospital, Piraeous (Greece); Banis, C. [`METAXA` Cancer Hospital, Piraeous (Greece); Daniilidis, J. [AHEPA Hospital, Thessaloniki (Greece)

    1994-12-31

    In an attempt to improve local control of locally advanced head and neck cancer, radiation therapy was combined with cisplatin. Forty-eight patients entered into this study. All patients were irradiated with a {sup 60}Co unit and according to the protocol they should receive 70 Gy in the tumor area and 45 Gy in the rest of neck. Cisplatin was administered at a dose of 100 mg/m{sup 2} on days 2, 22 and 42. Thirty-seven (80%) patients received the total radiation dose as initially planned. Thirty-four (72%) patients achieved complete and 5 (10%) partial response. Grade 3-4 toxicities included vomiting (14%) stomatitis (4%), diarrhea (2%), myelotoxicity (14%), hoarseness (4%), dysphagia (30%), weight loss (32%), nephrotoxicity (4%) and dermatitis (2%). After a median follow-up of 26 (range, 18-33) months, 16 patients have died. Among the 35 complete responders 6 later on relapsed. Median relapse-free survival has not yet been reached. Combined radiation therapy and cisplatin appears to be a highly active treatment in patients with advanced head and neck cancer as far as primary locoregional response is concerned. (orig.).

  8. Radiation therapy and concurrent cisplatin administration in locally advanced head and neck cancer. A Hellenic co-operative oncology group study

    International Nuclear Information System (INIS)

    In an attempt to improve local control of locally advanced head and neck cancer, radiation therapy was combined with cisplatin. Forty-eight patients entered into this study. All patients were irradiated with a 60Co unit and according to the protocol they should receive 70 Gy in the tumor area and 45 Gy in the rest of neck. Cisplatin was administered at a dose of 100 mg/m2 on days 2, 22 and 42. Thirty-seven (80%) patients received the total radiation dose as initially planned. Thirty-four (72%) patients achieved complete and 5 (10%) partial response. Grade 3-4 toxicities included vomiting (14%) stomatitis (4%), diarrhea (2%), myelotoxicity (14%), hoarseness (4%), dysphagia (30%), weight loss (32%), nephrotoxicity (4%) and dermatitis (2%). After a median follow-up of 26 (range, 18-33) months, 16 patients have died. Among the 35 complete responders 6 later on relapsed. Median relapse-free survival has not yet been reached. Combined radiation therapy and cisplatin appears to be a highly active treatment in patients with advanced head and neck cancer as far as primary locoregional response is concerned. (orig.)

  9. Metal concentrations in hair of patients with various head and neck cancers as a diagnostic aid.

    Science.gov (United States)

    Wozniak, Anna; Napierala, Marta; Golasik, Magdalena; Herman, Małgorzata; Walas, Stanisław; Piekoszewski, Wojciech; Szyfter, Witold; Szyfter, Krzysztof; Golusinski, Wojciech; Baralkiewicz, Danuta; Florek, Ewa

    2016-02-01

    Head and neck cancers are one of the most frequent cancers worldwide. This paper attempts to evaluate disturbances of homeostasis of the necessary elements (calcium, magnesium, zinc, copper, iron, manganese) and changes in the levels of toxic metals (lead, cadmium, cobalt, chromium VI) in hair of patients with head and neck cancers, as well as people without a diagnosed neoplastic disease. In order to quantify the necessary elements and toxic metals, a method using ICP-MS and ICP-OES techniques had been developed and validated. The studies have shown that patients with head and neck cancer used to drink alcohol and smoked much more frequently than healthy individuals, both in the past and presently. Statistically significant differences in concentrations of average metal content in the group of patients with head and neck cancers compared to the control group were confirmed. Significant differences in metal content between the group of patients with head and neck cancers and healthy individuals were found which enabled distinguishing between the study groups. To this end, a more advanced statistical tool, i.e. chemometrics, was used. The conducted research analyses and the use of advanced statistical techniques confirm the benefits of using alternative material to distinguish the patients with head and neck cancers from the healthy individuals. PMID:26660304

  10. [HPV associated head and neck cancers].

    Science.gov (United States)

    Vourexakis, Zacharias; Dulguerov, Pavel

    2011-10-01

    The incidence of oropharyngeal squamous cell carcinoma is rising and this increase is linked to sexual behaviors. Viral and epidemiological studies have linked tonsillar and base of tongue carcinoma with a human papilloma virus (HPV) infection. The patients involved are usually younger and do not exhibit other risk factors such as smoking and alcohol abuse. HPV positive squamous cell carcinoma are associated with a better prognosis than other head and neck carcinoma. Differences in the carcinogenesis mechanisms open options for different and specific oncologic treatments and the potential for prevention of these HPV-related carcinoma by vaccination. PMID:22046680

  11. Impact of weight loss on survival after chemoradiation for locally advanced head and neck Cancer: secondary results of a randomized phase III trial (SAKK 10/94)

    International Nuclear Information System (INIS)

    To analyze the impact of weight loss before and during chemoradiation on survival outcomes in patients with locally advanced head and neck cancer. From 07/1994-07/2000 a total of 224 patients with squamous cell carcinoma of the head and neck were randomized to either hyperfractionated radiation therapy alone or the same radiation therapy combined with two cycles of concomitant cisplatin. The primary endpoint was time to any treatment failure (TTF); secondary endpoints were locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS). Patient weight was measured 6 months before treatment, at treatment start and treatment end. The proportion of patients with >5% weight loss was 32% before, and 51% during treatment, and the proportion of patients with >10% weight loss was 12% before, and 17% during treatment. After a median follow-up of 9.5 years (range, 0.1 – 15.4 years) weight loss before treatment was associated with decreased TTF, LRRFS, DMFS, cancer specific survival and OS in a multivariable analysis. However, weight loss during treatment was not associated with survival outcomes. Weight loss before and during chemoradiation was commonly observed. Weight loss before but not during treatment was associated with worse survival

  12. Prospective Pilot Study of Consolidation Chemotherapy With Docetaxel and Cisplatin After Concurrent Chemoradiotherapy for Advanced Head and Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: With the improvement concurrent chemoradiotherapy (CCRT) in the management of patients with locoregionally advanced head and neck squamous cell carcinoma (HNSCC), distant failures have become a more relevant problem in terms of survival. The primary objective of this Phase II study is to assess the feasibility of docetaxel and cisplatin consolidation after primary CCRT for patients with HNSCC. Methods and Materials: Patients with locoregionally advanced HNSCC received chemotherapy with three cycles of cisplatin, 100 mg/m2, on Days 1, 22, and 43. Concurrent radiotherapy to the primary tumor and neck was given in a daily dose of 2 Gy to a total dose of 70-70.2 Gy over 7 weeks. After completion of CCRT, patients without evidence of disease progression received an additional four cycles of consolidation chemotherapy with docetaxel, 75 mg/m2, and cisplatin, 75 mg/m2, every 3 weeks. Results: Of 33 patients, 27 (81%) completed CCRT. After CCRT, three complete and 19 partial responses were recorded, giving an overall response rate of 67%. Of 19 patients who went to the consolidation phase, only 4 (21%) received all four cycles of docetaxel and cisplatin. Causes of failure of consolidation chemotherapy were toxicity in 11 patients, including three treatment-related deaths, and progression in 4 patients. Three patients died of sepsis during the consolidation phase. Median survival was 11 months for all patients and 8 months for those treated with consolidation chemotherapy. Conclusion: The poor compliance and high incidence of severe toxicities prompted no further evaluation of this consolidation chemotherapy after CCRT

  13. Taxane-containing induction chemotherapy followed by definitive chemoradiotherapy. Outcome in patients with locally advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Broemme, J.O.; Schmuecking, M.; Leiser, D.; Geretschlaeger, A.; Ghadjar, P.; Aebersold, D.M. [Bern Univ. Hospital and Bern Univ. (Switzerland). Dept. of Radiation Oncology; Arnold, A.; Giger, R. [Bern Univ. (Switzerland). Head and Neck Surgery; Rauch, D. [Bern Univ. (Switzerland). Medical Oncology; Plasswilm, L. [Kantonsspital, St. Gallen (Switzerland). Radiation Oncology

    2013-08-15

    Background: Induction chemotherapy followed by definitive chemoradiotherapy is an intensified treatment approach for locally advanced squamous cell carcinoma of the head and neck (HNSCC) that might be associated with high rates of toxicity. Materials and methods: The data of 40 consecutive patients who underwent induction chemotherapy with docetaxel-containing regimens followed by intensity-modulated radiotherapy (IMRT) and concomitant systemic therapy for unresectable locally advanced HNSCC were retrospectively analyzed. Primary objectives were RT-related acute and late toxicity. Secondary objectives were response to induction chemotherapy, locoregional recurrence-free survival (LRRFS), overall survival (OS), and influencing factors for LRRFS and OS. Results: The median follow-up for surviving patients was 21 months (range, 2-53 months). Patients received a median of three cycles of induction chemotherapy followed by IMRT to 72 Gy. Three patients died during induction chemotherapy and one during chemoradiotherapy. Acute RT-related toxicity was of grade 3 and 4 in 72 and 3 % of patients, respectively, mainly dysphagia and dermatitis. Late RT-related toxicity was mainly xerostomia and bone/cartilage necrosis and was of grade 3 and 4 in 15 % of patients. One- and 2-year LRRFS and OS were 72 and 49 % and 77 and 71 %, respectively. Conclusion: Induction chemotherapy followed by chemoradiotherapy using IMRT was associated with a high rate of severe acute and late RT-related toxicities in this selected patient cohort. Four patients were lost because of fatal complications. Induction chemotherapy did not compromise the delivery of full-dose RT; however, the use of three cycles of concomitant cisplatin was impaired. (orig.)

  14. Current relevance of hypoxia in head and neck cancer

    OpenAIRE

    Bredell, Marius G; Ernst, Jutta; El-Kochairi, Ilhem; Dahlem, Yuliya; Ikenberg, Kristian; Schumann, Desiree M.

    2016-01-01

    Head and Neck cancer (HNC) is a complex mix of cancers and one of the more common cancers with a relatively poor prognosis. One of the factors that may assist us in predicting survival and allow us to adjust our treatment strategies is the presence of tumor hypoxia. In this overview we aim to evaluate the current evidence and potential clinical relevance of tumor hypoxia in head and neck cancer according to an extensive search of current literature. An abundance of evidence and often contradi...

  15. Locally advanced head and neck cancer treated with accelerated radiotherapy, the hypoxic modifier nimorazole and weekly cisplatin. Results from the DAHANCA 18 phase II study

    DEFF Research Database (Denmark)

    Bentzen, Jens; Toustrup, Kasper; Eriksen, Jesper Grau; Primdahl, Hanne; Andersen, Lisbeth Juhler; Overgaard, Jens

    2015-01-01

    150 oropharyngeal cancers. Of these, 112 (79%) were p16 pos and 29 (21%) were p16 neg. LRC for the p16 neg oropharyngeal cancers was poorer than for the p16 pos (74% vs. 91%; p = 0.02). Tube feeding during treatment was necessary for 146 (64%) patients. At 12 months this number was reduced to 6......%. CONCLUSION: The treatment was tolerable in this cohort of locally advanced HNSCC patients. Acute and late toxicity was comparable to similar studies of chemoradiotherapy, and the outcome superior to the data reported in the literature. This strongly indicates that RT of a......PURPOSE/OBJECTIVE: A phase II clinical trial evaluating the feasibility and outcome of treating locally advanced head and neck squamous cell carcinoma (HNSCC) with accelerated radiotherapy, the hypoxic modifier nimorazole and weekly cisplatin. MATERIAL AND METHODS: A total of 227 patients with...

  16. Hypopharyngeal Dose Is Associated With Severe Late Toxicity in Locally Advanced Head-and-Neck Cancer: An RTOG Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Machtay, Mitchell, E-mail: mitchell.machtay@uhhospitals.org [University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (United States); Moughan, Jennifer [Radiation Therapy Oncology Group Headquarters and Statistical Center, Philadelphia, Pennsylvania (United States); Farach, Andrew [Thomas Jefferson University, Philadelphia, Pennsylvania (United States); University of Texas Health Science Center/Baylor College of Medicine, Houston, Texas (United States); Martin-O' Meara, Elizabeth [Radiation Therapy Oncology Group Headquarters and Statistical Center, Philadelphia, Pennsylvania (United States); Galvin, James [Radiation Therapy Oncology Group Headquarters and Statistical Center, Philadelphia, Pennsylvania (United States); Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Garden, Adam S.; Weber, Randal S. [MD Anderson Cancer Center, Houston, Texas (United States); Cooper, Jay S. [Maimonides Medical Center, New York, New York (United States); Forastiere, Arlene [Johns Hopkins University Medical Center, Baltimore, Maryland (United States); Ang, K. Kian [MD Anderson Cancer Center, Houston, Texas (United States)

    2012-11-15

    Purpose: Concurrent chemoradiation therapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases local tumor control but at the expense of increased toxicity. We recently showed that several clinical/pretreatment factors were associated with the occurrence of severe late toxicity. This study evaluated the potential relationship between radiation dose delivered to the pharyngeal wall and toxicity. Methods and Materials: This was an analysis of long-term survivors from 3 previously reported Radiation Therapy Oncology Group (RTOG) trials of CCRT for locally advanced SCCHN (RTOG trials 91-11, 97-03, and 99-14). Severe late toxicity was defined in this secondary analysis as chronic grade 3-4 pharyngeal/laryngeal toxicity and/or requirement for a feeding tube {>=}2 years after registration and/or potential treatment-related death (eg, pneumonia) within 3 years. Radiation dosimetry (2-dimensional) analysis was performed centrally at RTOG headquarters to estimate doses to 4 regions of interest along the pharyngeal wall (superior oropharynx, inferior oropharynx, superior hypopharynx, and inferior hypopharynx). Case-control analysis was performed with a multivariate logistic regression model that included pretreatment and treatment potential factors. Results: A total of 154 patients were evaluable for this analysis, 71 cases (patients with severe late toxicities) and 83 controls; thus, 46% of evaluable patients had a severe late toxicity. On multivariate analysis, significant variables correlated with the development of severe late toxicity, including older age (odds ratio, 1.062 per year; P=.0021) and radiation dose received by the inferior hypopharynx (odds ratio, 1.023 per Gy; P=.016). The subgroup of patients receiving {<=}60 Gy to the inferior hypopharynx had a 40% rate of severe late toxicity compared with 56% for patients receiving >60 Gy. Oropharyngeal dose was not associated with this outcome. Conclusions: Severe late toxicity following CCRT is

  17. Image guided surgery in the management of head and neck cancer.

    Science.gov (United States)

    Iqbal, Hassan; Pan, Quintin

    2016-06-01

    Complete resection of head and neck tumors relies on palpation and visual inspection. Achieving a negative margin in remote locations in the head and neck region, especially in close proximity to critical structures, is often difficult to achieve. Positive resection margins in head and neck cancer are at high risk to develop recurrent disease and associated with poor prognosis. Near-infrared fluorescence-guided optical imaging is an emerging technology with the potential to move the surgical field forward and facilitate surgeons to visualize tumors in real-time intra-operatively. In this review, our focus is to discuss the recent advances and the potential application of near infrared (NIR) fluorescent-guided surgery in the management of head and neck cancer. PMID:27208842

  18. Split Course Hyperfractionated Accelerated Radio-Chemotherapy (SCHARC) for patients with advanced head and neck cancer: Influence of protocol deviations and hemoglobin on overall survival, a retrospective analysis

    International Nuclear Information System (INIS)

    The advantage of hyperfractionated accelerated radiation therapy for advanced head and neck cancer has been reported. Furthermore, randomized trials and meta-analyses have confirmed the survival benefit of additional chemotherapy to radiotherapy. We retrospectively analyzed the efficiency and toxicity of the Regensburg standard therapy protocol 'SCHARC' and the overall survival of our patients. From 1997 to 2004, 64 patients suffering from advanced head and neck cancer (88 % stage IV, 12 % stage III) were assigned to receive the SCHARC protocol. Around half of the patients were diagnosed with oro-hypopharynx carcinoma (52 %), one third with tongue and floor of mouth tumors (29 %) and one fifth (19 %) suffered from H & N cancer at other sites. The schedule consisted of one therapy block with 30 Gy in 20 fractions over a two week period with concomitant chemotherapy (d 1–5: 20 mg/m2/d DDP + 750–1000 mg/m2/d 5FU (cont. infusion). This therapy block was repeated after a fortnight break up to a cumulative dose of 60 Gy and followed by a boost up to 70 Gy (69–70.5 Gy). All patients assigned to this scheme were included in the survival evaluation. Forty patients (63 %) received both radiation and chemotherapy according to the protocol. The mean follow up was 2.3 years (829 d) and the median follow up was 1.9 years (678 d), respectively. The analysis of survival revealed an estimated 3 year overall survival rate of 57 %. No patient died of complications, 52 patients (80 %) had acute grade 2–3 mucositis, and 33 patients (58 %) suffered from acute grade 3 skin toxicity. Leucopenia was no major problem (mean nadir 3.4 g/nl, no patient < 1.0 g/nl) and the mean hemoglobin value decreased from 13.2 to 10.5 g/dl. Univariate analysis of survival showed a better outcome for patients with a hemoglobin nadir >10.5 g/dl and for patients who completed the protocol. The SCHARC protocol was effective in patients diagnosed with advanced head and neck cancer. It led to

  19. Reconstruction of Segmental Hemi-Mandibular Defects Using Soft Tissue Flaps in Patients with Severe Co morbidity and Advanced Head and Neck Cancer

    International Nuclear Information System (INIS)

    Background and Purpose: The standard of care to reconstruct segmental oro-mandibular defects following head and neck oncological resection is to use osseocutaneous free-tissue transfer. Some patients however are not suitable for this type of complex reconstruction. The purpose of this paper is to study our results of soft-tissue flap reconstruction for segmental hemi-mandibular defects. Patients and Methods: Ten patients were included in the study, all had advanced squamous cell carcinoma of the oropharynx or oral cavity and all had hemi- mandibulectomies. Results: In eight cases a vertical rectus abdominis myocutaneous (VRAM) free flap was used and in two cases a pectoralis major myocutaneous pedicled flap was used. Normal oral feeding was achieved in six patients with a mean time for discontinuation of tube feeding of 18 days. Conclusion: In selected patients with severe co- morbidity and advanced oro-mandibular cancer, soft tissue flaps may be used for segmental hemi-mandibular defects

  20. Analysis of carotid artery deformation in different head and neck positions for maxillofacial catheter navigation in advanced oral cancer treatment

    OpenAIRE

    Ohya Takashi; Iwai Toshinori; Luan Kuan; Kato Takashi; Liao Hongen; Kobayashi Etsuko; Mitsudo Kenji; Fuwa Nobukazu; Kohno Ryuji; Sakuma Ichiro; Tohnai Iwai

    2012-01-01

    Abstract Background To improve the accuracy of catheter navigation, it is important to develop a method to predict shifts of carotid artery (CA) bifurcations caused by intraoperative deformation. An important factor affecting the accuracy of electromagnetic maxillofacial catheter navigation systems is CA deformations. We aimed to assess CA deformation in different head and neck positions. Methods Using two sets of computed tomography angiography (CTA) images of six patients, displacements of ...

  1. American Cancer Society Head and Neck Cancer Survivorship Care Guideline.

    Science.gov (United States)

    Cohen, Ezra E W; LaMonte, Samuel J; Erb, Nicole L; Beckman, Kerry L; Sadeghi, Nader; Hutcheson, Katherine A; Stubblefield, Michael D; Abbott, Dennis M; Fisher, Penelope S; Stein, Kevin D; Lyman, Gary H; Pratt-Chapman, Mandi L

    2016-05-01

    Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society. PMID:27002678

  2. Accelerated versus conventional fractionated postoperative radiotherapy for advanced head and neck cancer: Results of a multicenter Phase III study

    International Nuclear Information System (INIS)

    , respectively (p = 0.10). Conclusion: Accelerated fractionation does not seem to be worthwhile for squamous cell carcinoma of the head and neck after resection; however, AF might be an option for patients who delay starting RT

  3. Weekly chemotherapy as Induction chemotherapy in locally advanced head and neck cancer for patients ineligible for 3 weekly maximum tolerable dose chemotherapy

    Directory of Open Access Journals (Sweden)

    Vijay Maruti Patil

    2014-01-01

    Full Text Available Objective: To study the safety and efficacy of weekly chemotherapy as part of induction chemotherapy, in locally advanced head and neck cancer for patients, who are unfit for upfront radical treatment. Materials and Methods: It is a retrospective analysis of on-use weekly chemotherapy as Induction chemotherapy in locally advanced head and neck cancer, who are technically unresectable are unfit for upfront radical treatment. Induction chemotherapy given was a 2 drug combination of paclitaxel (80 mg/m 2 and carboplatin AUC 2. The decision to give weekly induction chemotherapy was given on the basis of presence of 2 more following features: Poor performance status (ECOG PS 2-3, presence of uncontrolled co morbidities, BMI below 18.5 kg/m 2 and age more than 60 years. The Statistical Package for the Social Sciences software (SPSS version 16.0 was used for analysis. The response rates, toxicity (accordance with CTCAE vs. 4.02, completion rate (Cp of radical intent treatment post neoadjuvant chemotherapy (NACT, progression-free survival (PFS and overall survival (OS are reported. Results: Fifteen patients were considered for such therapy. Fourteen out of fifteen patients completed NACT. The median numbers of planned weekly cycles were 6 (3-8. Response (CR + PR was seen in 10 patients. Overall grade 3-4 toxicity was seen in 6 patients. No toxicity related mortality was noted. The calculated completion rate (Cp of radical intent treatment post NACT was 46.7%. The median PFS and OS were 10.36 months (95% CI 6.73-14.00 months and 16.53 months (95% CI 4.22-28.84. Conclusion: Use of induction chemotherapy with weekly regimen is safe and effective selected cohort of patients with locally advanced disease who are unfit for upfront radical treatment.

  4. Spectrum of head and neck cancer in children

    Directory of Open Access Journals (Sweden)

    Sengupta Subhabrata

    2009-01-01

    Full Text Available Aim: To assess the incidence of different head and neck cancers in pediatric age group in a referral hospital. Methods: In this prospective study, children below the age of 12 years underwent a thorough clinical, ENT examination and the diagnosis was conformed histologically in all the cases. Results: Fifty-three were diagnosed to be suffering from different head and neck neoplasms among 21,216 children (0.25%. Male-to-female sex distribution was 1.78:1. The lymphomas were the most common (43.39% followed by the rhabdomyosarcoma (20.75% and the nasopharyngeal carcinoma (15.09%. Of the lymphomas, the non-Hodgkin′s lymphoma was predominant (26.41%. Other lesions were thyroid carcinomas and mucoepidermoid carcinoma of parotid. Conclusions: Malignancy should always be considered in the differential diagnosis of masses in the head and neck region in children.

  5. PET/MRI in head and neck cancer: initial experience

    OpenAIRE

    Platzek, Ivan; Beuthien-Baumann, Bettina; Schneider, Matthias; Gudziol, Volker; Langner, Jens; Schramm, Georg; Laniado, Michael; Kotzerke, Jörg; van den Hoff, Jörg

    2012-01-01

    Purpose To evaluate the feasibility of PET/MRI (positron emission tomography/magnetic resonance imaging) with FDG (18F-fluorodeoxyglucose) for initial staging of head and neck cancer. Methods The study group comprised 20 patients (16 men, 4 women) aged between 52 and 81 years (median 64 years) with histologically proven squamous cell carcinoma of the head and neck region. The patients underwent a PET scan on a conventional scanner and a subsequent PET/MRI examination on a whole-body hybrid sy...

  6. Supportive care for head and neck cancer patients receiving radiotherapy

    International Nuclear Information System (INIS)

    Recently (chemo-)radiotherapy has been widely used in head and neck cancer with definite evidence. As long survivor has increased, social problems associated with late toxicity have become more. Late toxicities induced by radiotherapy for head and neck lesion are often severe. Xerostomia is one of the severe late toxicities conventionally and dysphagia after chemoradiotherapy is a new topic. Some industrial development (ex. Intensity Modulated Radiotherapy: IMRT) play a great role in toxicity management. Multidisciplinary approach (cooperation between not only physicians but also nurses and dentists) is necessary to control toxicities. The research of supportive care will be needed same as definitive treatment in the future. (author)

  7. Uni- and multivariate analysis of eight indications for post-operative radiotherapy and their significance for local-regional cure in advanced head and neck cancer

    International Nuclear Information System (INIS)

    Eighty consecutive patients with advanced head and neck cancer were treated with combined therapy of radical surgery and post-operative radiotherapy. Indications for post-operative radiotherapy were pathological staging of the primary tumour (pT3 or pT4), poorly differentiated or undifferentiated carcinoma (G3, G4), tumour thickness, tumour invasion in the surrounding tissues with slender tumour strands and solitary tumour cells, perineural spread, lymphangio-invasive tumour growth, multiple positive neck nodes or extranodal spread, and microscopical irradicality of the surgical margins. The contribution for prognosis of these indications for post-operative radiotherapy were retrospectively calculated in univariate and multivariate analysis. Of all investigated parameters, the mode of tumour invasion and lymphangio-invasive growth were independent prognostic factors. If these unfavourable prognostic signs are present, post-operative radiotherapy has to be intensified to at least curative doses of 66 Gy or more to areas at risk. (author)

  8. Mouthwash use and associated head and neck cancer risk.

    Science.gov (United States)

    Wilson, Gavin; Conway, David I

    2016-03-01

    Data sourcesAll studies with questionnaire items on mouthwash use in the International Head and Neck Cancer Epidemiology Consortium (INHANCE).Data extraction and synthesisPooled analysis data from case controlled studies using Individual Patient Data (IPD) meta-analysis methods. Logistic regression was used to assess the association of mouthwash use with cancers of the oral cavity, oropharynx, hypopharynx and larynx, adjusting for study, age, sex, pack-years of tobacco smoking, number of alcoholic drinks/day and education.ResultsEight thousand, nine hundred and eighty-one cases of head and neck cancer and 10,090 controls from 12 case-control studies with comparable information on mouthwash use were included in the analysis. Compared with never users of mouthwash, the odds ratio (OR) of all head and neck cancers was 1.01 [95% confidence interval (CI): 0.94-1.08] for ever users, based on 12 studies. The corresponding ORs of cancer of the oral cavity and oropharynx were 1.11 (95% CI: 1.00-1.23) and 1.28 (95% CI: 1.06-1.56), respectively.ConclusionsAlthough limited by the retrospective nature of the study and the limited ability to assess risks of mouthwash use in nonusers of tobacco and alcohol, this large investigation shows potential risks for head and neck cancer subsites and in long-term and frequent users of mouthwash. PMID:27012566

  9. Primary Tumor Volume Is an Important Predictor of Clinical Outcomes Among Patients With Locally Advanced Squamous Cell Cancer of the Head and Neck Treated With Definitive Chemoradiotherapy

    International Nuclear Information System (INIS)

    Purpose: The tumor volume has been established as a significant predictor of outcomes among patients with head-and-neck cancer undergoing radiotherapy alone. The present study attempted to add to the existing data on tumor volume as a prognostic factor among patients undergoing chemoradiotherapy. Methods and Materials: A total of 78 patients who had undergone definitive chemoradiotherapy for Stage III-IV squamous cell cancer of the hypopharynx, oropharynx, and larynx were identified. The primary tumor volumes were calculated from the treatment planning computed tomography scans, and these were correlated to the survival and tumor control data obtained from the retrospective analysis. Results: The interval to progression correlated with the primary tumor volume (p = .007). The critical cutoff point for the tumor volume was identified as 35 cm3, and patients with a tumor volume 3 had a significantly better prognosis than those with a tumor volume >35 cm3 at 5 years (43% vs. 71%, p = .010). Longer survival was also correlated with smaller primary tumor volumes (p = .022). Similarly, patients with a primary tumor volume 3 had a better prognosis in terms of both progression-free survival (61% vs. 33%, p = .004) and overall survival (84% vs. 41%, p = 3 larger than tumors without locoregional failure (p = .028) and 27.1-cm3 larger than tumors that recurred as distant metastases (p = .020). Conclusion: The results of our study have shown that the primary tumor volume is a significant prognostic factor in patients with advanced cancer of the head and neck undergoing definitive chemoradiotherapy and correlated with the treatment outcomes better than the T or N stage.

  10. Public knowledge of head and neck cancer.

    LENUS (Irish Health Repository)

    O'Connor, T E

    2010-04-01

    Studies show 60% of patients with newly diagnosed Head & Neck Squamous Cell Cancer in Ireland, present with advanced disease. A poor level of knowledge and awareness among the public of Head & Neck Cancer, is an important consideration in the often delayed presentation for medical attention in many of these cases. Our study surveyed 200 members of the public to assess their knowledge and awareness of Head & Neck Cancer. One hundred and forty (70%) of respondents had never encountered the term "Head & Neck Cancer". One hundred and forty six (73%) failed to identify excessive alcohol consumption as a risk factor. Less than 100 (50%) would have concern about persisting hoarseness or a prolonged oral ulcer. An urgent need exists to raise awareness of Head & Neck Cancer among the public in Ireland.

  11. Progress and challenges in the vaccine-based treatment of head and neck cancers

    Directory of Open Access Journals (Sweden)

    Venuti Aldo

    2009-05-01

    Full Text Available Abstract Head and neck (HN cancer represents one of the most challenging diseases because the mortality remains high despite advances in early diagnosis and treatment. Although vaccine-based approaches for the treatment of advanced squamous cell carcinoma of the head and neck have achieved limited clinical success, advances in cancer immunology provide a strong foundation and powerful new tools to guide current attempts to develop effective cancer vaccines. This article reviews what has to be rather what has been done in the field for the development of future vaccines in HN tumours.

  12. Prolonged radiation time and low nadir hemoglobin during postoperative concurrent chemoradiotherapy are both poor prognostic factors with synergistic effect on locally advanced head and neck cancer patients

    Directory of Open Access Journals (Sweden)

    Su NW

    2015-01-01

    Full Text Available Nai-Wen Su,1 Chung-Ji Liu,2 Yi-Shing Leu,3 Jehn-Chuan Lee,3 Yu-Jen Chen,4 Yi-Fang Chang1,51Division of Medical Oncology and Hematology, Department of Internal Medicine, 2Department of Oral and Maxillofacial Surgery, 3Department of Otorhinolaryngology, 4Department of Radiation Oncology, 5Good Clinical Research Center, Department of Medical Research, Mackay Memorial Hospital, Taipei, TaiwanBackground: Anemia, a common complication of head and neck cancer treatment, is regarded as a poor prognostic factor. We evaluated the impact of low hemoglobin (Hb levels, measured at different time points, on a consecutive cohort of patients with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN who underwent postoperative concurrent chemoradiotherapy (CCRT.Materials and methods: From 2002 to 2009, 140 patients were enrolled and reviewed retrospectively. Preoperative (pre-op Hb, pre-CCRT Hb, and nadir Hb during CCRT were measured and recorded. The three Hb parameters were analyzed against several well-established pathologic risk factors and radiation-associated variables. Prognostic impacts were investigated with multivariate analysis by Cox proportional hazards model.Results: On Cox regression analysis, significantly higher risk of death was associated with pre-op Hb %13 g/dL (hazard ratio [HR] =1.8; 95% confidence interval [CI], 1.1–3.1; P=0.023, nadir Hb %11 g/dL (HR =1.9; 95% CI, 1.1–3.3; P=0.020, radiation treatment time (RTT >7 weeks (HR =1.9; 95% CI, 1.1–3.3; P=0.022, and multiple positive lymph nodes (HR =2.1; 95% CI, 1.2–3.7; P=0.010, after adjusting for primary tumor site and pathologic lymphovascular invasion. Patients with poor prognosticators including low nadir Hb %11 g/dL and RTT >7 weeks had a higher risk of death (HR =4.0; 95% CI =1.6–10.2; P=0.004.Conclusion: In the treatment setting of LA-SCCHN patients who underwent postoperative CCRT, coexistance of lower nadir Hb during CCRT and prolonged RTT resulted in

  13. Predicting recurrence after radiotherapy in head and neck cancer

    NARCIS (Netherlands)

    Begg, A.C.

    2012-01-01

    Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide. Radiotherapy is a mainstay of treatment, either alone for early stage tumors or combined with chemotherapy for late stage tumors. An overall 5-year survival rate of around 50% for HNSCC demonstrates that treatme

  14. The nutritional assessment of head and neck cancer patients.

    Science.gov (United States)

    Magnano, Mauro; Mola, Patrizia; Machetta, Giacomo; Maffeis, Paola; Forestiero, Ilenia; Cavagna, Roberta; Artino, Elena; Boffano, Paolo

    2015-12-01

    Patients affected by head and neck cancer are particularly at risk for nutritional depletion. The aim of this study was to evaluate the nutritional status of patients affected by head and neck cancer at diagnosis. All adult patients with head and neck cancer between January 2009 and December 2013 were included. The following data were recorded: demographics, tobacco and/or alcohol consumption, weight, height, the reference weight 6 months before the diagnosis, tumor site, tumor stage, and laboratory data. Then, Body mass index (BMI), and Buzby nutrition risk index (NRI) were calculated. Statistical analysis was used to search for associations among multiple variables. 122 men and 22 women were enrolled. As for reference BMI, 77 patients were overweight, whereas just 7 subjects were underweight. At diagnosis, 72 subjects were overweight according to BMI, whereas 52 patients were underweight. Instead, according to NRI, 96 patients were severely malnourished, 42 patients were moderately malnourished, whereas just 6 patients had a normal value of NRI. The assessment of nutrition by BMI excluded from a thorough consideration all overweight and obese patients with head and neck cancer. Instead, NRI correctly identified both undernourished and overweight/obese patients as "malnourished" subjects. PMID:25534287

  15. A review of scientific papers about head and neck cancers

    International Nuclear Information System (INIS)

    Head and neck cancer is one of the 10 most frequent cancers worldwide, with an estimated 500000 new cases diagnosed annually. Treatment of head and neck cancers require a multidisciplinary approach due their complexity and the functional and esthetic alterations that cancer can cause. The interest of the scientific community in a specific subject can be evaluated by analyzing of the number and the quality of published papers on the topic. The information obtained from PubMed (www.ncbi.nlm.nih.gov/sites/entrez) has been used as a tool in various publications to aid the evaluation of the scientific interest in specific research areas The aim of this work is to evaluate, using PubMed, the scientific interest in studies of head and neck cancer treatments such as radiotherapy, chemotherapy and surgery. The searches were performed on PubMed for publications from the period of 1949 to 2008 using the search terms 'head and neck cancer' and 'surgery' or 'radiotherapy' or 'chemotherapy'. The number of publications per year was determined in each search. The percentage of publications was also calculated for each subject in each year. An interest factor in a subject (IFS) was also determined. The number of publications was higher for surgery than chemotherapy or radiotherapy. The calculated 1964 IFS for surgery was 14.79, 12.74 for radiotherapy, and 19.58 for chemotherapy. The 1995 IFS for surgery was 1.99, 2.09 for radiotherapy, and 2.08 for chemotherapy. The relation obtained for 1995 was maintained in the subsequent years. There are more publications related to surgical treatment for head and neck cancer when compared with radiotherapy and chemotherapy. Moreover, in the recent years there has an increased interest in treatments utilizing chemotherapy, or this associated to radiotherapy. (author)

  16. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer.

    NARCIS (Netherlands)

    Vermorken, J.B.; Remenar, E.; Herpen, C.M.L. van; Gorlia, T.; Mesia, R.; Degardin, M.; Stewart, J.S.; Jelic, S.; Betka, J.; Preiss, J.H.; Weyngaert, D. van den; Awada, A.; Cupissol, D.; Kienzer, H.R.; Rey, A.; Desaunois, I.; Bernier, J.; Lefebvre, J.L.

    2007-01-01

    BACKGROUND: Phase 2 studies suggest that the standard regimen of cisplatin and fluorouracil (PF) plus docetaxel (TPF) improves outcomes in squamous-cell carcinoma of the head and neck. We compared TPF with PF as induction chemotherapy in patients with locoregionally advanced, unresectable disease. M

  17. Hyperfractionated accelerated radiotherapy with concomitant integrated boost of 70-75 Gy in 5 weeks for advanced head and neck cancer. A phase I dose escalation study

    Energy Technology Data Exchange (ETDEWEB)

    Cvek, J.; Skacelikova, E.; Otahal, B.; Halamka, M.; Feltl, D. [University Hospital Ostrava (Czech Republic). Dept. of Oncology; Kubes, J. [University Hospital Bulovka, Prague (Czech Republic). Dept. of Radiation Oncology; Kominek, P. [University Hospital Ostrava (Czech Republic). Dept. of Otolaryngology

    2012-08-15

    Background and purpose: The present study was performed to evaluate the feasibility of a new, 5-week regimen of 70-75 Gy hyperfractionated accelerated radiotherapy with concomitant integrated boost (HARTCIB) for locally advanced, inoperable head and neck cancer. Methods and materials: A total of 39 patients with very advanced, stage IV nonmetastatic head and neck squamous cell carcinoma (median gross tumor volume 72 ml) were included in this phase I dose escalation study. A total of 50 fractions intensity-modulated radiotherapy (IMRT) were administered twice daily over 5 weeks. Prescribed total dose/dose per fraction for planning target volume (PTV{sub tumor}) were 70 Gy in 1.4 Gy fractions, 72.5 Gy in 1.45 Gy fractions, and 75 Gy in 1.5 Gy fractions for 10, 13, and 16 patients, respectively. Uninvolved lymphatic nodes (PTV{sub uninvolved}) were irradiated with 55 Gy in 1.1 Gy fractions using the concomitant integrated boost. Results: Acute toxicity was evaluated according to the RTOG/EORTC scale; the incidence of grade 3 mucositis was 51% in the oral cavity/pharynx and 0% in skin and the recovery time was {<=} 9 weeks for all patients. Late toxicity was evaluated in patients in complete remission according to the RTOG/EORTC scale. No grade 3/4 late toxicity was observed. The 1-year locoregional progression-free survival was 50% and overall survival was 55%. Conclusion: HARTCIB (75 Gy in 5 weeks) is feasible for patients deemed unsuitable for chemoradiation. Acute toxicity was lower than predicted from radiobiological models; duration of dysphagia and confluent mucositis were particularly short. Better conformity of radiotherapy allows the use of more intensive altered fractionation schedules compared with older studies. These results suggest that further dose escalation might be possible when highly conformal techniques (e.g., stereotactic radiotherapy) are used.

  18. Intensity-modulated radiotherapy vs. parotid-sparing 3D conformal radiotherapy. Effect on outcome and toxicity in locally advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lambrecht, M.; Nevens, D.; Nuyts, S. [University Hospitals Leuven (Belgium). Dept. of Radiation Oncology

    2013-03-15

    Background and purpose: Intensity-modulated radiotherapy (IMRT) has rapidly become standard of care in the management of locally advanced head and neck squamous cell carcinoma (HNSCC). In this study, our aim was to retrospectively investigate the effect of the introducing IMRT on outcome and treatment-related toxicity compared to parotid-sparing 3D conformal radiotherapy (3DCRT). Material and methods: A total of 245 patients with stage III and IV HNSCC treated with primary radiotherapy between January 2003 and December 2010 were included in this analysis: 135 patients were treated with 3DCRT, 110 patients with IMRT. Groups were compared for acute and late toxicity, locoregional control (LRC), and overall survival (OS). Oncologic outcomes were estimated using Kaplan-Meier analysis and compared using a log-rank test. Acute toxicity was analyzed according to the Common Terminology Criteria for Adverse Events v3.0 and late toxicity was scored using the RTOG/EORTC late toxicity scoring system. Results: Median follow-up was 35 months in the IMRT group and 68 months in the 3DCRT group. No significant differences were found in 3-year LRC and OS rates between the IMRT group and 3DCRT group. Significantly less acute mucositis {>=} grade 3 was observed in the IMRT group (32% vs. 44%, p = 0.03). There was significantly less late xerostomia {>=} grade 2 in the IMRT group than in the 3DCRT group (23% vs. 68%, p < 0.001). After 24 months, there was less dysphagia {>=} grade 2 in the IMRT group although differences failed to reach statistical significance. Conclusion: The introduction of IMRT in the radiotherapeutic management of locally advanced head and neck cancer significantly improved late toxicity without compromising tumor control compared to a parotid-sparing 3D conformal radiotherapy technique. (orig.)

  19. Concurrent hyperfractionated accelerated radiotherapy with 5-FU and once weekly cisplatin in locally advanced head and neck cancer. The 10-year results of a prospective phase II trial

    International Nuclear Information System (INIS)

    In this study, the acute toxicity and long-term outcome of a hyperfractionated accelerated chemoradiation regimen with cisplatin/5-fluorouracil (5-FU) in patients with locally advanced squamous cell carcinomas of head and neck were evaluated. From 2000-2002, 38 patients with stage III (5.3 %) and stage IV (94.7 %) head and neck cancer were enrolled in a phase II study. Patients received hyperfractionated-accelerated radiotherapy with 72 Gy in 15 fractions of 2 Gy followed by 1.4 Gy twice daily with concurrent, continuous infusion 5-FU of 600 mg/m2 on days 1-5 and 6 cycles of weekly cisplatin (30 mg/m2). Acute toxicities (CTCAEv2.0), locoregional control (LRC), metastases-free (MFS), and overall survival (OS) were analyzed and exploratively compared with the ARO 95-06 trial. Median follow-up was 11.4 years (95 % CI 8.6-14.2) and mean dose 71.6 Gy. Of the patients, 82 % had 6 (n = 15) or 5 (n = 16) cycles of cisplatin, 5 and 2 patients received 4 and 3 cycles, respectively. Grade 3 anemia, leukopenia, and thrombocytopenia were observed in 15.8, 15.8, and 2.6 %, respectively. Grade 3 mucositis in 50 %, grade 3 and 4 dysphagia in 55 and 13 %. The 2-, 5-, and 10-year LRC was 65, 53.6, and 48.2 %, the MFS was 77.5, 66.7, and 57.2 % and the OS 59.6, 29.2, and 15 %, respectively. Chemoradiation with 5-FU and cisplatin seems feasible and superior in terms of LRC and OS to the ARO 95-06C-HART arm at 2 years. However, this did not persist at the 5- and 10-year follow-ups. (orig.)

  20. Systemic chemotherapy of advanced head and neck malignancies.

    Science.gov (United States)

    Dowell, K E; Armstrong, D M; Aust, J B; Cruz, A B

    1975-04-01

    Several Phase II chemotherapy protocols were evaluated in patients with advanced malignancies; 158 were evaluable head and neck cases. The protocols were as follows: five-drug combination (COMFP), four-drug (COMF), (CCNU, Adriamycin, DTIC, and cytosine arabinoside. Insufficient numbers and data were received to adequately evaluate Yoshi 864, 5 Azacytidine, porfiromycin, BCNU, and Azaserine. Significant responses to therapy were noted in the four and five-drug combinations in which 30-44% of the patients had 50% or greater regression, with an average duration of 2.2 months. Adriamycin and CCNU demonstrated lesser antitumor effects, while DTIC and cytosine arabinoside did not demonstrate significant antitumor activity in the head and neck areas. Usual toxicity consisted largely of nausea and vomiting, leukopenia, and thrombocytopenia. Alopecia was not pronouced in Adriamycin-treated patients. It appears that combination chemotherapy had a higher response rate compared to single agents used in the different cooperative protocols. PMID:1116105

  1. Improving Therapeutic Ratio in Head and Neck Cancer with Adjuvant and Cisplatin-Based Treatments

    Directory of Open Access Journals (Sweden)

    Loredana G. Marcu

    2013-01-01

    Full Text Available Advanced head and neck cancers are difficult to manage despite the large treatment arsenal currently available. The multidisciplinary effort to increase disease-free survival and diminish normal tissue toxicity was rewarded with better locoregional control and sometimes fewer side effects. Nevertheless, locoregional recurrence is still one of the main reasons for treatment failure. Today, the standard of care in head and neck cancer management is represented by altered fractionation radiotherapy combined with platinum-based chemotherapy. Targeted therapies as well as chronotherapy were trialled with more or less success. The aim of the current work is to review the available techniques, which could contribute towards a higher therapeutic ratio in the treatment of advanced head and neck cancer patients.

  2. An overview of gene therapy in head and neck cancer

    OpenAIRE

    Amit Bali; Deepika Bali; Ashutosh Sharma

    2013-01-01

    Gene therapy is a new treatment modality in which new gene is introduced or existing gene is manipulated to cause cancer cell death or slow the growth of the tumor. In this review, we have discussed the different treatment approaches for cancer gene therapy; gene addition therapy, immunotherapy, gene therapy using oncolytic viruses, antisense ribonucleic acid (RNA) and RNA interference-based gene therapy. Clinical trials to date in head and neck cancer have shown evidence of gene transduction...

  3. Cryotherapy and radiotherapy combination in extensive and recurrent types of head and neck skin cancer treatment

    International Nuclear Information System (INIS)

    The method of infiltrative skin cancer treatment based on different variants of radiotherapy and cryotherapy combination is described. During the period of 1988-2006 the Department of head and neck neoplasms of N. N. Blohin Russian Cancer Research Center provided radiation and cryogenic treatment of 94 patients with locally advanced head and neck epidermoid and basal cell cancer. For this purpose before every radiotherapy session the tumor was exposed to cryo cooling till freezing temperature (-5 degrees C). The total involution of tumors was observed at 91 patients. Residual tumors were removed surgically. The follow-up showed good functional and aesthetic results, retention of local tissues.

  4. An overview of gene therapy in head and neck cancer

    Directory of Open Access Journals (Sweden)

    Amit Bali

    2013-01-01

    Full Text Available Gene therapy is a new treatment modality in which new gene is introduced or existing gene is manipulated to cause cancer cell death or slow the growth of the tumor. In this review, we have discussed the different treatment approaches for cancer gene therapy; gene addition therapy, immunotherapy, gene therapy using oncolytic viruses, antisense ribonucleic acid (RNA and RNA interference-based gene therapy. Clinical trials to date in head and neck cancer have shown evidence of gene transduction and expression, mediation of apoptosis and clinical response including pathological complete responses. The objective of this article is to provide an overview of the current available gene therapies for head and neck cancer.

  5. Moving Toward Bioadjuvant Approaches to Head and Neck Cancer Prevention

    International Nuclear Information System (INIS)

    Head and neck squamous cell carcinoma affects >45,000 Americans annually. Patients who are successfully treated for their primary tumor are at high risk of developing a second primary tumor, making effective preventive strategies highly desirable for this disease. Although a landmark study in 1990 suggested some benefit of high-dose retinoids in head and neck cancer prevention, subsequent trials using more tolerable doses have shown limited clinical success. Newer preventive strategies have included bioadjuvant therapy combining retinoids with interferon and α-tocopherol, combinations of molecularly targeted agents, and oncolytic viruses. Furthermore, considerable evidence has supported a cancer protective role for several nutrients, including green tea and curcumin analogs. Natural compounds such as these with favorable long-term safety profiles might be particularly suited to the cancer prevention setting, in which patients will usually tolerate only moderate risk and toxicity

  6. Evaluation of a qualitative regression grading as a prognostic factor in advanced head and neck cancer after neoadjuvant radiochemotherapy

    International Nuclear Information System (INIS)

    Patients and methods: 43 patients with Stage IV squamous cell carcinoma of the head and neck have been treated neoadjuvantly with two cycles chemotherapy (ifosfamide 1.5 g/m2 day 1-5 with mesna [300 mg/m2], cisplatin 60 mg/m2 day 5, second cycle day 22). Hyperfractionated accelerated radiotherapy (30 Gy) was given from day 29 on. We divided the resected tumors histologically as follows: Grade I - no tumor cells to be identified, Grade II - necrosis, Grade III - partial destruction of the carcinoma, Grade IV - vital carcinoma. Results: After 1 year the overall survival amounted to 79%, after 2 years 56%. A significant correlation could be established between qualitative tumor regression and survival. The 1-year survival depended on the regression of the primary as follows: 94% in Grade I, 80% in Grade II, 60% in Grade III and 56% in Grade IV. For the 2-years survival: 76%, 40%, 40%, 11% (p<0,01). The results were similar regarding the neck dissections. Conclusions: After radiochemotherapy the histological regression is a significant prognostic factor of survival. A simple system with four subgroups is suggested which seems to be for a high prognostic value. We discuss to intensify the treatment for patients with good regression after neoadjuvant therapy for a further reduction of recurrence. (orig.)

  7. Metabolic microscopy of head and neck cancer organoids

    Science.gov (United States)

    Shah, Amy T.; Skala, Melissa C.

    2016-03-01

    Studies for head and neck cancer have primarily relied on cell lines or in vivo animal studies. However, a technique that combines the benefits of high-throughput in vitro studies with a complex, physiologically relevant microenvironment would be advantageous for understanding drug effects. Organoids provide a unique platform that fulfills these goals. Organoids are generated from excised and digested tumor tissue and are grown in culture. Fluorescence microscopy provides high-resolution images on a similar spatial scale as organoids. In particular, autofluorescence imaging of the metabolic cofactors NAD(P)H and FAD can provide insight into response to anti-cancer treatment. The optical redox ratio reflects relative amounts of NAD(P)H and FAD, and the fluorescence lifetime reflects enzyme activity of NAD(P)H and FAD. This study optimizes and characterizes the generation and culture of organoids grown from head and neck cancer tissue. Additionally, organoids were treated for 24 hours with a standard chemotherapy, and metabolic response in the organoids was measured using optical metabolic imaging. Ultimately, combining head and neck cancer organoids with optical metabolic imaging could be applied to test drug sensitivity for drug development studies as well as treatment planning for cancer patients.

  8. Nutrition in Head and Neck Cancer Patients

    OpenAIRE

    Varkey, Prashanth; Tang, Wen-Ruay; Tan, Ngian Chye

    2010-01-01

    Anorexia and cachexia frequently complicate the late stages of malignancy and can be a prominent feature of early disease. The resulting weight loss significantly affects the morbidity and mortality of the cancer patient. A fundamental understanding of nutrition and the pathophysiology of cancer cachexia will aid in diligent treatment decisions to achieve optimal results. The pathophysiology of cancer cachexia is discussed, together with methods of nutritional assessment, nutritional requirem...

  9. The role of EGFR-targeting strategies in the treatment of head and neck cancer

    Directory of Open Access Journals (Sweden)

    Dequanter D

    2012-07-01

    Full Text Available Didier Dequanter, Mohammad Shahla, Pascal Paulus, Philippe H LothaireDepartment of Surgery, CHU Charleroi (Hopital Andre Vésale, Montigny le Tilleul, BelgiumAbstract: With its targeted mechanism of action and synergistic activity with current treatment modalities, cetuximab is a potentially valuable treatment option for patients with recurrent and/or metastatic squamous cell cancer of the head and neck who have progressed on cisplatin-based chemotherapy. The use of cetuximab in combination with radiotherapy as definitive treatment for locoregionally advanced squamous cell cancer of the head and neck is generally restricted to patients unfit to receive cisplatin-based chemoradiation, which is still considered the standard of care. The effect of this epidermal growth factor receptor antagonist occurs without any change in the pattern and the severity of toxicity usually associated with head and neck radiation.Keywords: cetuximab, SCCHN, radiotherapy

  10. A Randomized Study of Accelerated Fractionation Radiotherapy with and Without Mitomycin C in the Treatment of Locally Advanced Head and Neck Cancer

    International Nuclear Information System (INIS)

    This single-institution study evaluates the feasibility of accelerated fractionation radiotherapy (AF) with and without mitomycin C (MMC) in thc treatment of locally advanced head and neck cancer. Patients and Methods: Between May 1998 and October 2001, sixty patients with locally advanced stage III and IV of head and neck cancer were randomized into three treatment arms: (I) conventional fractionation radiotherapy (CF) (5 fractions per week); (2) accelerated fractionation radiotherapy (AF) (6 fractions per week); and (3) AF plus Mitomycin C (MMC). The 2-year overall survival (OS) of the whole group was 21 %. The OS according to treatment arm was 23%, 20%. and 28% in CF. AF. and AF+MMC arms respectively (ρ<0. 19). The 2-year loco-regional control (LC) rate was 22% for the whole group of patients. The LC was 10%, 25%. and 30% for the CF, AF, and AF+MMC respectively (ρ=0.27). The only significant parameters for OS and LC were performance status and pre-treatment hemoglobin level. Mucositis grades 3 and 4 occurred in 70% and 90% of the patients in the AF and AF+MMC arm respectively compared to 55% of patients in the CF arm (ρ=0.04). However the addition of MMC did not significantly increase the incidence or severity of mucositis between AF and AF+MMC (ρ=0.13). Hematological toxicity grades 3 and 4 were significantly higher after MMC (occurred in 40% of patients versus 10% and 5% in CF and AF arms respectively, ρ=0.04). There was no statistically significant difference in the incidence of grade 3 dryness of mouth (ρ=0.06). fibrosis (ρ=0.6). or lymphoedema (ρ=0.39) among the three arms. There was a trend for improvement of LC and OS rates with the use or AF and the addition of MMC to AF compared to CF radiotherapy. although the difference was not statistically significant. The small number of the patients in each treatment arm and the inclusion or multiple tumor sites may contribute to these statistically insignificant results. Accordingly we advise to continue

  11. Human Papillomavirus in Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    Anna Rosa Garbuglia

    2014-08-01

    Full Text Available Human papillomavirus (HPV is currently considered to be a major etiologic factor, in addition to tobacco and alcohol, for oropharyngeal cancer (OPC development. HPV positive OPCs are epidemiologically distinct from HPV negative ones, and are characterized by younger age at onset, male predominance, and strong association with sexual behaviors. HPV16 is the most prevalent types in oral cavity cancer (OCC, moreover the prevalence of beta, and gamma HPV types is higher than that of alpha HPV in oral cavity.

  12. Analysis of carotid artery deformation in different head and neck positions for maxillofacial catheter navigation in advanced oral cancer treatment

    Directory of Open Access Journals (Sweden)

    Ohya Takashi

    2012-09-01

    Full Text Available Abstract Background To improve the accuracy of catheter navigation, it is important to develop a method to predict shifts of carotid artery (CA bifurcations caused by intraoperative deformation. An important factor affecting the accuracy of electromagnetic maxillofacial catheter navigation systems is CA deformations. We aimed to assess CA deformation in different head and neck positions. Methods Using two sets of computed tomography angiography (CTA images of six patients, displacements of the skull (maxillofacial segments, C1–C4 cervical vertebrae, mandible (mandibular segment, and CA along with its branches were analyzed. Segmented rigid bones around CA were considered the main causes of CA deformation. After superimposition of maxillofacial segments, C1–C4 and mandible segments were superimposed separately for displacement measurements. Five bifurcation points (vA–vE were assessed after extracting the CA centerline. A new standardized coordinate system, regardless of patient-specific scanning positions, was employed. It was created using the principal axes of inertia of the maxillofacial bone segments of patients. Position and orientation parameters were transferred to this coordinate system. CA deformation in different head and neck positions was assessed. Results Absolute shifts in the center of gravity in the bone models for different segments were C1, 1.02 ± 0.9; C2, 2.18 ± 1.81; C3, 4.25 ± 3.85; C4, 5.90 ± 5.14; and mandible, 1.75 ± 2.76 mm. Shifts of CA bifurcations were vA, 5.52 ± 4.12; vB, 4.02 ± 3.27; vC, 4.39 ± 2.42; vD, 4.48 ± 1.88; and vE, 2.47 ± 1.32. Displacements, position changes, and orientation changes of C1–C4 segments as well as the displacements of all CA bifurcation points were similar in individual patients. Conclusions CA deformation was objectively proven as an important factor contributing to errors in maxillofacial navigation. Our study results suggest that

  13. Phase II randomized trial of radiation therapy, cetuximab and pemetrexed with or without bevacizumab in patients with locoregionally-advanced head and neck cancer.

    OpenAIRE

    Argiris, A.; Bauman, JE; Ohr, J; Gooding, WE; Heron, DE; Duvvuri, U; Kubicek, GJ; Posluszny, DM; Vassilakopoulo, M; S. Kim; Grandis, JR; Johnson, JT; Gibson, MK; Clump, DA; Flaherty, JT

    2016-01-01

    We previously reported the safety of concurrent cetuximab, an antibody against epidermal growth factor receptor (EGFR), pemetrexed and radiation therapy (RT) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). In this non-comparative phase II randomized trial, we evaluated this non-platinum combination with or without bevacizumab, an inhibitor of vascular endothelial growth factor (VEGF).Patients with previously untreated stage III-IVB SCCHN were randomized...

  14. Head and neck cancer: from research to therapy and cure.

    Science.gov (United States)

    Varelas, Xaralabos; Kukuruzinska, Maria A

    2014-12-01

    Cumulative findings from many research groups have identified new signaling mechanisms associated with head and neck cancers. We summarize these findings, including discussion of aberrant NOTCH, PI3K, STAT3, immune recognition, oxidative pathway, and regulation of cell cycle and cell death. The genomic landscape of head and neck cancers has been shown to differ depending on human papillomavirus (HPV) status. We discuss studies examining the integration of HPV into genomic regions, as well as the epigenetic alterations that occur in response to HPV infection, and how these may help reveal new biomarker and treatment predictors. The characterization of premalignant lesions is also highlighted, as is evidence indicating that the surgical removal of these lesions is associated with better clinical outcomes. Current surgical methods are also discussed, including several less aggressive approaches such as minimal invasive robotic surgery. While much remains to be done in the fight against head and neck cancer, continued integration of basic research with new treatment options will likely lead to more effective therapeutic strategies directed against this disease. PMID:25532687

  15. Hypofractionated radiotherapy for the palliation of advanced head and neck cancer in patients unsuitable for curative treatment - 'Hypo Trial'

    International Nuclear Information System (INIS)

    Background and purpose: The primary purpose of the trial was to assess rate of tumour response to a hypofractionated course of radiotherapy in patients with incurable squamous cell carcinoma of the head and neck (HNSCC). Secondary objectives included radiation toxicity, symptom control, quality of life (QoL) and progression-free and overall survival. Patients and methods: Patients were planned to receive 30 Gy in 5 fractions at 2/week, at least 3 days apart, with an additional boost of 6 Gy for small volume disease (≤3 cm) in suitable patients. Thirty-seven patients were enrolled between August 2004 and March 2006. Median age was 68 (43-87) years, 81% were male and the predominant primary site was oropharynx (32%). The majority (73%) presented with Stage III-IV disease. Results: Thirty-five patients received radiotherapy, 1 died prior to treatment and one refused treatment. Of the 35 patients receiving radiotherapy, 31 (88%) received ≥30 Gy. Of the 35 patients who received treatment the overall objective response was 80%. Grade 3 mucositis and dysphagia were experienced in 9/35 (26%) and 4/35 (11%), respectively. QoL and symptom control were assessable in 21 patients. Thirteen (62%) reported an overall improvement in QoL and 14 (67%) experienced an improvement in pain. The median time to progression and death was 3.9 and 6.1 months, respectively. Conclusion: The 'Hypo Trial' regimen provided effective palliative treatment in HNSCC unsuitable for curative treatment. Compliance was excellent and resulted in high response rates, symptom control and improvement in QoL with acceptable toxicity. However, progression free and overall survival was short

  16. Hearing loss due to concurrent daily low-dose cisplatin chemoradiation for locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Background and purpose: Cisplatin-based chemo-irradiation (CRT) is increasingly used for head and neck squamous cell carcinoma (HNSCC). We aimed to assess hearing deterioration due to low-dose cisplatin chemoradiation and to compare the observed hearing loss with hearing loss in our previously described high-dose cisplatin CRT cohort. Materials and methods: A prospective analysis of hearing thresholds at low and (ultra)-high frequencies obtained before and after treatment in 60 patients. Patients received low-dose cisplatin (6 mg/m2, daily infusions, 20-25 days) with concomitant accelerated radiotherapy (70 Gy). Results: Audiometry up to 16 kHz was performed before therapy and 31 days (median) post-treatment. The total incidence of ototoxicity in CTCAEv3.0 was 31% in audiograms up to 8 kHz, and 5% of ears tested qualified for HAs due to treatment. The mean hearing loss at speech frequencies was 2.6 dB (SD 5.7) and 2.3 dB (SD 9.2) at PTA 1-2-4 kHz air-conduction and bone-conduction, respectively. The mean hearing loss at ultra-high frequencies (PTA AC 8-10-12.5 kHz) was 9.0 dB (SD 8.1). Low-dose cisplatin CRT caused less acute hearing loss (CTCAE 31%), compared to high-dose cisplatin CRT (CTCAE 78%). Conclusions: Low-dose cisplatin chemo-irradiation for HNSCC is a relatively safe treatment protocol with respect to ototoxicity

  17. Cancer stem cells in head and neck cancer.

    Science.gov (United States)

    Allegra, Eugenia; Trapasso, Serena

    2012-01-01

    differentiate, thus making them easier to remove. For all these reasons, we have collected existing literature on head and neck cancer stem cells that correlate the biological characteristics of this subpopulation of cancer cells with the clinical behavior of tumors. PMID:23189032

  18. Photodynamic therapy for treatment of head and neck cancer.

    Science.gov (United States)

    Schweitzer, V G

    1990-03-01

    Since 1975, photodynamic therapy has reportedly been effective in a variety of head and neck malignancies that failed traditional (conventional) therapy, including surgery, cryotherapy, chemotherapy, hyperthermia, and radiation therapy. Photodynamic therapy consists of the intravenous administration of (di)hematoporphyrin ether, a chemosensitizing drug selectively retained by neoplastic and reticuloendothelial tissues which, when exposed to a 630-nm argon laser, catalyzes a photochemical reaction to release free oxygen radicals, "the cytotoxic" agents responsible for cell death and tumor necrosis. Preliminary investigations have assessed the efficacy of photodynamic therapy in treatment of: (1) superficial "condemned mucosa" or "field cancerization" of the oral cavity and (2) stage III and IV head and neck carcinomas that had unsuccessful conventional therapy. Complete and/or partial remissions were obtained in 11 of 12 patients (16 treatments) with a variety of carcinomas of the nasopharynx, palate and uvula, retromolar trigone, temporal bone, cervical esophagus, and AIDS-related Kaposi's sarcoma of the oral cavity. PMID:2108409

  19. Pulmonary complication associated with head and neck cancer surgery

    International Nuclear Information System (INIS)

    To evaluate the frequency of short-term pulmonary complications in the patients undergoing various head and neck cancer surgeries in our setup and to assess possible risk factors responsible for these complications. Seventy patients of age group 20 to 80 years, regardless of gender, treated surgically for head and neck cancers were enrolled. Main outcome measures included development of pulmonary complications following 15 days of oncological surgery. The complications studied were pneumothorax, bronchopneumonia, atelectasis, pulmonary embolism and cardiopulmonary arrest. A total of 24.28% patients suffered from postoperative pulmonary complications; 17.14% developed bronchopneumonia, 5.71% pulmonary embolism, and 1.42% went into cardiopulmonary arrest, none developed pneumothorax or pulmonary atelectasis. A significant correlation of postoperative bronchopneumonia was seen with heavy smoking and assisted ventilation. Pulmonary embolism was associated with extended assisted ventilation and prolonged surgery. Cardiopulmonary arrest was associated with comorbidity and assisted ventilation after surgery. The frequency of bronchopneumonia supersedes all of the postoperative pulmonary complications in head and neck oncological surgery. Patients at risk of developing postoperative complications are heavy smokers, diabetics, those undergoing prolonged surgery, tracheostomy, and extended assisted ventilation. (author)

  20. Radiotherapy with or without mitomycin c in the treatment of locally advanced head and neck cancer: results of the IAEA multicentre randomised trial

    International Nuclear Information System (INIS)

    Background and purpose: Single agent mitomycin c (MMC) has been shown to improve the outcome of radiotherapy in single institution trials. In order to confirm these findings in a broader worldwide setting, the International Atomic Energy Agency (IAEA) initiated a multicentre trial randomising between radiotherapy alone versus radiotherapy plus MMC. Material and methods: Patients with advanced head and neck cancer were treated with primary curative radiotherapy (66 Gy in 33 fractions with five fractions per week) ±a single injection (15 mg/m2) of MMC at the end of the first week of radiotherapy. Stratification parameters were tumour localization, T-stage, N-stage, and institution. A total of 558 patients were recruited in the trial from February 1996 to December 1999. Insufficient accrual and reporting led to the exclusion of three centres. The final study population consisted of 478 patients from seven centres. Patients had stage III (n=223) or stage IV (n=255) squamous cell carcinoma of the oral cavity (n=230), oropharynx (n=140), hypopharynx (n=65) or larynx (n=43). Prognostic factors like age, gender, site, size, differentiation and stage were well balanced between the two arms. Results: The haematological side effects of MMC were very modest (<5% grade 3-4) and did not require any specific interventions. Furthermore, MMC did not enhance the incidence or severity of acute and late radiation side effects. Confluent mucositis and dry skin desquamation was common, occurring in 56% and 62% of patients, respectively. The overall 3-year primary locoregional tumour control, disease-specific and overall survival rates were 19, 36 and 30%, respectively. Gender, haemoglobin drop, tumour site, tumour and nodal stage were significant parameters for loco-regional tumour control. There was no significant effect of MMC on locoregional control or survival, except for the 161 N0 patients, where MMC resulted in a better loco-regional control (3-year estimate 16% vs. 29%, P=0

  1. Changes in hemoglobin concentration during chemoradiation of locally advanced head and neck tumors

    International Nuclear Information System (INIS)

    Background: Despite multimodality treatment strategies of locally advanced head and neck cancers long-term results leave much to be desired. There is evidence that oxygenation status of head and neck tumors is directly influenced by the hemoglobin concentration. The aim of this study was to verify changes in the hemoglobin level during combined radio-chemotherapy of locally advanced head and neck tumors. Patients and methods: Sixty-eight patients with locally advanced head and neck cancer had primary or adjuvant radiotherapy with doses of 60 to 74 Gy in combination with cisplatin (±5-FU) or carboplatin chemotherapy in the first and fifth week of treatment. Hemoglobin levels were analyzed before and at the end of radiotherapy. Results: In 41% of all patients the initial hemoglobin concentration was below normal levels. The mean hemoglobin values in all patients dropped significantly from 12.9±1.7 g/dl before to 11.6±1.6 g/dl at the end of treatment. In 12 cases (18%) allogeneic erythrocytes had to be transfused during treatment. At the end of treatment 76% of all patients had anemic hemoglobin levels. In the groups of patients with cisplatin and carboplatin chemotherapy a significant decrease in hemoglobin levels was seen without meaningful statistical difference between these 2 groups. Conclusions: In patients with locally advanced head and neck cancer a high initial rate of anemia was registered (41%): This rate was nearly doubled during chemoradiation (76%). Since several studies have shown a correlation between hemoglobin levels and local tumor control, there is evidence, that this group might benefit from correcting anemia before combined radio-chemotherapy. (orig.)

  2. Correlation of p16 status, hypoxic imaging using [18F]-misonidazole positron emission tomography and outcome in patients with loco-regionally advanced head and neck cancer

    International Nuclear Information System (INIS)

    We investigated the relationship between hypoxia, human papillomavirus (HPV) status and outcome in head and neck squamous cell carcinoma. Patients with stage III and IV head and neck squamous cell carcinoma treated on phase I and II chemoradiation trials with 70-Gy radiation combined with tirapazamine/cisplatin or cisplatin/fluorouracil (5FU), hypoxic imaging using [18F]-misonidazole positron emission tomography and known HPV status (by p16 immunohistochemistry) were included in this sub-study. Separate analyses were conducted to consider the impact of tirapazamine on HPV-negative tumours in the phase II trial. Both p16-positive oropharyngeal tumours and p16-negative head and neck squamous cell carcinoma tumours had a high prevalence of tumour hypoxia; 14/19 (74%) and 35/44 (80%), respectively. The distribution of hypoxia (primary, nodal) was similar. On phase II, trial patients with p16-negative hypoxic tumours had worse loco-regional control with cisplatin and 5FU compared with tirapazamine and cisplatin (P<0.001) and worse failure-free survival (hazard ratio=5.18; 95% confidence interval, 1.98–13.55; P=0.001). Only 1 out of 14 p16-positive patients on the phase II trial experienced loco-regional failure. Hypoxia, as assessed by [18F]-misonidazole positron emission tomography, is frequently present in both p16-positive and negative head and neck cancer. Further research is required to determine whether hypoxic imaging can be used to predict benefit from hypoxia-targeting therapies in patients with p16-negative tumours.

  3. Head and Neck Cancer Treatment with Particle Beam Therapy

    Directory of Open Access Journals (Sweden)

    Mehrzad Zargarzadeh

    2013-01-01

    Full Text Available In this century, cancer incidence has become one of the most significant problems concerning human. Conventional radiotherapy damage healthy tissue and in some cases may cause new primary cancers. This problem can be partially solved by hadron therapy which would be more effective and less harmful compared to other forms of radiotherapies used to treat some cancers. Although carbon ion and proton therapy both are effective treatments, they have serious differences which are mentioned in this paper and compared between the two methods. Furthermore, various treatments have been performed on head and neck cancer with hadrons so far will be discussed.

  4. Countermeasure against postoperative fistulas of head and neck cancer

    International Nuclear Information System (INIS)

    It is very difficult to treat postoperative fistulas of head and neck cancer by irradiation and other preoperative therapy. We reviewed 179 patients with oral cancer, mesopharyngeal and hypopharyngeal cancer underwent reconstruction between 1994 and 2003. Our analysis reveals that the incidence of fistula is 18.4% and exposure dose is predisposing factor for fistula formation. We observed many fistulas in posterior of oral floor and pedicle flap more than free flap. There are 14 patients of surgical repair, we detected pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) in them. (author)

  5. Targeted therapies and radiation for the treatment of head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Gwi Eon [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2004-06-15

    The purpose of this review is to provide an update on novel radiation treatments for head and neck cancer. Despite the remarkable advances in chemotherapy and radiotherapy techniques, the management of advanced head and neck cancer remains challenging. Epidermal growth factor receptor (EGFR) is an appealing target for novel therapies in head and neck cancer because not only EGFR activation stimulates many important signaling pathways associated with cancer development and progression, and importantly, resistance to radiation. Furthermore, EGFR overexpression is known to be portended for a worse outcome in patients with advanced head and neck cancer. Two categories of compounds designed to abrogate EGFR signaling, such as monoclonal antibodies (Cetuximab) and tyrosine kinase inhibitors (ZD1839 and OSI-774) have been assessed and have been most extensively studied in preclinical models and clinical trials. Additional TKIs in clinical trials include a reversible agent, Cl-1033, which blocks activation of all erbB receptors. Encouraging preclinical data for head and neck cancers resulted in rapid translation into the clinic. Results from initial clinical trials show rather surprisingly that only minority of patients benefited from EGFR inhibition as monotherapy or in combination with chemotherapy. In this review, we begin with a brief summary of erbB-mediated signal transduction. Subsequently, we present data on prognostic-predictive value of erbB receptor expression in HNC followed by preclinical and clinical data on the role of EGFR antagonists alone or in combination with radiation in the treatment of HNC. Finally, we discuss the emerging thoughts on resistance to EGFR blockade and efforts in the development of multiple-targeted therapy for combination with chemotherapy or radiation. Current challenges for investigators are to determine (1) who will benefit from targeted agents and which agents are most appropriate to combine with radiation and/or chemotherapy, (2

  6. Delayed damage after radiation therapy for head and neck cancer

    International Nuclear Information System (INIS)

    I investigated radiation damage, including osteoradionecrosis, arising from tooth extraction in fields that had received radiation therapy for head and neck cancer, and evaluated the effectiveness of pilocarpine for xerostomia. Between January 1990 and April 1996, I examined 30 patients for bone changes after tooth extraction in fields irradiated at the Department of Oral Radiology, Osaka Dental University Hospital. Nineteen of the patients had been treated for nasopharyngeal cancer and 11 for oropharyngeal cancer. Between January and April 1996, 4 additional patients were given pilocarpine hydrochloride (3-mg, 6-mg and 9-mg of KSS-694 orally three times a day) for 12 weeks and evaluated every 4 weeks as a base line. One had been treated for nasopharyngeal carcinoma, two for cancer of the cheek and one for an unknown carcinoma. Eighteen of the patients (11 with nasopharyngeal carcinoma and 7 with oropharyngeal carcinoma) had extractions. Use of preoperative and postoperative radiographs indicated that damage to the bone following tooth extraction after radiation exposure was related to whether antibiotics were administered the day before the extraction, whether forceps or elevators were used, and whether the tooth was in the field of radiation. Xerostomia improved in all 4 of the patients who received 6-mg or 9-mg of pilocarpine. It improved saliva production and relieved the symptoms of xerostomia after radiation therapy for head and neck cancer, although there were minor side effects such as fever. This information can be used to improve the oral environment of patients who have received radiation therapy for head and neck cancer, and to better understand their oral environment. (author)

  7. The role of human papillomavirus in head and neck cancer

    DEFF Research Database (Denmark)

    Lajer, Christel Braemer; Buchwald, Christian von

    2010-01-01

    Over the last 20 years, there has been increasing awareness of a subset of squamous cell carcinomas of the head and neck (HNSCC), i.e. HPV-positive HNSCC. These cancers seem to differ somewhat from HPV-negative HNSCC. Patients with HPV-positive HNSCC tend to be younger and have a lower intake of ......-negative HNSCC, and this seems to be related to the immune system. Whether the new vaccines for HPV will protect not only against cervical cancer but also against HPV-positive HNSCC remains unknown....

  8. Feasibility Study of Moderately Accelerated Intensity-Modulated Radiotherapy Plus Concurrent Weekly Cisplatin After Induction Chemotherapy in Locally Advanced Head-and Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: To evaluate the feasibility and efficacy of moderately accelerated intensity-modulated radiation therapy (IMRT) along with weekly cisplatin, after induction chemotherapy, in patients with locally advanced unresectable head and neck cancer (HNC). Methods and Materials: Patients with Stage III or IV locally advanced HNC, without progressive disease after three courses of induction chemotherapy, received concurrent chemo-IMRT (weekly cisplatin 30 mg/m2 plus simultaneous integrated boost IMRT). A total of 67.5 Gy in 30 fractions were delivered to primary tumor and involved nodes, 60 Gy in 30 fractions to high-risk nodal areas, and 55.5 Gy in 30 fractions to low-risk nodal areas. Results: In all, 36 patients (median age, 56 years) with International Union Against Cancer (UICC) Stage III (n = 5) and IV (n = 31) were included. Of the 36 patients, 17 had received CF (cisplatin and 5-fluorouracil (CF) and 19 had received docetaxel cisplatin and 5-fluorouracil (DCF). During concurrent chemoradiation, 11 of 36 patients (30.5%) experienced Grade III mucositis (CF, 47%; DCF, 15%; p < 0.04). Grade III pharyngeal-esophageal toxicity was observed in 5 of 19 patients (26.3%; CF, 0.0%; DCF, 26.3%; p = 0.02). Two patients died of complications (5.5%). After chemoradiation, the complete response rate was 63.8%. Two-year local control was 88.7%. Two-year progression free survival and overall survival were 74.5% and 60.9%, respectively. Conclusions: In our experience, a moderately accelerated chemo-IMRT was feasible after induction chemotherapy. However, a noteworthy early death rate of 5.5% was observed. Intensive supportive care strategies should be defined to better manage radiation-induced toxic effects. Longer follow-up is required to determine the incidence of late radiation toxicities and tumor control rates.

  9. Radiotherapy in combination with simultaneous intra-arterial chemotherapy (RADPLAT) in patients with advanced head and neck cancer

    International Nuclear Information System (INIS)

    A particular challenge for both laryngologists and oncologists is presented by the fact that treatment of patients in advanced stages of cancer disease, in whom either combined therapy (surgery and adjuvant radiotherapy) or radiotherapy alone have been applied, is associated with highly dissatisfying results. Clinical trials exploring the application of chemotherapy combined with simultaneous radiotherapy are arousing greater interest. This is because the results of recently published randomised prospective studies and meta analyses show improved loco-regional results of this treatment strategy, which in turn improves overall survival. Cytostatic drugs used in conjunction with radiotherapy have many functions but, above all, their purpose is to intensify the effects of irradiation which, in such treatment schemes, is the leading method. One of the basic factors limiting the application of such strategies is the problem of how to limit the toxicity from one side, while administering a sufficiently high dose of cytostatics, and to continue without any gaps the course of radiation from the other. A problem associated with combined therapy is how to ensure the highest concentration of cytostatics is in the malignant tumour. The need to break through both of these limiting factors has become the subject of intensive research. One of the possible solutions to these problems is the simultaneous application of irradiation in combination with selective intra-arterial chemotherapy. To date, final results are still unavailable from phase III clinical trials which are investigating this treatment method. Presented in this paper are the advantages and disadvantages in the treatment strategy called the RADPLAT programme. The RADPLAT programme is characterised by great local effects, somewhat lesser regional effects and still lesser effects in the treatment of micro-metastases. Research is continuing, in order to find methods for the improvement of treatment results, with a view

  10. Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer. Results of a prospective study

    International Nuclear Information System (INIS)

    Patients with locally advanced head and neck cancer (LAHNC) undergo life-changing treatments that can seriously affect quality of life (QoL). This prospective study examined the key QoL domains during the first year after intensity-modulated radiotherapy (IMRT) and identified predictors of these changes in order to improve patient outcomes. A consecutive series of patients with LAHNC completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core module (QLQ-C30) and the HNC-specific QLQ-HN35 before (t0) and at the end (t1) of definitive or adjuvant IMRT, then at 6-8 weeks (t2), 6 months (t3), and 1 year (t4) after IMRT. Patients (n = 111) completing questionnaires at all five time points were included (baseline response rate: 99 %; dropout rate between t0 and t4: 5 %). QoL deteriorated in all domains during IMRT and improved slowly during the first year thereafter. Many domains recovered to baseline values after 1 year but problems with smelling and tasting, dry mouth, and sticky saliva remained issues at this time. Increases in problems with sticky saliva were greater after 1 year in patients with definitive versus adjuvant IMRT (F = 3.5, P = 0.05). QoL in patients with LAHNC receiving IMRT takes approximately 1 year to return to baseline; some domains remain compromised after 1 year. Although IMRT aims to maintain function and QoL, patients experience long-term dry mouth and sticky saliva, particularly following definitive IMRT. Patients should be counseled at the start of therapy to reduce disappointment with the pace of recovery. (orig.)

  11. Immunohistochemical detection of HIF-1α and CAIX in advanced head-and-neck cancer. Prognostic role and correlation with tumor markers and tumor oxygenation parameters

    International Nuclear Information System (INIS)

    Background: tumor hypoxia has an impact on the outcome of cancer patients treated with radiotherapy. The validity of endogenous markers such as hypoxia-inducible factor-1α (HIF-1α) and carbonic anhydrase isozyme IX (CAIX) to detect therapeutically relevant levels of hypoxia within tumors is controversially discussed. Furthermore, the association of these hypoxia markers with tumor markers or tumor oxygenation parameters is of importance for understanding the relationship between the different factors. Patients and methods: tumor tissue sections of 34 patients with advanced head-and-neck cancer treated with radio(chemo)therapy were assessed by immunohistochemistry for the expression of HIF-1α and CAIX. The relationships of both markers with tumor oxygenation parameters, molecular factors like P53, OPN, VEGF, VHL, survivin, and Ki67 levels, and clinical parameters were studied. Results: bivariate analysis showed a significant correlation of HIF-1α expression with high P53 and high OPN expression, high serum VEGF levels, and low VHL and low Ki67 expression. The CAIX expression was inversely correlated with pH value and directly correlated with T-stage. However, no correlation was found between HIF-1α and CAIX expression. Neither in a univariate Cox proportional hazard regression nor in a Kaplan-Meier analysis did expression of HIF-1α or CAIX have a significant impact on clinical outcome. However, in a Kaplan-Meier analysis, the combination of both factors showed that patients with intratumoral overexpression of either HIF-1α or CAIX or both markers died on average 2 years earlier than patients whose tumors had low expression of both factors (p < 0.05). Conclusion: expression of HIF-1α and CAIX was correlated with different tumor parameters. Only combined HIF-1α and CAIX expression was significantly predictive of patients' overall survival. (orig.)

  12. A randomized phase III trial comparing concomitant chemoradiotherapy versus radiotherapy alone in advanced head and neck cancers - mature results: Yoodhvir Singh Nagar, Lucknow Cancer Institute, India

    International Nuclear Information System (INIS)

    To evaluate contribution of concomitant chemoradiotherapy (CTRT) over and above radiotherapy alone (RT) in previously untreated stage III/IV, squamous cell carcinoma of the head and neck (SCCH and N). Patients with cancers of oral cavity (OC), oropharynx (OP), supraglottis (SG) and hypopharynx (HP) were randomized into RT arm or CTRT arm. Radiotherapy was identical in both arms (70Gy/35 fractions/7 weeks). In CTRT arm concomitant cisplatin (35mg/m2) was given weekly for seven cycles. Surgery was reserved for salvage purposes when required. From May 1996 to December 1998, 155 patients (RT=78, CTRT=77) were enrolled and 139 patients (RT1,CTRT=68) were assessable. Over 90% patients in both arms completed planned treatment. The complete response rate was 51% in RT arm and 71% in CTRT arm (p=0.017). The median disease free survival (DFS) and overall survival (OS) in RT arm and CTRT arm were 3 months vs. 11 months (p=0.0009) and 9 months vs. 26 months (p=0.01) respectively. The 5-year DFS and OS in the two arms were 10% vs. 27% (p=0.000) and 16% vs. 29% (p=0.01) respectively. Acute grade III toxicity was comparable in both the arms (12% vs. 16%, p=0.74). Late grade I/II toxicity was higher in CTRT arm (70% vs. 51%, p=0.09). Serious late toxicities were not seen in both arms. On univariate analysis the favorable factors for immediate response were protocol (CTRT better), primary site (SG and OP better than OC and HP), T-stage (T1-T2 better), Nodes (N0 better than N+), Stage (III > IV), KPS (>80) and lesser overall treatment time (OTT). Multivariate analysis retained protocol, T stage, N stage and OTT as factors independently affecting the immediate response. Addition of concomitant weekly cisplatin (35mg/m2) to radiotherapy improves the likelihood of local control, DFS and OS with acceptable acute and late toxicities and can be recommended as a standard form of treatment in advanced SCCH and N

  13. Long-term outcome and toxicity of hypofractionated stereotactic body radiotherapy as a boost treatment for head and neck cancer: the importance of boost volume assessment

    OpenAIRE

    Lee, Dong Soo; Kim, Yeon Sil; Cheon, Jae Seok; Song, Jin Ho; SON, Seok Hyun; Jang, Ji Sun; Kang, Young Nam; Kang, Jing Hyoung; Jung, So Lyoung; Yoo, Ie Ryung; Jang, Hong Seok

    2012-01-01

    Background The aim of this study was to report the long-term clinical outcomes of patients who received stereotactic body radiotherapy (SBRT) as a boost treatment for head and neck cancer. Materials and methods Between March 2004 and July 2007, 26 patients with locally advanced, medically inoperable head and neck cancer or gross residual tumors in close proximity to critical structures following head and neck surgery were treated with SBRT as a boost treatment. All patients were initially tre...

  14. Long-term outcome and toxicity of hypofractionated stereotactic body radiotherapy as a boost treatment for head and neck cancer: the importance of boost volume assessment

    OpenAIRE

    Lee Dong; Kim Yeon; Cheon Jae; Song Jin; Son Seok; Jang Ji; Kang Young; Kang Jing; Jung So; Yoo Ie; Jang Hong

    2012-01-01

    Abstract Background The aim of this study was to report the long-term clinical outcomes of patients who received stereotactic body radiotherapy (SBRT) as a boost treatment for head and neck cancer. Materials and methods Between March 2004 and July 2007, 26 patients with locally advanced, medically inoperable head and neck cancer or gross residual tumors in close proximity to critical structures following head and neck surgery were treated with SBRT as a boost treatment. All patients were init...

  15. Radioactive suture in the treatment of head and neck cancer

    International Nuclear Information System (INIS)

    125I seeds in Vicryl suture have been used as a radioactive suture in 24 cases of advanced malignancy of the head and neck. Twelve cases had metastatic carcinoma attached to the internal or common carotid artery. The goal was to excise surgically as much tumor as possible, then implant any residual tumor with this radioactive suture which remains as a permanent implant (half-life of 60 days). This preliminary study shows that use of 125I impregnated Vicryl suture in this manner appears to produce improved long-term palliation and may increase local cure rates

  16. PET/MRI in head and neck cancer: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Platzek, Ivan; Laniado, Michael [Dresden University Hospital, Department of Radiology, Dresden (Germany); Beuthien-Baumann, Bettina [Dresden University Hospital, Department of Nuclear Medicine, Dresden (Germany); Schneider, Matthias [Dresden University Hospital, Oral and Maxillofacial Surgery, Dresden (Germany); Gudziol, Volker [Dresden University Hospital, Department of Otolaryngology, Dresden (Germany); Langner, Jens; Schramm, Georg; Hoff, Joerg van den [Institute of Bioinorganic and Radiopharmaceutical Chemistry, Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Kotzerke, Joerg [Dresden University Hospital, Nuclear Medicine, Dresden (Germany)

    2013-01-15

    To evaluate the feasibility of PET/MRI (positron emission tomography/magnetic resonance imaging) with FDG ({sup 18}F-fluorodeoxyglucose) for initial staging of head and neck cancer. The study group comprised 20 patients (16 men, 4 women) aged between 52 and 81 years (median 64 years) with histologically proven squamous cell carcinoma of the head and neck region. The patients underwent a PET scan on a conventional scanner and a subsequent PET/MRI examination on a whole-body hybrid system. FDG was administered intravenously prior to the conventional PET scan (267-395 MBq FDG, 348 MBq on average). The maximum standardized uptake values (SUV{sub max}) of the tumour and of both cerebellar hemispheres were determined for both PET datasets. The numbers of lymph nodes with increased FDG uptake were compared between the two PET datasets. No MRI-induced artefacts where observed in the PET images. The tumour was detected by PET/MRI in 17 of the 20 patients, by PET in 16 and by MRI in 14. The PET/MRI examination yielded significantly higher SUV{sub max} than the conventional PET scanner for both the tumour (p < 0.0001) and the cerebellum (p = 0.0009). The number of lymph nodes with increased FDG uptake detected using the PET dataset from the PET/MRI system was significantly higher the number detected by the stand-alone PET system (64 vs. 39, p = 0.001). The current study demonstrated that PET/MRI of the whole head and neck region is feasible with a whole-body PET/MRI system without impairment of PET or MR image quality. (orig.)

  17. Hypothyroidism as a Consequence of Intensity-Modulated Radiotherapy With Concurrent Taxane-Based Chemotherapy for Locally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: To conduct a retrospective review of 168 consecutively treated locally advanced head-and-neck cancer (LAHNC) patients treated with intensity-modulated radiotherapy (IMRT)/chemotherapy, to determine the rate and risk factors for developing hypothyroidism. Methods and Materials: Intensity-modulated radiotherapy was delivered in 33 daily fractions to 69.3 Gy to gross disease and 56.1 Gy to clinically normal cervical nodes. Dose-volume histograms (DVHs) of IMRT plans were used to determine radiation dose to thyroid and were compared with DVHs using conventional three-dimensional radiotherapy (3D-RT) in 10 of these same patients randomly selected for replanning and with DVHs of 16 patients in whom the thyroid was intentionally avoided during IMRT. Weekly paclitaxel (30 mg/m2) and carboplatin area under the curve-1 were given concurrently with IMRT. Results: Sixty-one of 128 evaluable patients (47.7%) developed hypothyroidism after a median of 1.08 years after IMRT (range, 2.4 months to 3.9 years). Age and volume of irradiated thyroid were associated with hypothyroidism development after IMRT. Compared with 3D-RT, IMRT with no thyroid dose constraints resulted in significantly higher minimum, maximum, and median dose (p < 0.0001) and percentage thyroid volume receiving 10, 20, and 60 Gy (p < 0.05). Compared with 3D-RT, IMRT with thyroid dose constraints resulted in lower median dose and percentage thyroid volume receiving 30, 40, and 50 Gy (p < 0.005) but higher minimum and maximum dose (p < 0.005). Conclusions: If not protected, IMRT for LAHNC can result in higher radiation to the thyroid than with conventional 3D-RT. Techniques to reduce dose and volume of radiation to thyroid tissue with IMRT are achievable and recommended.

  18. Luncheon seminar at 113th general meeting of the Oto-Rhino-Laryngological society of Japan. Advances in pharmacotherapy of the head and neck cancer

    International Nuclear Information System (INIS)

    Presented are the advances in the title from multidisciplinary fields involving chemoradiotherapy (CRT) and induction chemotherapy (IC) together with future therapeutics using molecular targeted drugs. Evidences at high levels have been accumulated concerning the head and neck cancer (HNC) treatment. CRT is found to be of higher efficacy than usual RT alone, where conventional or hyper-fractionated irradiation has been performed at around 70 Gy. CRT using cisplatin (CDDP) is a standard in foreign countries but Japan has insufficient data for this. IC has been doubtful for its efficacy, but is reconsidered by introduction of multi-drug therapy. The efficacy has been evaluated by aspects of suppression of remote metastasis and of functional preservation as well as of survival time (ST) elongation. The treatment is different between resectable and unresectable HNC. For the former cases, the protocol utilized aims at the elongation of ST and organ preservation with IC and CRT for improving QOL. For the latter cases, improvement of the complete remission (CR) rate by IC and CRT possibly elongates ST and can be further elevated with molecular targeted drugs in future. Superiority of IC and CRT has been proved by many clinical trials, but tasks to be solved remains still as seen in the guideline for HNC treatment (2013). This is probably because of lacks of satisfactorily high quality clinical trials in Japan, and of sufficient consensus for application of foreign data. HNC group in Japan Clinical Oncology Group (JCOG), founded in Apr. 2011, is conducting such high quality trials for establishing the standard therapeutic strategy and postoperative CRT regimen in Japan. Multidisciplinary treatment of HNC will further improve ST and QOL of the patients. (T.T.)

  19. Role of infectious agents in the carcinogenesis of brain and head and neck cancers

    OpenAIRE

    Alibek Kenneth; Kakpenova Ainur; Baiken Yeldar

    2013-01-01

    Abstract This review concentrates on tumours that are anatomically localised in head and neck regions. Brain cancers and head and neck cancers together account for more than 873,000 cases annually worldwide, with an increasing incidence each year. With poor survival rates at late stages, brain and head and neck cancers represent serious conditions. Carcinogenesis is a multi-step process and the role of infectious agents in this progression has not been fully identified. A major problem with s...

  20. [What makes "Head-and-Neck-Cancers" recur: Tumorinvasion "revisited"].

    Science.gov (United States)

    Simon, C; Koitschev, A; Plinkert, P K

    2007-03-01

    Head and neck squamous cell carcinomas (HNSCC) are common cancers with a relatively poor prognosis. Locoregionale recurrences are regularly encountered and associated with a detrimental outcome. Studies of the last few years report that not only tumor staging and grading influence locoregional control but also histologic and biological markers. One such histological marker is coined "worst pattern of invasion". It describes a histologic growth pattern consisting of invading tumor cell islands and strands that are dispatched from the invasion front (POI typ 4 and 5). Additional features of invasion are perineural invasion and extracapsular nodal extension. Besides histological markers there are molecular characteristics that include the expression of gene families involved in extracellular matrix degradation. The data suggest that head and neck cancers differ with respect to their invasive growth capacity and thus their ability to generate locoregionale recurrences. It appears that locoregionale control is a consequence of this growth pattern. This may explain, why in recent clincial studies the prognostic marker "pattern-of-invasion" outweights even such well established prognosticators such as "surgical margins". PMID:17351878

  1. Clinicopathological correlates of pediatric head and neck cancer

    Directory of Open Access Journals (Sweden)

    Sengupta Subhabrata

    2009-01-01

    Full Text Available Background : The spectrum of head and neck tumors in children continues to be the cause of diverse, diagnostically challenging issues. Aims : To demonstrate and compare the unique clinicopathological features in our study population and their correlations with the final histopathological diagnosis. Methods : Fifty-three children with head and neck cancer were examined thoroughly at the Otorhinolaryngology department in a tertiary care teaching hospital followed by histopathological studies. Results : Lymphomas were the most common malignant lesions seen followed by rhabdomyosarcomas, nasopharyngeal carcinomas, and others like thyroid carcinomas and eosinophilic granulomas. In the neck, the commonest cause of primary malignant disease was lymphoma; however, the most frequent lesion was reactive lymphadenitis. In the sinonasal region, the commonest malignancy was rhabdomyosarcoma, which often had extension to the orbit and the face. Recurrent epistaxis was found universally in the malignant cases of this region. In the facial region, disfiguring swelling with proptosis was mainly caused by rhabdomyosarcoma. The only case of tonsillar malignancy was due to non-Hodgkin lymphoma. The duration of disease was less than 1 year. Conclusion : The most common manifestation of the malignant lesions in the pediatric age group was with a history of an enlarging, painless neck swelling. Still, an insignificant lump in the neck or recurrent bleeding from nose may be the manifestation of an underlying cancer.

  2. Scoring irradiation mucositis in head and neck cancer patients

    International Nuclear Information System (INIS)

    Irradiation mucositis is defined as an inflammatory-like process of the oropharyngeal mucosa following therapeutic irradiation of patients who have head and neck cancer. Clinically, it is a serious side effect because severe mucositis can cause generalized problems (weight loss, nasogastic tube feedings) and interferes with the well-being of the patient seriously. Grading mucositis is important for the evaluation of preventive and therapeutic measures. The object of this study was to develop a scoring method based on local mucositis signs only. Four clinical local signs of mucositis were used in this score: white discoloration, erythema, pseudomembranes and ulceration. Mucositis of the oral cavity was calcualted during conventional irradiation protocol for 8 distinguishable areas using the 4 signs and their extent. A prospective evaluation of this method in 15 irradiated head and neck cancer patients displayed an S-curve reflecting a symptomless first irradiation week, followed by a rapid and steady increase of white discoloration, erythema and pseudomembranes during the second and third week. Oral candidiasis, generalized symptoms such as weight loss and the highest mucositis scores were seen after 3 weeks irradiation. The novel mucositis scoring method may be of value in studying the effect of hygiene programs, topical application of disinfectans or antibiotics on oral mucositis. (author)

  3. Scoring irradiation mucositis in head and neck cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Spijkervet, F.K.L.; Panders, A.K. (Departments of Oral and Maxillofacial Surgery, University Hospital Groningen (Netherlands)); Saene, H.K.F. van (Medical Microbiology, University of Liverpool (UK)); Vermey, A. (Department of Surgery Oncology Division, University Hospital Groningen (Netherlands)); Mehta, D.M. (Department of Radiotherapy, University Hospital Groningen (Netherlands))

    1989-01-01

    Irradiation mucositis is defined as an inflammatory-like process of the oropharyngeal mucosa following therapeutic irradiation of patients who have head and neck cancer. Clinically, it is a serious side effect because severe mucositis can cause generalized problems (weight loss, nasogastic tube feedings) and interferes with the well-being of the patient seriously. Grading mucositis is important for the evaluation of preventive and therapeutic measures. The object of this study was to develop a scoring method based on local mucositis signs only. Four clinical local signs of mucositis were used in this score: white discoloration, erythema, pseudomembranes and ulceration. Mucositis of the oral cavity was calcualted during conventional irradiation protocol for 8 distinguishable areas using the 4 signs and their extent. A prospective evaluation of this method in 15 irradiated head and neck cancer patients displayed an S-curve reflecting a symptomless first irradiation week, followed by a rapid and steady increase of white discoloration, erythema and pseudomembranes during the second and third week. Oral candidiasis, generalized symptoms such as weight loss and the highest mucositis scores were seen after 3 weeks irradiation. The novel mucositis scoring method may be of value in studying the effect of hygiene programs, topical application of disinfectans or antibiotics on oral mucositis. (author).

  4. Treatment of locally advanced head and neck cancer with misonidazole, hyperbaric oxygen and irradiation: an interim report

    International Nuclear Information System (INIS)

    Thirty-one patients with advanced inoperable squamous carcinoma of the mouth were treated in a pilot study with misonidazole with each of six fractions of 6.0 Gy in hyperbaric oxygen at 3 ATA. The one and two year disease free survival was 48 and 26%, respectively. A prospective randomized trial is now being conducted comparing this regimen with 63.0 Gy in 30 fractions in 38 days in air. One hundred-fourteen patients have been entered; 91 are available for analysis at six months or more. The preliminary results at 6 and 12 months favor the combination of sensitizers. There is no added toxicity

  5. Results of high dose radiation and surgery in the treatment of advanced cancer of the head and neck

    International Nuclear Information System (INIS)

    One hundred nineteen patients with stage III or IV cancer of the oral cavity or laryngopharynx were treated with combined radiation therapy and surgery at the University of Kentucky and the New Jersey Medical School since 1962. In the University of Kentucky series, the three year postoperative survival figures in patients with stage III or IV lesions were 43 percent for lesions of the laryngopharynx and 39 percent for lesions of the oral cavity. Of great interest are the survival figures for patients with stage IV lesions: 50 percent for those with lesions of the laryngopharynx and 11 percent for those with lesions of the oral cavity. Although the New Jersey Medical School series is still young, the results (by actuarial projection) approached those of the University of Kentucky series and will be interesting to follow. (U.S.)

  6. Concurrent hyperfractionated accelerated radiotherapy with 5-FU and once weekly cisplatin in locally advanced head and neck cancer. The 10-year results of a prospective phase II trial

    Energy Technology Data Exchange (ETDEWEB)

    Budach, V.; Boehmer, D.; Badakhshi, H.; Jahn, U.; Stromberger, C. [Campus Virchow Klinikum, Charite Universitaetsmedizin Berlin, Department for Radiooncology, Clinic for Radiooncology, Berlin (Germany); Becker, E.T. [Charite Universitaetsmedizin, Department of Otorhinolaryngology, Berlin (Germany); Wernecke, K.D. [Sostana Statistics GmbH, Charite Universitaetsmedizin Berlin, Berlin (Germany)

    2014-03-15

    In this study, the acute toxicity and long-term outcome of a hyperfractionated accelerated chemoradiation regimen with cisplatin/5-fluorouracil (5-FU) in patients with locally advanced squamous cell carcinomas of head and neck were evaluated. From 2000-2002, 38 patients with stage III (5.3 %) and stage IV (94.7 %) head and neck cancer were enrolled in a phase II study. Patients received hyperfractionated-accelerated radiotherapy with 72 Gy in 15 fractions of 2 Gy followed by 1.4 Gy twice daily with concurrent, continuous infusion 5-FU of 600 mg/m{sup 2} on days 1-5 and 6 cycles of weekly cisplatin (30 mg/m{sup 2}). Acute toxicities (CTCAEv2.0), locoregional control (LRC), metastases-free (MFS), and overall survival (OS) were analyzed and exploratively compared with the ARO 95-06 trial. Median follow-up was 11.4 years (95 % CI 8.6-14.2) and mean dose 71.6 Gy. Of the patients, 82 % had 6 (n = 15) or 5 (n = 16) cycles of cisplatin, 5 and 2 patients received 4 and 3 cycles, respectively. Grade 3 anemia, leukopenia, and thrombocytopenia were observed in 15.8, 15.8, and 2.6 %, respectively. Grade 3 mucositis in 50 %, grade 3 and 4 dysphagia in 55 and 13 %. The 2-, 5-, and 10-year LRC was 65, 53.6, and 48.2 %, the MFS was 77.5, 66.7, and 57.2 % and the OS 59.6, 29.2, and 15 %, respectively. Chemoradiation with 5-FU and cisplatin seems feasible and superior in terms of LRC and OS to the ARO 95-06C-HART arm at 2 years. However, this did not persist at the 5- and 10-year follow-ups. (orig.) [German] Untersuchung der Akuttoxizitaet und des Langzeitueberlebens einer hyperfraktioniert-akzelerierten simultanen Radiochemotherapie mit Cisplatin/5-Fluorouracil (5-FU) bei Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren. Von 2000 bis 2002 wurden 38 Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region im Stadium III (5,3 %) und IV (94,7 %) eingeschlossen. Es erfolgte eine simultane hyperfraktionierte akzelerierte Radiochemotherapie mit 72 Gy in 15 Fraktionen a 2 Gy

  7. Evaluation of comorbidity in 9388 head and neck cancer patients

    DEFF Research Database (Denmark)

    Bøje, Charlotte Rotbøl; Dalton, Susanne O; Primdahl, Hanne;

    2014-01-01

    BACKGROUND: Comorbidity is common in head and neck squamous cell carcinoma (HNSCC) patients due to the etiology of the disease being primarily smoking. The aim of this study was to investigate the impact of comorbidity on survival in a national population-based cohort study on 9388 HNSCC-patients......BACKGROUND: Comorbidity is common in head and neck squamous cell carcinoma (HNSCC) patients due to the etiology of the disease being primarily smoking. The aim of this study was to investigate the impact of comorbidity on survival in a national population-based cohort study on 9388 HNSCC...... diagnosed from 1992 to 2008 was identified from the DAHANCA-database. Data on comorbidity prior to HNSCC-diagnosis was obtained from the National Patient Registry and adapted to the CCI. RESULTS: By dividing the patients into two groups, we tested and validated which type of comorbidities within the CCI...... affected overall survival (OS) and cancer specific death (CSD). In total, 36% of patients had comorbidity. Six comorbid conditions within the CCI significantly reduced five-year OS probability: congestive heart failure, cerebrovascular disease, chronic pulmonary disease, peptic ulcer disease, liver disease...

  8. [The indication of panendoscopy in the search for synchronous and metachronous head and neck cancer].

    Science.gov (United States)

    Dulguerov, N; Dulguerov, P

    2013-10-01

    Head and neck cancer result from excessive tobacco and alcohol consumption. The survival has not improved in the last decades despite better loco-regional control, mainly because of secondary cancers. Head and neck cancer is associated to a high rate of synchronous esophageal and lung tumors and an annual 4% rate of new metachronous malignancies. The role of panendoscopy is evolving: a flexible esophagoscopy with Lugol's iodine staining should be performed and a chest CT-scan should replace bronchoscopy. During follow-up, metachronous malignancy should be searched for in the head and neck region; investigation beyond the head and neck is questionable since prognosis is poor. PMID:24187750

  9. Curative and organ-preserving treatment with intra-arterial carboplatin induction followed by surgery and/or radiotherapy for advanced head and neck cancer: single-center five-year results

    International Nuclear Information System (INIS)

    This study evaluated the feasibility, toxicity, response rate and survival of neoadjuvant superselective intra-arterial infusion of high dose carboplatin in advanced head and neck cancer. Forty-six patients with primary head and neck squamous cell carcinoma received 3 cycles of intra-arterial carboplatin (300 to 350 mg/m2 per cycle every 2 weeks), followed by radiotherapy or surgery plus radiotherapy. No complications or severe toxicity occurred. Sixteen patients (35%) were complete responders, 20 (43%) partial responders while 10 (22%) did not respond to treatment. After completion of the multimodality treatment, 38/46 patients (83%) were complete responders. After a 5-year follow-up period, 18/46 patients (39%) are alive and disease-free, 3 (6,5%) have died of a second primary tumor and 25 (54,5%) have died of the disease. Intra-arterial carboplatin induction chemotherapy is a safe, well-tolerated technique that discriminates between responders and non-responders and so may have prognostic significance in planning further integrated treatments aimed to organ preservation for advanced head and neck carcinomas

  10. Weekly Gemcitabine and Cisplatin in Combination With Radiotherapy in Patients With Locally Advanced Head-and-Neck Cancer: Phase I Study

    Energy Technology Data Exchange (ETDEWEB)

    Arruda Viani, Gustavo, E-mail: gusviani@gmail.com [Radiation Oncology Department, Faculty of Medicine of Marilia, Sao Paulo (Brazil); Afonso, Sergio Luis [Clinical Oncology Department, Faculty of Medicine of Marilia, Sao Paulo (Brazil); Cardoso Tavares, Vivian [Head and Neck Oncology Department, Faculty of Medicine of Marilia, Sao Paulo (Brazil); Bernardes Godoi da Silva, Lucas; Stefano, Eduardo Jose [Radiation Oncology Department, Faculty of Medicine of Marilia, Sao Paulo (Brazil)

    2011-11-15

    Purpose: To define the maximum tolerated dose by describing the dose-limiting toxicity (DLT) of weekly gemcitabine and cisplatin in patients with locally advanced head-and-neck (LAHN) cancer concomitant to irradiation. Methods and Materials: Patients with LAHN cancer were enrolled in a prospective, dose-escalation Phase I study. Toxicity was graded according to the Common Toxicity Criteria score. Maximum tolerated dose was defined when DLT developed in 2 of 6 patients. The starting dose of cisplatin was 20 mg/m{sup 2} and that of gemcitabine was 10 mg/m{sup 2} in 3 patients, with a subsequent dose escalation of 10 mg/m{sup 2} of cisplatin only for 3 new patients. In the next levels, only a dose escalation of gemcitabine with 10 mg/m{sup 2} for each new cohort was used (Level 1, 10 mg/m{sup 2} of gemcitabine and 20 mg/m{sup 2} of cisplatin; Level 2, 10 mg/m{sup 2} of gemcitabine and 30 mg/m{sup 2} of cisplatin; and Level 3, 20 mg/m{sup 2} of gemcitabine and 30 mg/m{sup 2} of cisplatin). Radiation therapy was administered by use of a conformal technique over a period of 6 to 7 weeks in 2.0-Gy daily fractions for 5 consecutive days per week to a total dose of 70 Gy. Results: From 2008 to 2009, 12 patients completing 3 dose levels were included in the study. At Dose Level 3, 1 of 3 patients had DLT with Grade 3 mucositis. Of the next 3 required patients, 2 showed DLT with Grade 3 dermatitis. At a follow-up of 3 months, 10 of 12 evaluable patients (83.3%) obtained a complete response and 1 patient (8.3%) obtained a partial response. Among the complete responders, at a median follow-up of 10 months (range, 6-14 months), 9 patients are alive and disease free. Conclusion: Gemcitabine at low doses combined with cisplatin is a potent radiosensitizer effective in patients with LAHN cancer. The recommended Phase II dose is 10 mg/m{sup 2} of gemcitabine and 30 mg/m{sup 2} of cisplatin with an acceptable tolerability profile.

  11. Advances in otolaryngology-Head and neck surgery. Volume 1

    International Nuclear Information System (INIS)

    This book consists of 14 sections. The section titles are: The impact of AIDS on otolaryngology--head and neck surgery; The management of sleep apneas and snoring; Antimicrobial agents for infections in the ear, nose, and throat--head and neck; Nasal allergy: Medical and surgical treatment; Uses of computerized tomography and magnetic resonance imaging in temporal bone imaging; Surgical management of otitis media with effusion; middle ear reconstruction: Current status; Cochlear implants: an overview; Diagnosis and management of acute facial paralysis; The use of the laser in head and neck surgery; The management and prevention of subglottic stenosis in infants and children; Management of the mass in the thyroid; Suction-assisted lipectomy of the head and neck area; and Ambulatory surgery

  12. Advances in otolaryngology-Head and neck surgery. Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    Myers, E.N. (Univ. of Pittsburgh School of Medicine, Pittsburgh, PA (US)); Bluestone, C.D. (Univ. of Pittsburgh, Pittsburgh, PA (US))

    1987-01-01

    This book consists of 14 sections. The section titles are: The impact of AIDS on otolaryngology--head and neck surgery; The management of sleep apneas and snoring; Antimicrobial agents for infections in the ear, nose, and throat--head and neck; Nasal allergy: Medical and surgical treatment; Uses of computerized tomography and magnetic resonance imaging in temporal bone imaging; Surgical management of otitis media with effusion; middle ear reconstruction: Current status; Cochlear implants: an overview; Diagnosis and management of acute facial paralysis; The use of the laser in head and neck surgery; The management and prevention of subglottic stenosis in infants and children; Management of the mass in the thyroid; Suction-assisted lipectomy of the head and neck area; and Ambulatory surgery.

  13. The role of human papillomavirus in head and neck cancer

    DEFF Research Database (Denmark)

    Lajer, Christel Braemer; Buchwald, Christian von

    Over the last 20 years, there has been increasing awareness of a subset of squamous cell carcinomas of the head and neck (HNSCC), i.e. HPV-positive HNSCC. These cancers seem to differ somewhat from HPV-negative HNSCC. Patients with HPV-positive HNSCC tend to be younger and have a lower intake of...... tobacco and alcohol. Distinct molecular profiles separate them from HPV-negative cancers and show similarities with HPV-positive cervical SCC. There is evidence that HPV-positive HNSCC is a sexually transmitted disease. Patients with HPV-positive HNSCC are often diagnosed at a late stage with large cystic...... lymph nodes in the neck. HPV-positive HNSCC show an affinity for the oropharynx, especially the tonsils and the base of the tongue, and tend to show low differentiation histopathologically. There is a better prognosis regardless of the treatment regimen for HPV-positive HNSCC compared with HPV...

  14. Monoclonal Antibodies as Treatment Modalities in Head and Neck Cancers

    Directory of Open Access Journals (Sweden)

    Vivek Radhakrishnan

    2015-11-01

    Full Text Available The standard treatments of surgery, radiation, and chemotherapy in head and neck squamous cell carcinomas (HNSCC causes disturbance to normal surrounding tissues, systemic toxicities and functional problems with eating, speaking, and breathing. With early detection, many of these cancers can be effectively treated, but treatment should also focus on retaining the function of the proximal nerves, tissues and vasculature surrounding the tumor. With current research focused on understanding pathogenesis of these cancers in a molecular level, targeted therapy using monoclonal antibodies (MoAbs, can be modified and directed towards tumor genes, proteins and signal pathways with the potential to reduce unfavorable side effects of current treatments. This review will highlight the current MoAb therapies used in HNSCC, and discuss ongoing research efforts to develop novel treatment agents with potential to improve efficacy, increase overall survival (OS rates and reduce toxicities.

  15. Oxygenation measurements in head and neck cancers during hyperbaric oxygenation

    International Nuclear Information System (INIS)

    Background: Tumor hypoxia has proven prognostic impact in head and neck cancers and is associated with poor response to radiotherapy. Hyperbaric oxygenation (HBO) offers an approach to overcome hypoxia. We have performed pO2 measurements in selected patients with head and neck cancers under HBO to determine in how far changes in the oxygenation occur and whether a possible improvement of oxygenation parameters is maintained after HBO. Patients and Methods: Seven patients (five male, two female, age 51-63 years) with squamous cell cancers of the head and neck were investigated (six primaries, one local recurrence). The median pO2 prior to HBO was determined with the Eppendorf histograph. Sites of measurement were enlarged cervical lymph nodes (n = 5), the primary tumor (n = 1) and local recurrence (n = 1). Patients then underwent HBO (100% O2 at 240 kPa for 30 minutes) and the continuous changes in the oxygenation during HBO were determined with a Licox probe. Patients had HBO for 30 minutes (n = 6) to 40 minutes (n = 1). HBO was continued because the pO2 had not reached a steady state after 30 minutes. After decompression, patients ventilated pure oxygen under normobaric conditions and the course of the pO2 was further measured over about 15 minutes. Results: Prior to HBO, the median tumor pO2 in the Eppendorf histography was 8.6 ± 5.4 mm Hg (range 3-19 mm Hg) and the pO2 measured with the Licox probe was 17.3 ± 25.5 mm Hg (range 0-73 mm Hg). The pO2 increased significantly during HBO to 550 ± 333 mm Hg (range 85-984 mm Hg, p = 0.018). All patients showed a marked increase irrespective of the oxygenation prior to HBO. The maximum pO2 in the tumor was reached after 10-33 minutes (mean 17 minutes). After leaving the hyperbaric chamber, the pO2 was 282 ± 196 mm Hg. All patients maintained an elevated pO2 for further 5-25 minutes (138 ± 128 mm Hg, range 42-334 mm Hg, p = 0.028 vs the pO2 prior to HBO). Conclusions: Hyperbaric oxygenation resulted in a significant

  16. Carotenoid intake and head and neck cancer: a pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.

    Science.gov (United States)

    Leoncini, Emanuele; Edefonti, Valeria; Hashibe, Mia; Parpinel, Maria; Cadoni, Gabriella; Ferraroni, Monica; Serraino, Diego; Matsuo, Keitaro; Olshan, Andrew F; Zevallos, Jose P; Winn, Deborah M; Moysich, Kirsten; Zhang, Zuo-Feng; Morgenstern, Hal; Levi, Fabio; Kelsey, Karl; McClean, Michael; Bosetti, Cristina; Schantz, Stimson; Yu, Guo-Pei; Boffetta, Paolo; Lee, Yuan-Chin Amy; Chuang, Shu-Chun; Decarli, Adriano; La Vecchia, Carlo; Boccia, Stefania

    2016-04-01

    Food and nutrition play an important role in head and neck cancer (HNC) etiology; however, the role of carotenoids remains largely undefined. We explored the relation of HNC risk with the intake of carotenoids within the International Head and Neck Cancer Epidemiology Consortium. We pooled individual-level data from 10 case-control studies conducted in Europe, North America, and Japan. The analysis included 18,207 subjects (4414 with oral and pharyngeal cancer, 1545 with laryngeal cancer, and 12,248 controls), categorized by quintiles of carotenoid intake from natural sources. Comparing the highest with the lowest quintile, the risk reduction associated with total carotenoid intake was 39 % (95 % CI 29-47 %) for oral/pharyngeal cancer and 39 % (95 % CI 24-50 %) for laryngeal cancer. Intakes of β-carotene equivalents, β-cryptoxanthin, lycopene, and lutein plus zeaxanthin were associated with at least 18 % reduction in the rate of oral and pharyngeal cancer (95 % CI 6-29 %) and 17 % reduction in the rate of laryngeal cancer (95 % CI 0-32 %). The overall protective effect of carotenoids on HNC was stronger for subjects reporting greater alcohol consumption (p tobacco consumption versus high carotenoid intake and low alcohol or tobacco consumption ranged from 7 (95 % CI 5-9) to 33 (95 % CI 23-49). A diet rich in carotenoids may protect against HNC. Persons with both low carotenoid intake and high tobacco or alcohol are at substantially higher risk of HNC. PMID:25930054

  17. Concurrent weekly docetaxel and concomitant boost radiation therapy in the treatment of locally advanced squamous cell cancer of the head and neck

    International Nuclear Information System (INIS)

    Purpose: In a Phase I/II trial, we investigated concurrent weekly docetaxel and concomitant boost radiation in patients with locally advanced squamous cell cancer of the head and neck (SCCHN) after induction chemotherapy. Patients and Methods: Patients presented with American Joint Committee on Cancer Stage III/IV and were treated initially with induction chemotherapy using cisplatinum/5-fluorouracil (PF), carboplatinum-5-FU, or docetaxel-PF. Patients then received docetaxel four times weekly with concomitant boost (CB) radiation (1.8 Gy once-daily X20, 1.8/1.5 Gy twice a day). Fifteen patients each received 20 mg/M2 and 25 mg/M2. Results: Thirty-one patients were enrolled and 30 were evaluable for response and toxicity. Median follow-up was 42 months (range, 27-63 months). Primary sites were: oropharynx 19, oral cavity 2, larynx/hypopharynx 5, and unknown primary 4. Eighty-seven percent of patients had N2/N3 disease; 60% had T3/T4 disease. Twenty percent of patients had a complete response (CR) to induction chemotherapy. After chemoradiotherapy, 21 of 30 patients had a CR, 2 had progressive disease, and 7 had partial response (PR). Nineteen of 26 patients presenting with neck disease had neck dissections, and 7 of 19 were positive. Ninety-three percent of all patients were rendered disease-free after all planned therapy. Treatment failed in 8 patients, and 7 have died of disease. An additional patient died with no evidence of disease. Twenty-one patients (70%) are currently alive with no evidence of disease. No acute dose-limiting toxicity was observed at either dose level. Conclusions: This intensive treatment regimen of concurrent docetaxel/concomitant boost radiation and surgery after induction chemotherapy in poor prognosis patients yields good local regional control and survival. Docetaxel/CB chemoradiotherapy represents an aggressive alternative regimen to platinum-based chemoradiotherapy or surgery in patients who have a poor response to induction

  18. Locoregionally Advanced Head and Neck Cancer Treated With Primary Radiotherapy: A Comparison of the Addition of Cetuximab or Chemotherapy and the Impact of Protocol Treatment

    International Nuclear Information System (INIS)

    Purpose: The addition of platinum-based chemotherapy (ChRT) or cetuximab (ExRT) to concurrent radiotherapy (RT) has resulted in improved survival in Phase III studies for locoregionally advanced head and neck cancer (LAHNC). However the optimal treatment regimen has not been defined. A retrospective study was performed to compare outcomes in patients who were treated definitively with ExRT or ChRT. Methods: Cetuximab with concurrent RT was used to treat 29 patients with LAHNC, all of whom had tumors of the oral cavity, oropharynx, or larynx. All patients were T2 to T4 and overall American Joint Committee on Cancer Stage III to IVB, with a Karnofsky Performance Status (KPS) score of 60 or greater. ChRT was used to treat 103 patients with similar characteristics. Patients were evaluated for locoregional control (LRC), distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS). Median follow-up for patients alive at last contact was 83 months for those treated with ExRT and 53 months for those treated with ChRT. Cox proportional hazard models were used to assess independent prognostic factors. Results: The LRC, DMFS, and DSS were not significantly different, with 3-year rates of 70.7%, 92.4%, and 78.6% for ExRT and 74.7%, 86.6%, and 76.5% for ChRT, respectively. The OS was significantly different between the two groups (p = 0.02), with 3-year rates of 75.9% for ExRT and 61.3% for ChRT. OS was not significant when patients who were on protocol treatments of ExRT or ChRT were compared. Also, OS was not significant when multivariate analysis was used to control for potential confounding factors. Conclusion: In our single-institution retrospective review of patients treated with ExRT or ChRT, no significant differences were found in LRC, DMFS, DSS, or OS

  19. Prospective, longitudinal, multi-modal functional imaging for radical chemo-IMRT treatment of locally advanced head and neck cancer: the INSIGHT study

    International Nuclear Information System (INIS)

    Radical chemo-radiotherapy (CRT) is an effective organ-sparing treatment option for patients with locally advanced head and neck cancer (LAHNC). Despite advances in treatment for LAHNC, a significant minority of these patients continue to fail to achieve complete response with standard CRT. By constructing a multi-modality functional imaging (FI) predictive biomarker for CRT outcome for patients with LAHNC we hope to be able to reliably identify those patients at high risk of failing standard CRT. Such a biomarker would in future enable CRT to be tailored to the specific biological characteristics of each patients’ tumour, potentially leading to improved treatment outcomes. The INSIGHT study is a single-centre, prospective, longitudinal multi-modality imaging study using functional MRI and FDG-PET/CT for patients with LAHNC squamous cell carcinomas receiving radical CRT. Two cohorts of patients are being recruited: one treated with, and another treated without, induction chemotherapy. All patients receive radical intensity modulated radiotherapy with concurrent chemotherapy. Patients undergo functional imaging before, during and 3 months after completion of radiotherapy, as well as at the time of relapse, should that occur within the first two years after treatment. Serum samples are collected from patients at the same time points as the FI scans for analysis of a panel of serum markers of tumour hypoxia. The primary aim of the INSIGHT study is to acquire a prospective multi-parametric longitudinal data set comprising functional MRI, FDG PET/CT, and serum biomarker data from patients with LAHNC undergoing primary radical CRT. This data set will be used to construct a predictive imaging biomarker for outcome after CRT for LAHNC. This predictive imaging biomarker will be used in future studies of functional imaging based treatment stratification for patients with LAHNC. Additional objectives are: defining the reproducibility of FI parameters; determining robust

  20. Hypothyroidism following radiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    The incidence of hypothyroidism following radiotherapy for head and neck cancer is 10-45% in several series. In order to identify possible riskfactors a multivariate analysis was performed in 221 patients previously treated with radiotherapy alone or combined with surgery or chemotherapy. Diagnostic procedures included: total T3 and T4, free T4 and TSH measured by radio-immunoassay, and thyroid scintigraphy. The absolute rate of hypothyroidism was 41.17% (subclinical 26.24%, clinical 14.93%). No thyroid nodules were detected in any patient. By multivariate analysis, risk factors that significantly influenced a higher incidence of hypofunction were: high radiation dose (p=0.000), a combination of radiotherapy and cervical surgery (p=0.003), time from therapy (p=0.022) and no shielding of midline (p=0.026). (author). 34 refs., 8 tabs

  1. PET imaging biomarkers in head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Differding, Sarah; Gregoire, Vincent [Universite Catholique de Louvain, St-Luc University Hospital, Department of Radiation Oncology, and Center for Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Experimentale et Clinique (IREC), Brussels (Belgium); Hanin, Francois-Xavier [Universite Catholique de Louvain, St-Luc University Hospital, Department of Nuclear Medicine, and Center for Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Experimentale et Clinique (IREC), Brussels (Belgium)

    2015-04-01

    In locally advanced head and neck squamous cell carcinoma (HNSCC), the role of imaging becomes more and more critical in the management process. In this framework, molecular imaging techniques such as PET allow noninvasive assessment of a range of tumour biomarkers such as metabolism, hypoxia and proliferation, which can serve different purposes. First, in a pretreatment setting they can influence therapy selection strategies and target delineation for radiation therapy. Second, their predictive and/or prognostic value could help enhance the therapeutic ratio in the management of HNSCC. Third, treatment modification can be performed through the generation of a molecular-based heterogeneous dose distribution with dose escalation to the most resistant parts of the tumour, a concept known as dose painting. Fourth, they are increasingly becoming a tool for monitoring response to therapy. In this review, PET imaging biomarkers used in the routine management of HNSCC or under investigation are discussed. (orig.)

  2. Differential risk assessments from five hypoxia specific assays: The basis for biologically adapted individualized radiotherapy in advanced head and neck cancer patients

    DEFF Research Database (Denmark)

    Nordsmark, Marianne; Eriksen, Jesper Grau; Gebski, Val; Alsner, Jan; Horsman, Michael Robert; Overgaard, Jens

    2007-01-01

    PURPOSE: Hypoxia adversely relates with prognosis in human tumours. Five hypoxia specific predictive marker assays were compared and correlated with definitive radiotherapy. PATIENTS AND METHODS: Sixty-seven patients with advanced head and neck carcinomas were studied for pre-treatment plasma...... osteopontin measured by ELISA, tumour oxygenation status using pO(2) needle electrodes and tumour osteopontin, hypoxia inducible factor 1alpha (HIF-1alpha) and carboxyanhydrase 9 (CA9) by immunohistochemistry. The primary treatment was radiotherapy and the hypoxic radiosensitizer nimorazole. Loco......-regional tumour control was evaluated at 5 years. RESULTS: All five markers showed inter-tumour variability. Inter-marker correlations were inconsistent. Only plasma osteopontin inversely correlated with median tumour pO(2), (p=0.02, r=0.28) and CA9 correlated with HIF-1alpha (p<0.01, r=0.45). In Kaplan...

  3. Final Results of Local-Regional Control and Late Toxicity of RTOG 9003: A Randomized Trial of Altered Fractionation Radiation for Locally Advanced Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Beitler, Jonathan J., E-mail: jjbeitl@emory.edu [Winship Cancer Institute of Emory University School of Medicine, Atlanta, Georgia (United States); Zhang, Qiang [Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States); Fu, Karen K. [University of California San Francisco, San Francisco, California (United States); Trotti, Andy [H. Lee Moffitt Cancer Center at the University of South Florida, Tampa, Florida (United States); Spencer, Sharon A. [University of Alabama at Birmingham Medical Center, Birmingham, Alabama (United States); Jones, Christopher U. [Radiological Associates of Sacramento, Sacramento, California (United States); Garden, Adam S. [MD Anderson Cancer Center, University of Texas, Houston, Texas (United States); Shenouda, George [McGill University, Montréal, Quebec (Canada); Harris, Jonathan [Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States); Ang, Kian K. [MD Anderson Cancer Center, University of Texas, Houston, Texas (United States)

    2014-05-01

    Purpose: To test whether altered radiation fractionation schemes (hyperfractionation [HFX], accelerated fractionation, continuous [AFX-C], and accelerated fractionation with split [AFX-S]) improved local-regional control (LRC) rates for patients with squamous cell cancers (SCC) of the head and neck when compared with standard fractionation (SFX) of 70 Gy. Methods and Materials: Patients with stage III or IV (or stage II base of tongue) SCC (n=1076) were randomized to 4 treatment arms: (1) SFX, 70 Gy/35 daily fractions/7 weeks; (2) HFX, 81.6 Gy/68 twice-daily fractions/7 weeks; (3) AFX-S, 67.2 Gy/42 fractions/6 weeks with a 2-week rest after 38.4 Gy; and (4) AFX-C, 72 Gy/42 fractions/6 weeks. The 3 experimental arms were to be compared with SFX. Results: With patients censored for LRC at 5 years, only the comparison of HFX with SFX was significantly different: HFX, hazard ratio (HR) 0.79 (95% confidence interval 0.62-1.00), P=.05; AFX-C, 0.82 (95% confidence interval 0.65-1.05), P=.11. With patients censored at 5 years, HFX improved overall survival (HR 0.81, P=.05). Prevalence of any grade 3, 4, or 5 toxicity at 5 years; any feeding tube use after 180 days; or feeding tube use at 1 year did not differ significantly when the experimental arms were compared with SFX. When 7-week treatments were compared with 6-week treatments, accelerated fractionation appeared to increase grade 3, 4 or 5 toxicity at 5 years (P=.06). When the worst toxicity per patient was considered by treatment only, the AFX-C arm seemed to trend worse than the SFX arm when grade 0-2 was compared with grade 3-5 toxicity (P=.09). Conclusions: At 5 years, only HFX improved LRC and overall survival for patients with locally advanced SCC without increasing late toxicity.

  4. Optimizing multimodality treatment for head and neck cancer in rural India

    Directory of Open Access Journals (Sweden)

    N P Trivedi

    2012-01-01

    Full Text Available Background: Multimodality treatment of head and neck cancer in rural India is not always feasible due to lack of infrastructure and logistics. Aim: To demonstrate the feasibility of multimodality treatment for head and neck cancer in a community setting in rural India. Setting and Design: Community cancer center, retrospective review. Materials and Methods: This article focuses on practice environment in a cancer clinic in rural India. We evaluated patient profile, treatment protocols, infrastructure availability, factors impacting treatment decisions, cost estimations, completion of treatment, and major treatment-related complications for the patient population treated in our clinic for a 2-year period. Results: A total of 230 head and neck cancer patients were treated with curative intent. Infrastructure support included basic operating room facility (cautery machine, suction, drill system, microscope, and anesthesia machine without ventilator support, blood bank, histopathology laboratory, and computerized tomography machine. Radiation therapy (RT facility was available in a nearby city, about 75 km away. One hundred and fifty-four (67% patients presented at an advanced stage, with 138 (60% receiving multimodality treatment. One hundred and eighty-four (80% patients underwent primary surgery and 167 (73% received radiotherapy. Two hundred and twelve (92% patients completed the treatment, 60 (26% were lost to follow-up at 18-month median follow-up (range 12-26 months, with 112 patients (66% being alive, disease free. Totally 142 were major head neck surgeries with 25 free flap reconstructions and 41 regional flaps. There were 15 (6% major post-op complications and two perioperative mortalities. Average cost of treatment for single modality treatment was approximately 40,000 INR and for multimodality treatment was 80,000 INR. Conclusions: This study demonstrates that it is feasible to provide basic multimodality treatment to head and neck

  5. Radical treatment of locally advanced head and neck cancer with concurrent chemo radiation-cisplatin versus carboplatin: A randomized comparative phase III trial

    Directory of Open Access Journals (Sweden)

    Shatarupa Dutta

    2013-01-01

    Full Text Available Context: Concurrent chemoradiation with cisplatin is a standard approach for definitive management of locally advanced head and neck squamous cell carcinoma (LAHNSCC. Carboplatin, though a platinum group of drug, is generally well-tolerated compared to cisplatin. Aim: The aim is whether carboplatin can be a substitute of cisplatin with equivalent response and with less toxicity profile. Settings and Design: Single institutional prospective randomized phase III study. Materials and Methods: Between January 2011 and August 2012, 100 patients LAHNSCC with normal comorbidities were included. The patients in Arm A received injection carboplatin (AUC 6 3 weeks along with external beam radiotherapy (EBRT dose 66-70 Gy in conventional fractionation and Arm B received injection cisplatin (100 mg/m 2 3 weeks with same EBRT schedule. Detailed clinical examination along with biopsy for residual or recurrent disease, CT scan of head and neck were done to assess the response, toxicities, and disease-free survival (DFS in follow-up. Statistical Analysis Used: SPSS version 17 used for statistical calculation. For categorical variables, Chi-Square and Fisher Exact tests were used. For continuous variables, independent samples t test were used with 95% CI. Kaplan-Meier survival analysis was used for comparing the DFS. Results: Overall response rate (CR + PR were 76.9% in Arm A and 63.6% in Arm B (P = 0.06, non-significant. Statistically significant acute skin (P = 0.003, mucosa (P = 0.003, and upper GI (P = <0.0001 toxicities were found more in cisplatin arm compared to carboplatin arm except acute haematological toxicities. Conclusions: It can be concluded that carboplatin is non-inferior in response with statistically significant less toxicities when compared with cisplatin.

  6. Immunohistochemical detection of osteopontin in advanced head-and-neck cancer: Prognostic role and correlation with oxygen electrode measurements, hypoxia-inducible-factor-1α-related markers, and hemoglobin levels

    International Nuclear Information System (INIS)

    Purpose: The tumor-associated glycoprotein osteopontin (OPN) is discussed as a plasma marker of tumor hypoxia. However, the association of immunohistochemical OPN expression in tumor sections with tumor oxygenation parameters (HF5, median pO2), the hypoxia-related markers hypoxia-inducible factor-1α (HIF-1α) and carbonic anhydrase IX (CAIX), or hemoglobin and systemic vascular endothelial growth factor (VEGF) levels has not been investigated. Methods and Materials: Tumor tissue sections of 34 patients with advanced head-and-neck cancer treated with radiotherapy were assessed by immunochemistry for the expression of OPN, HIF-1α, and CA IX. Relationship of OPN expression with tumor oxygenation parameters (HF5, median pO2), HIF-1α and CA IX expression, hemoglobin and serum VEGF level, and clinical parameters was studied. Results: Bivariate analysis showed a significant correlation of positive OPN staining with low hemoglobin level (p = 0.02), high HIF-1α expression (p = 0.02), and high serum vascular endothelial growth factor level (p = 0.02) for advanced head-and-neck cancer. Furthermore, considering the 31 Stage IV patients, the median pO2 correlated significantly with the OPN expression (p = 0.02). OPN expression alone had only a small impact on prognosis. However, in a univariate Cox proportional hazard regression model, the expression of either OPN or HIF-1α or CA IX was associated with a 4.1-fold increased risk of death (p = 0.02) compared with negativity of all three markers. Conclusion: Osteopontin expression detected immunohistochemically is associated with oxygenation parameters in advanced head-and-neck cancer. When the results of OPN, HIF-1α, and CA IX immunohistochemistry are combined into a hypoxic profile, a strong and statistically significant impact on overall survival is found

  7. CHANGES IN NUTRITIONAL STATUS AND DIETARY INTAKE DURING AND AFTER HEAD AND NECK CANCER TREATMENT

    NARCIS (Netherlands)

    Jager-Wittenaar, Harriet; Dijkstra, Pieter U.; Vissink, Arjan; Langendijk, Johannes A.; van der Laan, Bernard F. A. M.; Pruim, Jan; Roodenburg, Jan L. N.

    2011-01-01

    Background. The purpose of this study was to test whether nutritional status of patients with head and neck cancer changes during and after treatment. Methods. Nutritional status (including body weight, lean mass, and fat mass) and dietary intake were assessed in 29 patients with head and neck cance

  8. Clinical impact of radiographic carotid artery involvement in neck metastases from head and neck cancer.

    Science.gov (United States)

    Teymoortash, A; Rassow, S; Bohne, F; Wilhelm, T; Hoch, S

    2016-04-01

    The treatment of lymph node metastases involving the carotid artery is controversial. The aim of the present study was to determine the outcomes of head and neck cancer patients with radiographic carotid artery involvement in neck metastases. A total of 27 patients with head and neck cancer and radiologically diagnosed advanced metastases involving the common carotid artery or internal carotid artery were enrolled. All patients underwent a primary or salvage neck dissection and surgical carotid peeling. The oncological outcome and survival of all patients were analyzed. Loco-regional control was observed in 13 of the 27 patients (48.1%). During follow-up, five patients (18.5%) developed second primaries and 11 (40.7%) developed distant metastases. The survival time was poor independent of regional control. The median overall survival was 1.55 years and disease-free survival was 0.71 year. Radiographic carotid artery involvement in neck metastases in head and neck cancer appears to correlate with a poor long-term prognosis, with a high rate of distant metastases despite loco-regional control. PMID:26723499

  9. Changes in Quality of Life of Head-and-Neck Cancer Patients Following Postoperative Radiotherapy

    International Nuclear Information System (INIS)

    The purpose of this study was to investigate the longitudinal changes in quality of life (QoL) for 77 head-and-neck squamous cell cancer (HNSCC) patients receiving postoperative radiotherapy (RT). The data pertaining to their QoL were collected using the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) and the EORTC Head and Neck Module (QLQ-HandN35) before and two years after postoperative RT. The differences in all the QLQ-C30 scales between the two time points were not statistically (p<0.01) or clinically (difference <+10 points) significant. Of all the scales in the QLQ-HandN35, only problems in social eating, teeth, dry mouth, and sticky saliva became worse with both statistical and clinical significance. Clinical cancer stage and marital status were the only variables significantly associated with the change in global QoL. The subjects with stage IV disease (5.0-fold) and those with a spouse (5.5-fold) had a lower risk of reporting negative changes in global QoL. The study indicates that some individual HNSCC patients, after receiving postoperative RT, suffered from a deterioration of QoL scales, especially in some specific head-and-neck symptoms. Meanwhile, we found some patients, especially those with more advanced HNSCC, might have developed somewhat tougher coping abilities to deal with the adverse effects of adjuvant RT on their global QoL

  10. Changes in Quality of Life of Head-and-Neck Cancer Patients Following Postoperative Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Fu-min Fang; Chih-yen Chien; Shun-ching Kuo; Herng-chia Chiu; Chong-jong Wang [Kaohsiung Medical Univ., Kaohsiung, TW (China). Dept. of Radiation Oncology

    2004-09-01

    The purpose of this study was to investigate the longitudinal changes in quality of life (QoL) for 77 head-and-neck squamous cell cancer (HNSCC) patients receiving postoperative radiotherapy (RT). The data pertaining to their QoL were collected using the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) and the EORTC Head and Neck Module (QLQ-HandN35) before and two years after postoperative RT. The differences in all the QLQ-C30 scales between the two time points were not statistically (p<0.01) or clinically (difference <+10 points) significant. Of all the scales in the QLQ-HandN35, only problems in social eating, teeth, dry mouth, and sticky saliva became worse with both statistical and clinical significance. Clinical cancer stage and marital status were the only variables significantly associated with the change in global QoL. The subjects with stage IV disease (5.0-fold) and those with a spouse (5.5-fold) had a lower risk of reporting negative changes in global QoL. The study indicates that some individual HNSCC patients, after receiving postoperative RT, suffered from a deterioration of QoL scales, especially in some specific head-and-neck symptoms. Meanwhile, we found some patients, especially those with more advanced HNSCC, might have developed somewhat tougher coping abilities to deal with the adverse effects of adjuvant RT on their global QoL.

  11. Delayed airway stenosis after radiotherapy for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yuta, Atsushi; Tatematsu, Masanori; Ishinaga, Hajime; Harada, Teruhiko; Majima, Yuichi [Mie Univ., Tsu (Japan). School of Medicine

    2002-03-01

    Seven cases of delayed airway stenosis after radiotherapy for early staged head and neck cancers during 1989 and 1999 were evaluated (aged 54-77 yrs, 6 male and a female). The cases included five glottic laryngeal cancers (T1a, T1b, and three T2), a subglottic laryngeal cancer, and an unknown origin, but strongly suspected laryngeal cancer, with neck metastasis. Radio injury was found from 3 months to 47 months after radiotherapy. {sup 60}Co for radiotherapy was used in all seven cases, although {sup 60}Co radionuclide was changed to Liniac in 1997. The total dose was 60 Gy for 3 cases, and 70 Gy for 4 cases. Tracheostomy was performed in 3 cases due to bilateral vocal cord impairment. Background, treatment, and response to radiotherapy were compared to those of 90 patients of a control group with early staged laryngeal cancer who did not fail radiation injury during the same period. As a result, radionuclide ({sup 60}Co), total dose, cervical surgery, antiinflammatory drugs, laryngeal edema during radiotherapy were risk factors. The intensity and the period of mucositis by radiotherapy was important for indicating delayed airway stenosis. (author)

  12. Mouthwash use and cancer of the head and neck: a pooled analysis from the International Head and Neck Cancer Epidemiology Consortium.

    Science.gov (United States)

    Boffetta, Paolo; Hayes, Richard B; Sartori, Samantha; Lee, Yuan-Chin A; Muscat, Joshua; Olshan, Andrew; Winn, Deborah M; Castellsagué, Xavier; Zhang, Zuo-Feng; Morgenstern, Hal; Chen, Chu; Schwartz, Stephen M; Vaughan, Thomas L; Wunsch-Filho, Victor; Purdue, Mark; Koifman, Sergio; Curado, Maria P; Vilensky, Marta; Gillison, Maura; Fernandez, Leticia; Menezes, Ana; Daudt, Alexander W; Schantz, Stimson; Yu, Guopei; D'Souza, Gypsyamber; Haddad, Robert I; La Vecchia, Carlo; Hashibe, Mia

    2016-07-01

    Most mouthwashes contain alcohol, a known cause of head and neck cancer (oral cavity, pharynx, larynx), likely through the carcinogenic activity of acetaldehyde, formed in the oral cavity from alcohol. We carried out a pooled analysis of 8981 cases of head and neck cancer and 10 090 controls from 12 case-control studies with comparable information on mouthwash use in the International Head and Neck Cancer Epidemiology Consortium. Logistic regression was used to assess the association of mouthwash use with cancers of the oral cavity, oropharynx, hypopharynx, and larynx, adjusting for study, age, sex, pack-years of tobacco smoking, number of alcoholic drinks/day, and education. Compared with never users of mouthwash, the odds ratio (OR) of all head and neck cancers was 1.01 [95% confidence interval (CI): 0.94-1.08] for ever users, based on 12 studies. The corresponding ORs of cancer of the oral cavity and oropharynx were 1.11 (95% CI: 1.00-1.23) and 1.28 (95% CI: 1.06-1.56), respectively. OR for all head and neck cancer was 1.15 (95% CI: 1.01-1.30) for use for more than 35 years, based on seven studies (P for linear trend=0.01), and OR 1.31 (95% CI: 1.09-1.58) for use more than one per day, based on five studies (P for linear trend <0.001). Although limited by the retrospective nature of the study and the limited ability to assess risks of mouthwash use in nonusers of tobacco and alcohol, this large investigation shows potential risks for head and neck cancer subsites and in long-term and frequent users of mouthwash. This pooled analysis provides the most precise estimate of the association between mouthwash use and head and neck cancer. PMID:26275006

  13. Erlotinib Hydrochloride and Cetuximab in Treating Patients With Advanced Gastrointestinal Cancer, Head and Neck Cancer, Non-Small Cell Lung Cancer, or Colorectal Cancer

    Science.gov (United States)

    2015-09-28

    Adenocarcinoma of the Colon; Adenocarcinoma of the Rectum; Advanced Adult Primary Liver Cancer; Carcinoma of the Appendix; Gastrointestinal Stromal Tumor; Metastatic Gastrointestinal Carcinoid Tumor; Metastatic Squamous Neck Cancer With Occult Primary; Recurrent Adenoid Cystic Carcinoma of the Oral Cavity; Recurrent Adult Primary Liver Cancer; Recurrent Anal Cancer; Recurrent Basal Cell Carcinoma of the Lip; Recurrent Colon Cancer; Recurrent Esophageal Cancer; Recurrent Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Recurrent Extrahepatic Bile Duct Cancer; Recurrent Gallbladder Cancer; Recurrent Gastric Cancer; Recurrent Gastrointestinal Carcinoid Tumor; Recurrent Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Recurrent Lymphoepithelioma of the Nasopharynx; Recurrent Lymphoepithelioma of the Oropharynx; Recurrent Metastatic Squamous Neck Cancer With Occult Primary; Recurrent Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Recurrent Mucoepidermoid Carcinoma of the Oral Cavity; Recurrent Non-small Cell Lung Cancer; Recurrent Pancreatic Cancer; Recurrent Rectal Cancer; Recurrent Salivary Gland Cancer; Recurrent Small Intestine Cancer; Recurrent Squamous Cell Carcinoma of the Hypopharynx; Recurrent Squamous Cell Carcinoma of the Larynx; Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity; Recurrent Squamous Cell Carcinoma of the Nasopharynx; Recurrent Squamous Cell Carcinoma of the Oropharynx; Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Recurrent Verrucous Carcinoma of the Larynx; Recurrent Verrucous Carcinoma of the Oral Cavity; Small Intestine Adenocarcinoma; Small Intestine Leiomyosarcoma; Small Intestine Lymphoma; Stage IV Adenoid Cystic Carcinoma of the Oral Cavity; Stage IV Anal Cancer; Stage IV Basal Cell Carcinoma of the Lip; Stage IV Colon Cancer; Stage IV Esophageal Cancer; Stage IV Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Stage IV Gastric Cancer

  14. Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer. Results of a prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Tribius, Silke; Raguse, Marieclaire; Voigt, Christian; Petersen, Cordula; Kruell, Andreas [University Medical Center Hamburg-Eppendorf, Department of Radiation Oncology, Hamburg (Germany); Muenscher, Adrian [University Medical Center Hamburg-Eppendorf, Department of Otorhinolaryngology and Head and Neck Surgery, Hamburg (Germany); Groebe, Alexander [University Medical Center Hamburg-Eppendorf, Department of Maxillofacial Surgery, Hamburg (Germany); Bergelt, Corinna [University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg (Germany); Singer, Susanne [University Medical Center Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz (Germany)

    2015-03-08

    Patients with locally advanced head and neck cancer (LAHNC) undergo life-changing treatments that can seriously affect quality of life (QoL). This prospective study examined the key QoL domains during the first year after intensity-modulated radiotherapy (IMRT) and identified predictors of these changes in order to improve patient outcomes. A consecutive series of patients with LAHNC completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core module (QLQ-C30) and the HNC-specific QLQ-HN35 before (t0) and at the end (t1) of definitive or adjuvant IMRT, then at 6-8 weeks (t2), 6 months (t3), and 1 year (t4) after IMRT. Patients (n = 111) completing questionnaires at all five time points were included (baseline response rate: 99 %; dropout rate between t0 and t4: 5 %). QoL deteriorated in all domains during IMRT and improved slowly during the first year thereafter. Many domains recovered to baseline values after 1 year but problems with smelling and tasting, dry mouth, and sticky saliva remained issues at this time. Increases in problems with sticky saliva were greater after 1 year in patients with definitive versus adjuvant IMRT (F = 3.5, P = 0.05). QoL in patients with LAHNC receiving IMRT takes approximately 1 year to return to baseline; some domains remain compromised after 1 year. Although IMRT aims to maintain function and QoL, patients experience long-term dry mouth and sticky saliva, particularly following definitive IMRT. Patients should be counseled at the start of therapy to reduce disappointment with the pace of recovery. (orig.) [German] Die Therapie von Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren (LFKHT) geht mit einschneidenden Veraenderungen einher und beeinflusst die Lebensqualitaet (LQ) erheblich. Diese prospektive Studie untersucht die LQ waehrend des ersten Jahres nach intensitaetsmodulierter Strahlentherapie (IMRT) und hat Praediktoren dieser Veraenderungen herausgearbeitet, um

  15. Bridging Gaps in Multidisciplinary Head and Neck Cancer Care: Nursing Coordination and Case Management

    International Nuclear Information System (INIS)

    Patients with advanced head and neck cancer face not only a life-threatening malignancy, but also a remarkably complex treatment regimen that can affect their cosmetic appearance and ability to speak, breathe, and swallow. These patients benefit from the coordinated interaction of a multidisciplinary team of specialists and a comprehensive plan of care to address their physical and psychosocial concerns, manage treatment-related toxicities, and prevent or limit long-term morbidities affecting health-related quality of life. Although little has been published on patient-provider communication with a multidisciplinary team, evidence has suggested that gaps often occur in communication between patients and providers, as well as between specialists. These communication gaps can hinder the multidisciplinary group from working toward common patient-centered goals in a coordinated 'interdisciplinary' manner. We discuss the role of a head-and-neck oncology nurse coordinator at a single institution in bridging gaps across the continuum of care, promoting an interdisciplinary team approach, and enhancing the overall quality of patient-centered head-and-neck cancer care

  16. Technical guidelines for head and neck cancer IMRT on behalf of the Italian association of radiation oncology - head and neck working group

    International Nuclear Information System (INIS)

    Performing intensity-modulated radiotherapy (IMRT) on head and neck cancer patients (HNCPs) requires robust training and experience. Thus, in 2011, the Head and Neck Cancer Working Group (HNCWG) of the Italian Association of Radiation Oncology (AIRO) organized a study group with the aim to run a literature review to outline clinical practice recommendations, to suggest technical solutions and to advise target volumes and doses selection for head and neck cancer IMRT. The main purpose was therefore to standardize the technical approach of radiation oncologists in this context. The following paper describes the results of this working group. Volumes, techniques/strategies and dosage were summarized for each head-and-neck site and subsite according to international guidelines or after reaching a consensus in case of weak literature evidence

  17. Perceived stress and coping in patients with head and neck cancer

    OpenAIRE

    Kunal Deb; Kamala Deka

    2015-01-01

    Background: Head and neck cancer accounts for 30% of all cancers. The diagnosis with cancer imparts a lot of stress and the patient’s ability to cope with this stress reflects in their quality of life. Aim: To study perceived stress, coping and its correlation in patients with head and neck cancer. Materials and methods: The study was a case controlled study. After ethical clearance from institutional review board, 50 subjects with head and neck cancer, and 50 age and sex matched heal...

  18. Chemoradiation for Advanced Head and Neck Cancer: Potential for Improving Results to Match Those of Current Treatment Modalities for Early-Stage Tumors-Long-Term Results of Hyperfractionated Chemoradiation With Carbogen Breathing and Anemia Correction With Erythropoietin

    International Nuclear Information System (INIS)

    Purpose: To attempt to improve results of chemoradiation for head and neck cancer. Methods and Materials: From March 1996 to April 2007, 98 patients with head and neck cancer (15 Stage III and 83 Stage IV) were treated with a twice-daily hyperfractionated schedule. Eleven patients presented with N0, 11 with N1, 13 with N2A, 17 with N2B, 24 with N2C, and 22 with N3. Each fraction of treatment consisted of 5 mg/m2 of carboplatin plus 115 cGy with carbogen breathing. Treatment was given 5 days per week up to total doses of 350 mg/m2 of carboplatin plus 8050 cGy in 7 weeks. Anemia was corrected with erythropoietin. Results: Ninety-six patients tolerated the treatment as scheduled. All patients tolerated the planned radiation dose. Local toxicity remained at the level expected with irradiation alone. Chemotherapy toxicity was moderate. Ninety-seven complete responses were achieved. After 11 years of follow-up (median, 81 months), actuarial locoregional control, cause-specific survival, overall survival, and nodal control rates at 5 and 10 years were, respectively, 83% and 83%, 68% and 68%, 57% and 55%, and 100% and 100%. Median follow-up of disease-free survivors was 80 months. No significant differences in survival were observed between the different subsites or between the pretreatment node status groups (N0 vs. N+, N0 vs. N1, N0 vs. N2A, N0 vs. N2B, N0 vs. N2C, and N0 vs. N3). Conclusions: Improving results of chemoradiation for advanced head and neck cancer up to the level obtained with current treatments for early-stage tumors is a potentially reachable goal

  19. Cetuximab in the treatment of head and neck cancer: preliminary results outside clinical trials

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the clinical efficacy in our daily practice, outside clinical trials, of cetuximab plus radiotherapy in a majority of treatment-naive patients with locoregionally advanced head and neck squamous cell carcinomas. A retrospective study was performed to evaluate outcomes in patients who were treated definitively with cetuximab and radiotherapy (ExRT). Patients with stage III or IV, nonmetastatic, measurable squamous cell carcinoma of the head and neck (SCCHN) were eligible. There were 18 males and two females. The median age was 61 years (range from 49 to 87 years old). Concurrent radiotherapy and cetuximab was used, in first line, in 17 patients with locally advanced disease; two patients with recurrent SCCHN, who were intolerant of Cisplatin-based regimens, were treated with radiotherapy combined with weekly cetuximab; and 1 patient received cetuximab and radiotherapy postoperatively. The median time of response was 10 months (range from 2 to 24 months). A partial response was observed in 11 cases; a complete response in nine cases. The occurrence of grade 2–3 skin toxicity was observed in 11 cases. Skin toxicity was clearly correlated with a better response and the duration of the response to the treatment. The use of cetuximab in combination with radiotherapy does not increase the side effects of radiotherapy. At the end of the follow-up, 17 patients died. Cetuximab, with its highly targeted mechanism of action and synergistic activity with current treatment modalities, is a valuable treatment option in head and neck patients. The effect of the epidermal growth factor receptor antagonist occurs without any change in the pattern and the severity of toxicity usually associated with head and neck radiation. Cetuximab seems not to provide the most benefit for patients with oropharyngeal cancers but will in patients with T4 tumors. However, the median duration of local control was less as described in the clinical trials

  20. Nutritional consequences of the radiotherapy of head and neck cancer

    International Nuclear Information System (INIS)

    Nutrition-related complications of radiotherapy were evaluated in 74 head and neck cancer patients. Subjective changes of mouth dryness, taste, dysphagia, appetite, and food preferences were determined by questionnaire before and at weekly intervals during curative radiotherapy. Changes in body weight during therapy were also recorded. In addition, 24-hour dietary histories were taken from eight patients at the beginning and end of treatment. Results of the study indicate that patients were subjectively aware of nutritional problems prior to therapy and that therapy exacerbated these problems. As many as 25% of the patients experienced oral complications such as taste loss and/or dry mouth prior to initiation of radiotherapy. By the end of radiotherapy, over 80% of the patients were aware of oral and nutritional problems. Patients had an average weight loss of 5 kg prior to therapy; this loss of weight did not change during therapy. Diet histories of eight patients indicate significant caloric deficiencies early and late in radiotherapy. The oral and nutritional problems experienced by patients, even prior to therapy, support the idea that nutritional evaluation and maintenance are important not only during therapy, but prior to radiotherapy as well. Nutritional evaluation should be made a routine, integral part of therapy for every cancer patient

  1. Evaluation of the benefit and use of multidisciplinary teams in the treatment of head and neck cancer.

    Science.gov (United States)

    Licitra, Lisa; Keilholz, Ulrich; Tahara, Makoto; Lin, Jin-Ching; Chomette, Pauline; Ceruse, Philippe; Harrington, Kevin; Mesia, Ricard

    2016-08-01

    Given the complexities of multimodality treatment for patients with head and neck cancer, the rationale for the use of multidisciplinary teams (MDTs) to define individual optimal treatment strategies on a per-patient basis is apparent. Increased use of guideline-directed approaches, reduced time to treatment and improved outcomes, which result from use of an MDT approach in head and neck cancer, have been documented. A discussion of these recent advances, as well as presentation of available country-specific guidance on the roles and responsibilities of team members, supports the creation of similar local-language recommendations for the treatment of patients with head and neck cancer. Finally, expert practical advice on the implementation of MDTs may enable the establishment of the MDT approach more universally around the world. PMID:27424185

  2. Reviewing and reconsidering invasion assays in head and neck cancer.

    Science.gov (United States)

    Inglehart, Ronald C; Scanlon, Christina S; D'Silva, Nisha J

    2014-12-01

    Head and neck squamous cell carcinomas (HNSCC) are malignant tumors that arise from the surface epithelium of the oral cavity, oropharynx and larynx, primarily due to exposure to chemical carcinogens or the human papilloma virus. Due to their location, dental practitioners are well-positioned to detect the lesions. Deadlier than lymphoma or melanoma, HNSCC is incompletely understood. For these reasons, dental practitioners and researchers are focused on understanding HNSCC and the processes driving it. One of these critical processes is invasion, the degradation of the basement membrane by HNSCC cells with subsequent movement into the underlying connective tissue, blood vessels or nerves. Cancer cells metastasize to distant sites via the blood vessels, lymphatics and nerves. Metastasis is associated with poor survival. Since invasion is essential for development and metastasis of HNSCC, it is essential to understand the mechanism(s) driving this process. Elucidation of the mechanisms involved will facilitate the development of targeted treatment, thereby accelerating development of precision/personalized medicine to treat HNSCC. Robust in vitro and in vivo assays are required to investigate the mechanistic basis of invasion. This review will focus on in vitro and in vivo assays used to study invasion in HNSCC, with special emphasis on some of the latest assays to study HNSCC. PMID:25448226

  3. Changes in functional imaging parameters following induction chemotherapy have important implications for individualised patient-based treatment regimens for advanced head and neck cancer

    International Nuclear Information System (INIS)

    Background: When induction chemotherapy (IC) is used prior to chemoradiotherapy (CRT) in head and neck cancer (HNC), functional imaging (FI) may inform adaptation of treatment plans with the aim of optimising outcomes. Understanding the impact of IC on FI parameters is, therefore, essential. Purpose: To prospectively evaluate the feasibility of acquiring serial FI (18F-FDG-PET, diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) MRI) and its role in defining individualised treatment regimens following IC in HNC. Methods and materials: Ten patients with stage III and IV HNC underwent conventional (CT and MRI) and functional (DW, DCE-MRI and 18F-FDG-PET/CT) imaging at baseline and following two cycles of IC prior to definitive CRT. Results: One patient withdrew due to claustrophobia. Seven out of nine patients had a complete metabolic response to IC on 18F-FDG-PET imaging. DCE-MRI showed a significant fall in transfer constant (Ktrans) (0.209 vs 0.129 min−1P < 0.01) and integrated area under gadolinium curve at 60 s (IAUGC6O) (18.4 vs 11.9 mmol/min, P < 0.01) and DW-MRI a rise in ADC (0.89 vs 1.06 × 10−3 mm2/s, P < 0.01) following IC. Conclusions: Acquiring FI sequences is feasible in HNC. There are marked changes in FI parameters following IC which may guide adaptation of individualised treatment regimens

  4. Toxicity of aggressive multimodality therapy including cisplatinum, bleomycin and methotrexate with radiation and/or surgery for advanced head and neck cancer

    International Nuclear Information System (INIS)

    A combined modality regimen employing induction chemotherapy with cisplatinum, bleomycin and methotrexate followed by surgery and/or radiation therapy was initiated in patients with advanced squamous cell carcinoma of the head and neck. In the first 23 patients treated with this program there was a 90% response rate to induction chemotherapy (9% CR and 81% PR). Toxicity associated with radiotherapy, but not surgery, was increased with 11 of 23 patients (48%) who experienced some toxicity during or immediately after radiotherapy. Mucositis was worse than expected and severe delayed mucositis was seen in 2 patients, one of whom required hospitalization. Late complications, possibly related to therapy included one myocardial infarction and one episode of hypoglycemia, both of which were fatal. One other patient voluntarily failed to take prescribed oral leucovorin, dying of unrescued methotrexate toxicity during adjuvant therapy, a questionable suicide. Further follow-up analysis of failure will be necessary to determine if the value of a combined modality regimen in producing an increased cure rate and long term survival will out weigh increased toxicity

  5. Postoperative radiotherapy with concurrent cisplatin appears to improve locoregional control of advanced, resectable head and neck cancers: RTOG 88-24

    International Nuclear Information System (INIS)

    Purpose: Despite aggressive surgery and postoperative radiation therapy, only 30% of patients who have advanced, potentially resectable carcinomas of the head and neck survive for 5 years. In the hope of improving this situation we studied the effect of postoperative radiotherapy delivered concurrently with cisplatin. Methods and Materials: Patients who had Stage IV tumors and/or involved surgical margins received 60 Gy in 30 fractions over 6 weeks plus 100 mg/m2 of cisplatin on radiotherapy days 1, 23 and 43. Fifty-two patients participated in this trial and 51 were evaluated. Forty-three (84%) patients had pathologic T3 or T4 disease, 43 (84%) had Stage IV disease, and 27 (53%) had histologically involved surgical margins. Results: Severe and life-threatening toxicities occurred in 20% and 12% of patients, respectively; the most common drug-related toxicities were leukopenia, anemia, nausea, and vomiting. Seventeen patients (43%) remain alive with no evidence of disease. Four patients (8%) died with no evidence of neoplastic disease, and one patient has died of a second independent malignancy. By actuarial analysis at 3 years, 48% of patients are alive, 81% have locoregional control of disease, and 57% are free of distant metastases. Conclusions: Based on comparison with similar patients treated in a prior Radiation Therapy Oncology Group/Intergroup trial (RTOG), we conclude that postoperative radiotherapy with concurrent cisplatin may improve locoregional control rates and should be prospectively tested

  6. Postoperative concurrent radio-chemotherapy for locally advanced head and neck cancer;Avaliacao de radio e quimioterapia concomitantes pos-operatorias nos pacientes portadores de tumores de cabeca e pescoco localmente avancados

    Energy Technology Data Exchange (ETDEWEB)

    Fortuna, Ana Paula Diniz; Carvalho, Ravenna Nogueira; Dias, Rodrigo Souza; Giordani, Adelmo Jose; Segreto, Helena Regina Comodo; Segreto, Roberto Araujo, E-mail: segreto.dmed@epm.b [Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP (Brazil). Dept. de Oncologia Clinica e Experimental. Setor de Radioterapia

    2009-12-15

    To evaluate the clinical outcome of patients with locally advanced head and neck cancer treated with postoperative concurrent radio-chemotherapy. Material and method: thirty nine patients with locally advanced head and neck cancer submitted to resection of all visible and palpable disease, followed by radiotherapy (60-66 Gy in 30 to 33 fractions over a period of 6 to 6.6 weeks) and concurrent cisplatin between May 2004 and June 2007 were retrospectively analyzed. Results: a predominance of male with a median age of 54 years was observed; 30.8% of patients were in stage III and 61.5% in stage IVA; 77% of patients received a radiation dose of 66 Gy; dermatitis grade III occurred in 46.2% and fibrosis in 48.7% of patients. The 5-year loco-regional failure and overall survival were 30% and 76%, respectively. Conclusion: data show that surgery followed by concurrent radio-chemotherapy presents reasonable rate of loco-regional control and disease-free survival in high-risk patients. Our index of loco-regional and distant failure and the rate of acute and late complication are compatible with other series in the literature (author)

  7. Optimizing multimodality treatment for head and neck cancer in rural India

    OpenAIRE

    N P Trivedi; Trivedi, P.; Trivedi, H; S. Trivedi; N Trivedi

    2012-01-01

    Background: Multimodality treatment of head and neck cancer in rural India is not always feasible due to lack of infrastructure and logistics. Aim: To demonstrate the feasibility of multimodality treatment for head and neck cancer in a community setting in rural India. Setting and Design: Community cancer center, retrospective review. Materials and Methods: This article focuses on practice environment in a cancer clinic in rural India. We evaluated patient profile, treatment protocols, infras...

  8. EPIDEMIOLOGICAL PROFILE OF HEAD AND NECK CANCERS AT A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Saquib

    2015-10-01

    Full Text Available Head and neck cancer is the fifth most common malignancy globally among adults and comprises 5% of all malignancies worldwide. There is scarcity of data regarding the clinico epidemiological profile of head and neck carcinomas in our population. The demographic presentation & exact prevalence of these malignancies in our population is not known. AIMS & OBJECTIVES: To study the clinico - epidemiological profile of head and Neck carcinoma in Kashmiri ethnic population of India. MATERIAL & METHODS : This study was conducted at Cancer center at SMHS Srinagar, J & K, India from 2012 to 2014. The study included total of 106 patients with Head and Neck Squamous Cell Carcinoma (HNSCC registered with the department from 2012 to 2014. It was a prospective and retrospective study. Patients having histopathological (HPE confirmation of the disease were enrolled for the study. All the demo graphic & clinical details of the recruited patients were studied thoroughly including history, physical examination, investigations and mode of treatment. RESULTS : Male to female ratio was 2.7:1. The mean age was 55.3 years. Among both males and females, the highest incidence of HNSCC was seen within the age group of 51 - 60 years. The most common primary site of disease was Oral Cavity – 36(33.96%, Larynx - 28 (26.41%, Pharynx in 16(15.09%, Nasopharynx in 10(9.43% , Sinonasal in 10(9.43%, and Tonsil in 6 cases(5.66%. Patients usually presented with advanced stage of disease {( S tage III, IV - (64.15% 68 versus stage I, II - (35.84% 38}. Tobacco consumption in any form was present in 89% of our population. Lack of balanced diet (28% and poor dental hygiene (50% and belonging to low socioeconomic class (57% were also thought to be significant factors for the disease burden. Most of our patients were treated with surgery followed by adjuvant chemo - radiotherapy (37.73%, chemo and radiotherapy (28.31%, radiotherapy alone (16.98% & surgery alone (9.4%. CONCLUSION

  9. Survival Prediction in Head and Neck Cancer: Impact of Tumor and Patient Specific Characteristics

    OpenAIRE

    Datema, Frank

    2012-01-01

    textabstractHead and neck cancer accounts for almost 5% of all malignant tumors in the Netherlands. The most up‐todate Dutch Cancer Registry (NCR) database from 2009 reported 2878 new patients with an invasive carcinoma of the lip, oral cavity, pharynx and larynx (general incidence 17:100.000). In this thesis we focus on head and neck squamous cell carcinoma (HNSCC). Head and neck squamous cell carcinomas originate from the mucosal lining of the upper aero‐digestive tract. Tobacco and alcohol...

  10. Effects of Swallowing Exercises on Patients Undergoing Radiation Treatment for Head and Neck Cancer

    Science.gov (United States)

    2013-02-27

    Head and Neck Cancer; Stage I Hypopharyngeal Cancer; Stage I Laryngeal Cancer; Stage I Oropharyngeal Cancer; Stage II Hypopharyngeal Cancer; Stage II Laryngeal Cancer; Stage II Oropharyngeal Cancer; Stage III Hypopharyngeal Cancer; Stage III Laryngeal Cancer; Stage III Oropharyngeal Cancer; Stage IV Hypopharyngeal Cancer; Stage IV Laryngeal Cancer; Stage IV Oropharyngeal Cancer

  11. Multicenter phase II study of weekly docetaxel, cisplatin, and S-1 (TPS) induction chemotherapy for locally advanced squamous cell cancer of the head and neck

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the efficacy and tolerability of weekly docetaxel, cisplatin, and S-1 (weekly TPS) as induction chemotherapy for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). A total of 35 patients with previously untreated, locally advanced HNSCC were enrolled. Seven patients (20%) were diagnosed with stage III HNSCC and 28 patients (80%) were diagnosed with stage IV. Induction treatment included 30 mg/m2 docetaxel on day 1 and 8, 60 mg/m2 cisplatin on day 1, and 70 mg/m2 S-1 on days 1 to 14. The regimen was repeated every 21 days. After three courses of induction chemotherapy, patients received concurrent chemoradiotherapy. Among the 35 patients, 30 (85.7%) completed induction chemotherapy. The response to induction chemotherapy was as follows: nine patients (25.7%) achieved a complete response (CR) and the overall response rate (ORR) was 85.7%. Grades 3–4 toxicity during induction therapy included neutropenia (28.5%), neutropenic fever (8.5%), and diarrhea (17.1%). After completion of concurrent chemoradiotherapy, the CR rate was 62.8% and the partial response (PR) was 22.8%. Estimates of progression-free and overall survival at 2 years were 73.2% and 79.3%, respectively. Weekly TPS is a promising regimen that is well-tolerated, causes minimal myelosuppression and is effective as an outpatient regimen for locally advanced HNSCC. ClinicalTrials.gov: http://www.clinicaltrials.gov/NCT01645748

  12. Eicosapentaenoic Acid Enriched Enteral Nutrition Improves Lean Body Mass in Esophageal, Head and Neck Cancer Patients

    OpenAIRE

    Shieh, Christine

    2015-01-01

    OBJECTIVE: Cachexia is a nutrient deficient condition affecting millions of cancer patients. Cancers of the upper gastrointestinal tract, head and neck are often the most severely affected. Currently, there is no established therapy for cachexia, although several potential anti-cachectic agents are being explored. A meta-analysis was conducted to review the effect of eicosapentaenoic acid (EPA) enriched enteral nutrition on lean body mass (LBM) in esophageal, head and neck cancer patients at ...

  13. Evaluation of DNA Double Strand Breaks Repair Efficiency in Head and Neck Cancer

    OpenAIRE

    Walczak, Anna; Rusin, Pawel; Dziki, Lukasz; Zielinska-Blizniewska, Hanna; Olszewski, Jurek; Majsterek, Ireneusz

    2012-01-01

    Head and neck cancers (head and neck squamous cell carcinomas [HNSCC]) are a heterogeneous group of neoplasms with varying presenting symptoms, treatment, and expected outcome. There is a need to find an effective way of its treatment at the molecular level. Thus, we should identify the mechanism of cancer cell response to damaging agents' activity, especially at DNA level. Our major goal was to evaluate the efficacy of DNA double strand breaks (DSBs) repair in HTB-43 and SCC-25 cancer cell l...

  14. Metal concentrations in hair of patients with various head and neck cancers as a diagnostic aid

    OpenAIRE

    Wozniak, Anna; Napierala, Marta; Golasik, Magdalena; Herman, Małgorzata; Walas, Stanisław; Piekoszewski, Wojciech; Szyfter, Witold; Szyfter, Krzysztof; Golusinski, Wojciech; Baralkiewicz, Danuta; Florek, Ewa

    2015-01-01

    Head and neck cancers are one of the most frequent cancers worldwide. This paper attempts to evaluate disturbances of homeostasis of the necessary elements (calcium, magnesium, zinc, copper, iron, manganese) and changes in the levels of toxic metals (lead, cadmium, cobalt, chromium VI) in hair of patients with head and neck cancers, as well as people without a diagnosed neoplastic disease. In order to quantify the necessary elements and toxic metals, a method using ICP-MS and ICP-OES techniqu...

  15. Oncogenic impact of human papilloma virus in head and neck cancer.

    LENUS (Irish Health Repository)

    Heffernan, C B

    2012-02-01

    There is considerable debate within the literature about the significance of human papilloma virus in head and neck squamous cell carcinoma, and its potential influence on the prevention, diagnosis, grading, treatment and prognosis of these cancers. Cigarette smoking and alcohol consumption have traditionally been cited as the main risk factors for head and neck cancers. However, human papilloma virus, normally associated with cervical and other genital carcinomas, has emerged as a possible key aetiological factor in head and neck squamous cell carcinoma, especially oropharyngeal cancers. These cancers pose a significant financial burden on health resources and are increasing in incidence. The recent introduction of vaccines targeted against human papilloma virus types 16 and 18, to prevent cervical cancer, has highlighted the need for ongoing research into the importance of human papilloma virus in head and neck squamous cell carcinoma.

  16. Increase in tumor control and normal tissue complication probabilities in advanced head-and-neck cancer for dose-escalated intensity-modulated photon and proton therapy

    Directory of Open Access Journals (Sweden)

    Annika eJakobi

    2015-11-01

    Full Text Available Introduction:Presently used radio-chemotherapy regimens result in moderate local control rates for patients with advanced head and neck squamous cell carcinoma (HNSCC. Dose escalation (DE may be an option to improve patient outcome, but may also increase the risk of toxicities in healthy tissue. The presented treatment planning study evaluated the feasibility of two DE levels for advanced HNSCC patients, planned with either intensity-modulated photon therapy (IMXT or proton therapy (IMPT.Materials and Methods:For 45 HNSCC patients, IMXT and IMPT treatment plans were created including DE via a simultaneous integrated boost (SIB in the high-risk volume, while maintaining standard fractionation with 2 Gy per fraction in the remaining target volume. Two DE levels for the SIB were compared: 2.3 Gy and 2.6 Gy. Treatment plan evaluation included assessment of tumor control probabilities (TCP and normal tissue complication probabilities (NTCP.Results:An increase of approximately 10% in TCP was estimated between the DE levels. A pronounced high-dose rim surrounding the SIB volume was identified in IMXT treatment. Compared to IMPT, this extra dose slightly increased the TCP values and to a larger extent the NTCP values. For both modalities, the higher DE level led only to a small increase in NTCP values (mean differences < 2% in all models, except for the risk of aspiration, which increased on average by 8% and 6% with IMXT and IMPT, respectively, but showed a considerable patient dependence. Conclusions:Both DE levels appear applicable to patients with IMXT and IMPT since all calculated NTCP values, except for one, increased only little for the higher DE level. The estimated TCP increase is of relevant magnitude. The higher DE schedule needs to be investigated carefully in the setting of a prospective clinical trial, especially regarding toxicities caused by high local doses that lack a sound dose response description, e.g., ulcers.

  17. Molecular and Clinical Responses in a Pilot Study of Gefitinib With Paclitaxel and Radiation in Locally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: Epidermal growth factor receptor (EGFR) overexpression in head-and-neck squamous cell carcinoma (HNSCC) stimulates tumor cell proliferation, inhibits apoptosis, and increases chemotherapy and radiation resistance. We examined the toxicity, safety and the effects on EGFR signaling in tumor biopsy samples from patients with locally advanced HNSCC treated with the EGFR signaling inhibitor gefitinib (GEF) combined with weekly intravenous paclitaxel (PAC) and radiation therapy (RT). Methods and Materials: This was a pilot Phase I dose-escalation study. Eligibility included Stage III to IVB HNSCC, age ≥18 years, no prior RT or chemotherapy, adequate organ function, and informed consent. Endpoints included determination of maximum tolerated dose (MTD) and analysis of treatment effect on EGFR signaling, tumor cell proliferation, and apoptosis in biopsy samples. Results: Ten patients were treated. The MTD of this combination was GEF 250 mg/d with PAC 36 mg/m2 intravenously weekly x 6 with concurrent RT. Grade 3/4 toxicities included prolonged (>8 weeks) stomatitis (7 patients), infection (2 patients), and interstitial pneumonitis (1 patient). There were five complete responses (CR) and two partial responses (PR). Of 7 patients undergoing serial biopsies, only 1 patient demonstrated a reduction in phosphorylated EGFR, decreased downstream signaling, and reduced cellular proliferation after initiating GEF. Conclusions: Inhibition of EGFR by GEF was observed in only one of seven tumors studied. The addition of GEF to PAC and RT did not appear to improve the response of locally advanced HNSCC compared with our prior experience with PAC and RT alone. This treatment appeared to delay recovery from stomatitis.

  18. Sentinel node biopsy in head and neck cancer

    DEFF Research Database (Denmark)

    Ross, Gary L; Soutar, David S; Gordon MacDonald, D;

    2004-01-01

    BACKGROUND: The aim was to determine the reliability and reproducibility of sentinel node biopsy (SNB) as a staging tool in head and neck squamous cell carcinoma (HNSCC) for T1/2 clinically N0 patients by means of a standardized technique. METHODS: Between June 1998 and June 2002, 227 SNB...

  19. Nucleic Acid Targeting: Towards Personalized Therapy for Head and Neck Cancer

    Science.gov (United States)

    Parsel, Sean M; Grandis, Jennifer R; Thomas, Sufi M

    2015-01-01

    In light of a detailed characterization of genetic aberrations in cancer, nucleic acid targeting represents an attractive therapeutic approach with significant translational potential. Head and neck squamous cell carcinoma (HNSCC) is a leading cause of cancer deaths worldwide with stagnant 5-year survival rates. Advances in conventional treatment have done little to improve survival and combined chemoradiation is associated with significant adverse effects. Recent reports have characterized the genetic alterations in HNSCC and demonstrated that mutations confer resistance to conventional and molecular targeted therapies. The ability to use specific nucleic acid sequences to inhibit cancer-associated genes including non-druggable targets facilitates personalized medicine approaches with less adverse effects. Additionally, advances in drug delivery mechanisms have increased the transfection efficiency aiding in greater therapeutic responses. Given these advances, the stage has been set to translate the information garnered from genomic studies into personalized treatment strategies. Genes involved in the tumor protein 53 (TP53) and epidermal growth factor receptor (EGFR) pathways have been extensively investigated and many promising preclinical studies have shown tumor inhibition through genetic modulation. We, and others, have demonstrated that targeting oncogene expression with gene therapy approaches is feasible in patients. Other methods such as RNA interference have proven to be effective and are potential candidates for clinical studies. This review summarizes the major advances in sequence-specific gene modulation in the preclinical setting and in clinical trials in head and neck cancer patients. PMID:26592450

  20. Hyperfractionated stereotactic reirradiation for recurrent head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cvek, Jakub; Knybel, Lukas; Skacelikova, Eva; Otahal, Bretislav; Molenda, Lukas; Feltl, David [University Hospital Ostrava, Department of Oncology, Ostrava (Czech Republic); Stransky, Jiri; Res, Oldrich [University Hospital Ostrava, Department of Maxilofacial Surgery, Ostrava (Czech Republic); Matousek, Petr; Zelenik, Karol [University Hospital Ostrava, Department of Otolaryngology, Ostrava (Czech Republic)

    2016-01-15

    The goal of this work was to evaluate the efficacy and toxicity of hyperfractionated stereotactic reirradiation (re-RT) as a treatment for inoperable, recurrent, or second primary head and neck squamous cell cancer (HNSCC) that is not suitable for systemic treatment. Forty patients with recurrent or second primary HNSCC were included in this study. The patients had a median gross tumor volume of 76 ml (range 14-193 ml) and a previous radiotherapy dose greater than 60 Gy. Treatment was designed to cover 95 % of the planning target volume (PTV, defined as gross tumor volume [GTV] + 3 mm to account for microscopic spreading, with no additional set-up margin) with the prescribed dose (48 Gy in 16 fractions b.i.d.). Treatment was administered twice daily with a minimum 6 h gap. Uninvolved lymph nodes were not irradiated. Treatment was completed as planned for all patients (with median duration of 11 days, range 9-14 days). Acute toxicity was evaluated using the RTOG/EORTC scale. A 37 % incidence of grade 3 mucositis was observed, with recovery time of ≤ 4 weeks for all of these patients. Acute skin toxicity was never observed to be higher than grade 2. Late toxicity was also evaluated according to the RTOG/EORTC scale. Mandible radionecrosis was seen in 4 cases (10 %); however, neither carotid blowout syndrome nor other grade 4 late toxicity occurred. One-year overall survival (OS) and local progression-free survival (L-PFS) were found to be 33 and 44 %, respectively. Performance status and GTV proved to be significant prognostic factors regarding local control and survival. Hyperfractionated stereotactic re-RT is a reasonable treatment option for patients with recurrent/second primary HNSCC who were previously exposed to high-dose irradiation and who are not candidates for systemic treatment or hypofractionation. (orig.) [German] Ziel der Studie war es, die Effektivitaet und Toxizitaet der hyperfraktionierten akzelerierten stereotaktischen Wiederbestrahlung (re

  1. Feasibility and impact of a dedicated multidisciplinary rehabilitation program on health-related quality of life in advanced head and neck cancer patients.

    Science.gov (United States)

    Passchier, Ellen; Stuiver, Martijn M; van der Molen, Lisette; Kerkhof, Stefanie I C; van den Brekel, Michiel W M; Hilgers, Frans J M

    2016-06-01

    In an observational prospective study, feasibility and outcomes of a dedicated multidisciplinary rehabilitation program (HNR) for head and neck cancer (HNC) patients were evaluated. HRQoL was assessed before and after HNR with EORTC C30 and H&N-35 QoL questionnaires in 52 consecutive patients. Initial HRQoL scores were compared with EORTC reference scores for HNC patients and post-HNR with those available for the general healthy population. Distress was assessed before and after HNR with the distress thermometer (DT). At completion of HNR with a mean duration of 7 months, overall HRQoL was significantly improved (p Emotional, and Social function scales and most EORTC C30 and H&N35 symptom scale items showed a statistically significant (p distress score before HNR was above the cutoff value of 5, suggesting the need for referral to rehabilitation. After completing HNR, distress decreased significantly to 3.0 (p < 0.001). HRQoL pretreatment was poorer than that of the EORTC reference HNC population, whereas at the completion of the HNR program, the HRQoL was comparable to that of the general population reference level. We conclude that a dedicated multidisciplinary HNR program is feasible and suggest that it has a positive impact on HRQoL. The multidisciplinary approach may have added value over mono-disciplinary interventions. However, our results should be judged cautiously due to the observational nature of the study. PMID:26024692

  2. Risk Factors of Ototoxicity After Cisplatin-Based Chemo-Irradiation in Patients With Locally Advanced Head-and-Neck Cancer: A Multivariate Analysis

    International Nuclear Information System (INIS)

    Purpose: Cisplatin chemo-irradiation is increasingly used in locally advanced squamous cell carcinoma of the head and neck. The objective of this study is to determine risk factors of ototoxicity due to intra-arterial high-dose cisplatin chemoradiation. Methods and Materials: A prospective analysis of hearing thresholds at low and (ultra) high frequencies obtained before, during, and after treatment in 146 patients. Treatment consisted of intra-arterial infusion of high-dose cisplatin (150 mg/m2, four courses) with sodium thiosulfate rescue and concurrent radiation therapy (70 Gy). Patient and chemoradiation variables were studied in a multivariate analysis. Results: After treatment, 23% of the ears were under consideration for hearing aids because of therapy. Twenty-two percent of the patients developed an increase in air-bone gap >10 dB during or after therapy. In the multivariate explanatory analysis, cumulative dose of cisplatin and radiation therapy, and young age displayed a causal relationship with increased sensorineural hearing loss during and after therapy (p < 0.001). In the multivariate prediction analysis, pretreatment hearing level of the concerning ear was identified as an independent predictive factor for hearing capability after therapy (p < 0.0001). Conclusions: Both cisplatin and radiation therapy were proven to induce sensorineural hearing loss, in this study with short-term follow-up. Of all patient and treatment variables studied, the patients pretreatment hearing level appeared to be the main predictive factor for hearing capability after high-dose intra-arterial cisplatin chemoradiation

  3. High-grade acute organ toxicity as positive prognostic factor in primary radio(chemo)therapy for locally advanced, inoperable head and neck cancer

    International Nuclear Information System (INIS)

    Purpose: to test for a possible correlation between high-grade acute organ toxicity during primary radio(chemo)therapy and treatment outcome in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Patients and methods: from 05/1994 to 01/2009, 216 HNSCC patients were treated with radio(chemo)therapy in primary approach. They received normofractionated (2 Gy/fraction) irradiation including associated nodal drainage sites to a cumulative dose of 70 Gy. 151 patients received additional concomitant chemotherapy (111 patients 5-fluorouracil/mitomycin C, 40 patients cisplatin-based). Toxicity during treatment was monitored weekly according to the Common Toxicity Criteria (CTC), and any toxicity grade CTC ≥ 3 of mucositis, dysphagia or skin reaction was assessed as high-grade acute organ toxicity for later analysis. Results: a statistically significant coherency between high-grade acute organ toxicity and overall survival as well as locoregional control was found: patients with CTC ≥ 3 acute organ toxicity had a 5-year overall survival rate of 4% compared to 8% in patients without (p < 0.01). Thereby, multivariate analyses revealed that the correlation was independent of other possible prognostic factors or factors that may influence treatment toxicity, especially concomitant chemotherapy and radiotherapy technique or treatment-planning procedure. Conclusion: these data indicate that normal tissue and tumor tissue may behave similarly with respect to treatment response, as high-grade acute organ toxicity during radio(chemo)therapy showed to be an independent prognostic marker in the own patient population. However, the authors are aware of the fact that a multivariate analysis in a retrospective study generally has statistical limitations. Therefore, their hypothesis should be further analyzed on biomolecular and clinical levels and other tumor entities in prospective trials. (orig.)

  4. An update on the pathobiological relevance of nuclear receptors for cancers of the head and neck

    OpenAIRE

    Stauber, Roland H; Wünsch, Desiree; Knauer, Shirley K.; Fetz, Verena

    2010-01-01

    Cancers of the head and neck are among the most common neoplasms worldwide, characterized by local tumor aggressiveness, high rate of early recurrence, development of metastasis and second primary tumors. Although disease management of head and neck cancer has improved significantly, overall survival-rates remained largely unchanged over the last decades. Thus, in addition to modern chemo-radiation treatment strategies combined with sophisticated surgery, there is s...

  5. The effect of radiotherapy on survival of dental implants in head and neck cancer patients

    OpenAIRE

    Shugaa-Addin, Bassam; Al-Shamiri, Hashem M.; Al-Maweri, Sadeq A.; Tarakji, Bassel

    2016-01-01

    Objectives: To explore the current literature of the survival of dental implants in irradiated head and neck cancer patients considering the role of implant location, bone augmentation, dose of radiation and timing of implant placement. Study Design: Pubmed search was conducted to identify articles published between January 2000 and December 2014 and presenting data of dental implant survival with radiotherapy in head and neck cancer patients. Studies on animal subjects and crani...

  6. The effect of radiotherapy on survival of dental implants in head and neck cancer patients

    OpenAIRE

    Shugaa-Addin, Bassam; Al-Shamiri, Hashem-Motahir; Al-Maweri, Sadeq; Tarakji, Bassel

    2016-01-01

    Objectives To explore the current literature of the survival of dental implants in irradiated head and neck cancer patients considering the role of implant location, bone augmentation, dose of radiation and timing of implant placement. Study Design Pubmed search was conducted to identify articles published between January 2000 and December 2014 and presenting data of dental implant survival with radiotherapy in head and neck cancer patients. Studies on animal subjects and craniofacial implant...

  7. Exosomes Derived from Squamous Head and Neck Cancer Promote Cell Survival after Ionizing Radiation

    OpenAIRE

    Lisa Mutschelknaus; Carsten Peters; Klaudia Winkler; Ramesh Yentrapalli; Theresa Heider; Michael John Atkinson; Simone Moertl

    2016-01-01

    Exosomes are nanometer-sized extracellular vesicles that are believed to function as intercellular communicators. Here, we report that exosomes are able to modify the radiation response of the head and neck cancer cell lines BHY and FaDu. Exosomes were isolated from the conditioned medium of irradiated as well as non-irradiated head and neck cancer cells by serial centrifugation. Quantification using NanoSight technology indicated an increased exosome release from irradiated compared to non-i...

  8. Polaprezinc reduces the severity of radiation-induced mucositis in head and neck cancer patients

    OpenAIRE

    Doi, Hiroshi; Fujiwara, Masayuki; Suzuki, Hitomi; Niwa, Yasue; Nakayama, Masahiro; SHIKATA, TOSHIYUKI; Odawara, Soichi; Takada, Yasuhiro; Kimura, Takeshi; KAMIKONYA, NORIHIKO; Hirota, Shozo

    2014-01-01

    Polaprezinc (PZ), an antiulcer drug, has been reported to have antioxidant properties. The aim of the present study was to assess the feasibility and efficacy of administering PZ for radiation-induced mucositis in head and neck cancer patients. Patients with newly diagnosed head and neck cancer were enrolled in this prospective study. PZ was prepared as an oral rinse. The PZ oral rinse was used four times per day during the course of radiotherapy. Sequential changes in radiation mucositis wer...

  9. Managing complications of radiation therapy in head and neck cancer patients: Part I. Management of xerostomia

    OpenAIRE

    W. C. Ngeow; Chai, W. L.; Rahman, R.A.; Ramli, R

    2006-01-01

    Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Where possible, pretreatment dental assessment shall be provided for these patients before they receive radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally for radiation therapy. Because of this, they succumb to complicated oral adverse effects after radiation therap...

  10. Accuracy of self-reported tobacco assessments in a head and neck cancer treatment population

    International Nuclear Information System (INIS)

    Prospective analysis was performed of self-reported and biochemically confirmed tobacco use in 50 head and neck cancer patients during treatment. With 93.5% compliance to complete weekly self-report and biochemical confirmatory tests, 29.4% of smokers required biochemical assessment for identification. Accuracy increased by 14.9% with weekly vs. baseline self-reported assessments. Data confirm that head and neck cancer patients misrepresent true tobacco use during treatment.

  11. Comparison of acute toxicities of two chemotherapy schedules for head and neck cancers

    Directory of Open Access Journals (Sweden)

    Geeta S

    2006-01-01

    Full Text Available Background: Chemo-radiotherapy has become the standard of care for loco-regionally advanced head and neck cancers. Platinum based regimens are the most effective. Although benefits are proven with chemo-radiation, acute toxicities are markedly increased. The dose and delivery schedules of Cisplatin have ranged from intermittent higher dose [100 mg/m2] every 3 weeks to low dose [6 mg/m2] daily administration. At present there is no data indicating which regimen is superior. Purpose: To compare acute toxicities of two chemotherapy schedules for head and neck cancers. Materials and Methods: A total of 83 head and neck cancer patients treated with two schedules of concurrent chemo RT were analyzed, retrospectively, for treatment toxicity. In group A [51 patients], chemotherapy [CT] was administered on week 1, 4 and 7 [cisplatin 100 mg/m2] over a period of 2-3 days. In group B [32 patients], CT was delivered weekly [cisplatin 40 mg/m2]. Radiotherapy dose was 7000 cGy in 35 fractions for definitive concurrent chemo-radiation and 6600 cGy in 33 fractions for adjuvant treatment. Results: Group B patients had increased grade III skin and hematological toxicity, where as patients in group A had more pharyngeal toxicity. Treatment interruptions and percentage of weight loss were higher in group B. Weekly CT schedule had higher rate of severe mucositis, which was statistically significant on both univariate [ P =0.005] and multivariate [ P =0.007] analysis. Conclusions: Three weekly CT is less toxic than weekly. Weekly CT can be made more acceptable by reducing the dose and using feeding tubes for nutrition.

  12. Psychological functioning of caregivers for head and neck cancer patients

    OpenAIRE

    Longacre, Margaret L.; Ridge, John A.; Burtness, Barbara A.; Galloway, Thomas J.; Fang, Carolyn Y.

    2011-01-01

    Patients with head and neck squamous cell carcinoma (HNSCC) often require assistance from family caregivers during the treatment and post-treatment period. This review article sought to summarize current findings regarding the psychological health of HNSCC caregivers, including factors that may be associated with poorer psychological health. Online databases (PUBMED, MEDLINE and PSYCINFO) were searched for papers published in English through September 2010 reporting on the psychological healt...

  13. Identification of Patient Benefit From Proton Therapy for Advanced Head and Neck Cancer Patients Based on Individual and Subgroup Normal Tissue Complication Probability Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Jakobi, Annika, E-mail: Annika.Jakobi@OncoRay.de [OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Bandurska-Luque, Anna [OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden (Germany); Stützer, Kristin; Haase, Robert; Löck, Steffen [OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Wack, Linda-Jacqueline [Section for Biomedical Physics, University Hospital for Radiation Oncology, Eberhard Karls Universät Tübingen (Germany); Mönnich, David [Section for Biomedical Physics, University Hospital for Radiation Oncology, Eberhard Karls Universät Tübingen (Germany); German Cancer Research Center, Heidelberg (Germany); German Cancer Consortium, Tübingen (Germany); Thorwarth, Daniela [Section for Biomedical Physics, University Hospital for Radiation Oncology, Eberhard Karls Universät Tübingen (Germany); and others

    2015-08-01

    Purpose: The purpose of this study was to determine, by treatment plan comparison along with normal tissue complication probability (NTCP) modeling, whether a subpopulation of patients with head and neck squamous cell carcinoma (HNSCC) could be identified that would gain substantial benefit from proton therapy in terms of NTCP. Methods and Materials: For 45 HNSCC patients, intensity modulated radiation therapy (IMRT) was compared to intensity modulated proton therapy (IMPT). Physical dose distributions were evaluated as well as the resulting NTCP values, using modern models for acute mucositis, xerostomia, aspiration, dysphagia, laryngeal edema, and trismus. Patient subgroups were defined based on primary tumor location. Results: Generally, IMPT reduced the NTCP values while keeping similar target coverage for all patients. Subgroup analyses revealed a higher individual reduction of swallowing-related side effects by IMPT for patients with tumors in the upper head and neck area, whereas the risk reduction of acute mucositis was more pronounced in patients with tumors in the larynx region. More patients with tumors in the upper head and neck area had a reduction in NTCP of more than 10%. Conclusions: Subgrouping can help to identify patients who may benefit more than others from the use of IMPT and, thus, can be a useful tool for a preselection of patients in the clinic where there are limited PT resources. Because the individual benefit differs within a subgroup, the relative merits should additionally be evaluated by individual treatment plan comparisons.

  14. Identification of Patient Benefit From Proton Therapy for Advanced Head and Neck Cancer Patients Based on Individual and Subgroup Normal Tissue Complication Probability Analysis

    International Nuclear Information System (INIS)

    Purpose: The purpose of this study was to determine, by treatment plan comparison along with normal tissue complication probability (NTCP) modeling, whether a subpopulation of patients with head and neck squamous cell carcinoma (HNSCC) could be identified that would gain substantial benefit from proton therapy in terms of NTCP. Methods and Materials: For 45 HNSCC patients, intensity modulated radiation therapy (IMRT) was compared to intensity modulated proton therapy (IMPT). Physical dose distributions were evaluated as well as the resulting NTCP values, using modern models for acute mucositis, xerostomia, aspiration, dysphagia, laryngeal edema, and trismus. Patient subgroups were defined based on primary tumor location. Results: Generally, IMPT reduced the NTCP values while keeping similar target coverage for all patients. Subgroup analyses revealed a higher individual reduction of swallowing-related side effects by IMPT for patients with tumors in the upper head and neck area, whereas the risk reduction of acute mucositis was more pronounced in patients with tumors in the larynx region. More patients with tumors in the upper head and neck area had a reduction in NTCP of more than 10%. Conclusions: Subgrouping can help to identify patients who may benefit more than others from the use of IMPT and, thus, can be a useful tool for a preselection of patients in the clinic where there are limited PT resources. Because the individual benefit differs within a subgroup, the relative merits should additionally be evaluated by individual treatment plan comparisons

  15. Human Papillomavirus Induced Transformation in Cervical and Head and Neck Cancers

    International Nuclear Information System (INIS)

    Human papillomavirus (HPV) is one of the most widely publicized and researched pathogenic DNA viruses. For decades, HPV research has focused on transforming viral activities in cervical cancer. During the past 15 years, however, HPV has also emerged as a major etiological agent in cancers of the head and neck, in particular squamous cell carcinoma. Even with significant strides achieved towards the screening and treatment of cervical cancer, and preventive vaccines, cervical cancer remains the leading cause of cancer-associated deaths for women in developing countries. Furthermore, routine screens are not available for those at risk of head and neck cancer. The current expectation is that HPV vaccination will prevent not only cervical, but also head and neck cancers. In order to determine if previous cervical cancer models for HPV infection and transformation are directly applicable to head and neck cancer, clinical and molecular disease aspects must be carefully compared. In this review, we briefly discuss the cervical and head and neck cancer literature to highlight clinical and genomic commonalities. Differences in prognosis, staging and treatment, as well as comparisons of mutational profiles, viral integration patterns, and alterations in gene expression will be addressed

  16. Human Papillomavirus Induced Transformation in Cervical and Head and Neck Cancers

    Energy Technology Data Exchange (ETDEWEB)

    Adams, Allie K. [Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229 (United States); Wise-Draper, Trisha M. [Division of Hematology/Oncology, University of Cincinnati Medical Center, University of Cincinnati, Cincinnati, OH 45229 (United States); Wells, Susanne I., E-mail: Susanne.Wells@cchmc.org [Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229 (United States)

    2014-09-15

    Human papillomavirus (HPV) is one of the most widely publicized and researched pathogenic DNA viruses. For decades, HPV research has focused on transforming viral activities in cervical cancer. During the past 15 years, however, HPV has also emerged as a major etiological agent in cancers of the head and neck, in particular squamous cell carcinoma. Even with significant strides achieved towards the screening and treatment of cervical cancer, and preventive vaccines, cervical cancer remains the leading cause of cancer-associated deaths for women in developing countries. Furthermore, routine screens are not available for those at risk of head and neck cancer. The current expectation is that HPV vaccination will prevent not only cervical, but also head and neck cancers. In order to determine if previous cervical cancer models for HPV infection and transformation are directly applicable to head and neck cancer, clinical and molecular disease aspects must be carefully compared. In this review, we briefly discuss the cervical and head and neck cancer literature to highlight clinical and genomic commonalities. Differences in prognosis, staging and treatment, as well as comparisons of mutational profiles, viral integration patterns, and alterations in gene expression will be addressed.

  17. Gene Expression Profiling to Predict Outcome After Chemoradiation in Head and Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: The goal of the present study was to improve prediction of outcome after chemoradiation in advanced head and neck cancer using gene expression analysis. Materials and Methods: We collected 92 biopsies from untreated head and neck cancer patients subsequently given cisplatin-based chemoradiation (RADPLAT) for advanced squamous cell carcinomas (HNSCC). After RNA extraction and labeling, we performed dye swap experiments using 35k oligo-microarrays. Supervised analyses were performed to create classifiers to predict locoregional control and disease recurrence. Published gene sets with prognostic value in other studies were also tested. Results: Using supervised classification on the whole series, gene sets separating good and poor outcome could be found for all end points. However, when splitting tumors into training and validation groups, no robust classifiers could be found. Using Gene Set Enrichment analysis, several gene sets were found to be enriched in locoregional recurrences, although with high false-discovery rates. Previously published signatures for radiosensitivity, hypoxia, proliferation, 'wound,' stem cells, and chromosomal instability were not significantly correlated with outcome. However, a recently published signature for HNSCC defining a 'high-risk' group was shown to be predictive for locoregional control in our dataset. Conclusion: Gene sets can be found with predictive potential for locoregional control after combined radiation and chemotherapy in HNSCC. How treatment-specific these gene sets are needs further study

  18. Treatment of head and neck cancer with CHART and nimorazole: phase II study

    International Nuclear Information System (INIS)

    Background and purpose: Causes of failure of radiotherapy in squamous cell carcinoma of the head and neck probably include repopulation and hypoxia. Very accelerated schedules such as continuous hyperfractionated accelerated radiation therapy (CHART) overcome the repopulation problem but allow limited time for reoxygenation, so a hypoxic-cell sensitizer may be especially beneficial. Nimorazole is the only such agent to have shown a significant effect in a randomized controlled trial in head and neck cancer. Accordingly we studied the combination of CHART and nimorazole. Methods: Sixty-one patients with advanced stage III (21) or IV (40) squamous cell carcinoma of the head and neck unsuitable for surgery were treated in a phase II study of the combination. The radiation dose was 56.75 Gy in 36 fractions in 12 consecutive days. Nimorazole was administered orally or enterally 90 min before radiotherapy at a dose of 1.2, 0.9, and 0.6 g/m2 with the first, second and third daily fractions, respectively. This dosage consistently yielded plasma concentrations above 30 μg/ml. Results: All the patients have been followed for a minimum of 2 years since treatment. Loco-regional control at 2 years is 55%, stage III 62% and stage IV 50%. Normal tissue effects were the same as those previously seen with CHART, except for a possible slight increase in acute skin reaction. Nimorazole toxicity was somewhat greater than with once daily administration in previous studies. Grade 3 nausea or vomiting occurred in 22% of patients. Two patients developed grade 1 peripheral neuropathy, and one patient died during treatment of encephalopathy, which was probably an idiosyncratic reaction to the drug. Conclusions: Local control rates are higher than those previously seen with CHART, suggesting a positive effect of nimorazole. Further studies of hypoxia-modifying agents with accelerated radiotherapy are warranted, and nimorazole is the simplest of these

  19. Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic

    Energy Technology Data Exchange (ETDEWEB)

    Ruetten, Heidi, E-mail: h.rutten@rther.umcn.nl [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Pop, Lucas A.M.; Janssens, Geert O.R.J. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Takes, Robert P. [Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Knuijt, Simone [Department of Rehabilitation/Speech Pathology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Rooijakkers, Antoinette F. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Berg, Manon van den [Department of Gastroenterology-Dietetics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Merkx, Matthias A. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Herpen, Carla M.L. van [Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Kaanders, Johannes H.A.M. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)

    2011-11-15

    Purpose: To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer. Methods and Materials: Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients. Results: Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence-free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients. Conclusion: This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.

  20. Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic

    International Nuclear Information System (INIS)

    Purpose: To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer. Methods and Materials: Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients. Results: Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence–free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients. Conclusion: This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.

  1. Simultaneous chemo-radiotherapy with Cisplatin/5-Fluorouracil/Leucovorin and hyperfractionated radiation for patients with advanced unresectable head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Reitmeier, M.; Pohlmann, H.; Schorer, H.; Hartenstein, R. [Munich-Harlaching City Hospital, Dept. of medicine IV, Munich (Germany)

    1994-12-31

    Thirty-one previously untreated patients with unresectable stage 3rd and 4th squamous cell carcinoma of the head and neck were treated with a simultaneous chemo-radiotherapy consisting of a cisplatin/5-fluoroucil/leucovorin-combination and of an accelerated split course radiotherapy. severe mucositis (77 %) and weight loss of 10 % or more (48 %) were the most common toxic effects. The overall response rate was 81 % with a 45 % complete response rate and a 36 % partial response rate. Median follow up time of the surviving patients was 50 %, the actuarial survival probability at 2 years was 63 % (Kaplan-Meier estimates).

  2. Simultaneous chemo-radiotherapy with Cisplatin/5-Fluorouracil/Leucovorin and hyperfractionated radiation for patients with advanced unresectable head and neck cancer

    International Nuclear Information System (INIS)

    Thirty-one previously untreated patients with unresectable stage 3rd and 4th squamous cell carcinoma of the head and neck were treated with a simultaneous chemo-radiotherapy consisting of a cisplatin/5-fluoroucil/leucovorin-combination and of an accelerated split course radiotherapy. severe mucositis (77 %) and weight loss of 10 % or more (48 %) were the most common toxic effects. The overall response rate was 81 % with a 45 % complete response rate and a 36 % partial response rate. Median follow up time of the surviving patients was 50 %, the actuarial survival probability at 2 years was 63 % (Kaplan-Meier estimates)

  3. Amifostine - a radioprotector in locally advanced head and neck tumors

    Energy Technology Data Exchange (ETDEWEB)

    Schoenekaes, K.G.; Wagner, W. [Paracelsus-Strahlenklinik, Osnabrueck (Germany); Prott, F.J. [Muenster Univ. (Germany). Inst. fuer Strahlenonkologie

    1999-11-01

    Purpose: There are some preliminary informations about the beneficial use of amifostine in avoiding side effects in patients with head and neck tumors who underwent radiotherapy. Patients and method: Amifostine was given as daily intravenous application (500 mg) 10 to 15 minutes prior to radiotherapy in 20 patients. The results were compared with another collective of patients which was similar. Results: According to the WHO score mucositis became manifest in 10 patients (Grade I) and 4 patients (Grade II) in the amifostine group vs 9 patients (Grade II), 6 patients (Grade III) and 1 patient (Grade IV) in the control group. Xerostomia has been seen in 15 patients (Grade I) and 5 patients (Grade II) after administration of amifostine. Without the drug 2 patients suffered from xerostomia (Grade I), 8 patients (Grade II) and 8 patients (Grade III), respectively. Administering amifostine had been feasible and non problematic. Only a small rate of toxic side effects like nausea (11%) or emesis (4%) was documented. Conclusions: Amifostine is an effective radioprotector decreasing acute and late side effects in patients with head and neck tumors. (orig.) [German] Zielsetzung: Bisher gibt es nur wenige Informationen ueber den Nutzen von Amifostin bezueglich der Verminderung oder Vermeidung von Nebenwirkungen einer Radiatio bei Patienten mit Tumoren im HNO-Trakt. Patienten und Methode: Amifostin wurde als intravenoese Kurzinfusion mit einer Dosis von 500 mg zehn bis 15 Minuten vor der Bestrahlung bei 20 Patienten appliziert. Die unter Radiatio aufgetretenen Nebenwirkungen wurden nach WHO bzw. nach dem Oral Assessment Guide nach Eilers ausgewertet und mit einem entsprechenden historischen Kollektiv der Klinik verglichen. Ergebnisse: In der Amifostin-Gruppe wurde bei zehn Patienten eine Mukositis Grad I und bei vier Patienten eine Mukositis Grad II nach WHO beobachtet. Grad-III- und Grad-IV-Nebenwirkungen traten nicht auf. In der Kontrollgruppe waren dagegen bei neun

  4. Positron Emission Tomography and head and neck cancers: Recurrence and post-treatment surveillance

    International Nuclear Information System (INIS)

    Recurrence of head and neck squamous cell carcinomas occurs early and currently, with poor prognosis. Post-therapeutic surveillance aims to diagnose a recurrence as early as possible in order to perform curative salvage therapy. The risk of recurrence is highest in locally advanced cancers. Morphological imaging, including Computed Tomography (CT Scan) and magnetic resonance imaging, can be limited by the anatomic changes following surgery and radiotherapy, and sometimes cannot provide early diagnosis of recurrence. Histology presents some risk of morbidity, especially in irradiated tissues, and sampling error. Positron Emission Tomography (PET) with 18F-fluorodeoxyglucose (F.D.G.) is superior to conventional imaging for the diagnosis and staging of recurrence, especially when it is performed three months after the end of treatments. F.D.G.-PET has high sensitivity and negative predictive value for recurrence, so that further morphological and invasive investigations should not be performed in case of negative examination. On the other hand, because of its limited specificity and positive predictive value, any positive PET finding should be documented, in order to avoid false positives findings. The diagnosis of recurrence is the field of application in which F.D.G.-PET has the greatest impact on head and neck cancer management: it is considered as a standard. However, the interest of F.D.G.-PET during systematic follow-up has not yet been confirmed. PET should only be performed in difficult cases and within evaluation protocols. (authors)

  5. [Radioresistance parameters in head and neck cancers and methods to radiosensitize].

    Science.gov (United States)

    Biau, J; Chautard, E; Miroir, J; Lapeyre, M

    2015-08-01

    Head and neck cancers have been widely studied concerning their sensitivity to radiation therapy. Several parameters affect tumour response to radiation therapy. Some parameters are linked to the tumour. Large or invasive tumours, localization, such as oral cavity or adenopathy, are factors of radioresistance. Others parameters are linked to the patients themselves. Tobacco intoxication during radiotherapy and a low hemoglobin level contribute to radioresistance. More recently, a positive human papilloma virus (HPV) status has been reported to positively affect radiosensitivity. Finally, other parameters are related to tumour biology. Hypoxia, intrinsic radiosensitivity of tumour cells, tumour differentiation and repopulation (provided by Ki-67 index or EGFR level) are components of radiosensitivity. Currently, concurrent chemoradiotherapy is one of the gold standard treatments to overcome clinical outcome of locally advanced head and neck cancer. This combination increases locoregional control and survival. Taxane-based induction chemotherapy can also be an alternative. Another validated approach is the association of radiotherapy with cetuximab (EGFR targeting) but only one randomized study has been published. Fractionation modifications, especially hyperfractionation, have given positive results on both tumour control and survival. Strategies targeting hypoxia improve locoregional control but have less clinical impact. PMID:26119219

  6. Combined Chemoradiotherapy vs Radiotherapy Alone for Locally Advanced Squamous Cell Carcinoma of the Head and Neck

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Hyeon Ju; Suh, Hyun Suk; Kim, Chul Soo; Kim, Re Hwe; Kim, Sung Rok [Inje University College of Medicine, Seoul (Korea, Republic of)

    1996-03-15

    Purpose : The traditional approach with surgery and/or radiotherapy(RT) for advanced head and neck cancer provides anticipated cure rates of 10-65% depending on stages and sites. Recently, combined modality with chemotherapy have been extensively investigated in attempts to improve survival and local control. We retrospectively analysed our experience of 31 patients with advanced head and neck cancer. Methods and Materials : From November 1983 to October 1994, 31 patients with Stage II and IV squamous cell head and neck cancer were treated with RT. Sixteen patients were treated with RT alone. and 15 patients were treated with combined RT plus chemotherapy. All patients were treated with 4-MV LINAC and radiation dose ranged from 5000 cGy to 7760 cGy(median 7010 cGy). In combined group. 7 patients were treated with cis-platin plus 5-FU, 2 patients were treated with methotrexate plus leucovorin plus 5-FU plus cisplatin or carboplatin, and 6 patients were treated with cisplatin as a radiosensitizer. Results : Median follow up period was 16 months (range 4-134 months). The major responses (CR+PR) were noted in 10 patient (66.6%) of the RT alone group and 14 patient (93.3%) of the chemoradiation group. There was no statistical difference in CR rate between the two groups. The overall survival rates at 5 years were 23.4% in the radiation alone group. 23.5% in the chemoradiation group. Disease-free survival rates at 3 year were 44.5% in the radiation alone group. 40% in the chemoradiation group. There was no statistical differences in overall survival rates and disease free survival rates between the two groups. Local recurrences occurred in 71.5% of the radiation alone group. 72.7% of the chemoradiation group and distant metastasis occurred in 14.4% of radiation alone group. 9.1% of the chemoradiation group. The frequencies of complications were comparable in both groups except hematologic toxicity. Conclusion : Total response rates in the combined chemotherapy and

  7. 14-3-3 zeta is a molecular target in guggulsterone induced apoptosis in Head and Neck cancer cells

    International Nuclear Information System (INIS)

    The five-year survival rates for head and neck squamous cell carcinoma (HNSCC) patients are less than 50%, and the prognosis has not improved, despite advancements in standard multi-modality therapies. Hence major emphasis is being laid on identification of novel molecular targets and development of multi-targeted therapies. 14-3-3 zeta, a multifunctional phospho-serine/phospho-threonine binding protein, is emerging as an effector of pro-survival signaling by binding to several proteins involved in apoptosis (Bad, FKHRL1 and ASK1) and may serve as an appropriate target for head and neck cancer therapy. Herein, we determined effect of guggulsterone (GS), a farnesoid X receptor antagonist, on 14-3-3 zeta associated molecular pathways for abrogation of apoptosis in head and neck cancer cells. Head and neck cancer cells were treated with guggulsterone (GS). Effect of GS-treatment was evaluated using cell viability (MTT) assay and apoptosis was verified by annexin V, DNA fragmentation and M30 CytoDeath antibody assay. Mechanism of GS-induced apoptosis was determined by western blotting and co-IP assays using specific antibodies. Using in vitro models of head and neck cancer, we showed 14-3-3 zeta as a key player regulating apoptosis in GS treated SCC4 cells. Treatment with GS releases BAD from the inhibitory action of 14-3-3 zeta in proliferating HNSCC cells by activating protein phosphatase 2A (PP2A). These events initiate the intrinsic mitochondrial pathway of apoptosis, as revealed by increased levels of cytochrome c in cytoplasmic extracts of GS-treated SCC4 cells. In addition, GS treatment significantly reduced the expression of anti-apoptotic proteins, Bcl-2, xIAP, Mcl1, survivin, cyclin D1 and c-myc, thus committing cells to apoptosis. These events were followed by activation of caspase 9, caspase 8 and caspase 3 leading to cleavage of its downstream target, poly-ADP-ribose phosphate (PARP). GS targets 14-3-3 zeta associated cellular pathways for reducing

  8. Role of radiation therapy in the multi-modal treatment of head and neck cancer

    International Nuclear Information System (INIS)

    The role of radiation therapy as part of the multi-modal treatment of head and neck cancer appeared to be important with respect to functional and cosmetic morbidity. As for oral cancer, the value of brachytherapy was excellent in cases of localized disease. As far as the latter technique was applicable, patients with tongue cancer at T1, T2 and T3 could be treated by radiation as the initial choice unless palpable neck node metastasis was present. In contrast, cure of the lesion would not be expected from external irradiation alone even when combined with chemotherapy. Accordingly, in such advanced cases, salvage surgery should be applied with or without radiation and/or chemotherapy. As for maxillary cancer, the introduction of ''trimodal therapy'' has improved the local control rate only to a slight degree. After the application of conservative surgery followed by conventional trimodal combination therapy, local control and five-year survival rates have been improved markedly. (author)

  9. The Role of HPV in Head and Neck Cancer Stem Cell Formation and Tumorigenesis

    Directory of Open Access Journals (Sweden)

    Mark S. Swanson

    2016-02-01

    Full Text Available The cancer stem cell (CSC theory proposes that a minority of tumor cells are capable of self-replication and tumorigenesis. It is these minority of cells that are responsible for cancer metastasis and recurrence in head and neck squamous cell cancers (HNSCC. Human papilloma virus (HPV-related cancer of the oropharynx is becoming more prevalent, which makes understanding of the relationship between HPV and CSCs more important than ever. This relationship is critical because CSC behavior can be predicted based on cell surface markers, which makes them a suitable candidate for targeted therapy. New therapies are an exciting opportunity to advance past the stalled outcomes in HNSCC that have plagued patients and clinicians for several decades.

  10. Short-term health-related quality of life and symptom control with docetaxel, cisplatin, 5-fluorouracil and cisplatin (TPF), 5-fluorouracil (PF) for induction in unresectable locoregionally advanced head and neck cancer patients (EORTC 24971/TAX 323).

    NARCIS (Netherlands)

    Herpen, C.M.L. van; Mauer, M.E.; Mesia, R.; Degardin, M.; Jelic, S.; Coens, C.; Betka, J.; Bernier, J.; Remenar, E.; Stewart, J.S.; Preiss, J.H.; Weyngaert, D. van den; Bottomley, A.; Vermorken, J.B.

    2010-01-01

    BACKGROUND: The EORTC 24971/TAX 323, a phase III study of 358 patients with unresectable locoregionally advanced squamous cell carcinoma of the head and neck, showed an improved progression-free and overall survival (OS) with less toxicity when docetaxel (T) was added to cisplatin and 5-fluorouracil

  11. Simultaneous radiation plus cis-platinum/5-fluorouracil infusion in locally advanced squamous cell carcinoma of the head and neck

    International Nuclear Information System (INIS)

    This paper reports twenty patients with advanced untreated head and neck cancer (curative) and five with recurrence (palliative) treated with three 2-week courses of radiation (1,500 rad/10 treatments), cis-platinum, and a 5-day 5-fluorouracil infusion. A fourth 2-week course of radiation (2,000 rad/10 treatments) brought the final tumor dose to 6,500 rad. Nineteen (95%) of the curative patients and four (80%) of the palliative patients experienced complete or partial response. There have been 12 recurrences (nine local, two distant, and one local + distant). Most patients experienced toxicity, including nausea, vomiting, weight loss, and mucositis. In this study, chemoradiotherapy was effective in achieving local/regional control in advanced head and neck cancer

  12. Value of Dynamic Contrast-Enhanced MRI to Detect Local Tumor Recurrence in Primary Head and Neck Cancer Patients

    OpenAIRE

    Choi, Young Jun; Lee, Jeong Hyun; Sung, Yu Sub; Yoon, Ra Gyoung; Park, Ji Eun; Nam, Soon Yuhl; Baek, Jung Hwan

    2016-01-01

    Abstract Treatment failures in head and neck cancer patients are mainly related to locoregional tumor recurrence. The objective of the present study was to evaluate the diagnostic accuracy of model-free dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to detect local recurrence during the surveillance of head and neck cancer patients. Our retrospective study enrolled 24 patients with primary head and neck cancer who had undergone definitive treatment. Patients were grouped into ...

  13. Increase in head and neck cancer in younger patients due to human papillomavirus (HPV).

    Science.gov (United States)

    Young, David; Xiao, Christopher C; Murphy, Benjamin; Moore, Michael; Fakhry, Carole; Day, Terry A

    2015-08-01

    The face of head and neck cancer has changed dramatically over the past 30 years. There has been a steady decline in the number of tobacco and alcohol related squamous cell carcinomas over the past 30 years, but and increasing incidence of human papillomavirus (HPV) related cancers. Some estimates suggest that 70-90% of new oropharyngeal cancers have evidence of HPV. These patients have different demographic patterns, in that they are more likely to be younger, white adults in their 40s and 50s who are never smokers or have reduced tobacco exposure. Studies have shown that a higher number of lifetime oral sex partners (>5) and a higher number of lifetime vaginal sex partners (>25) have been associated with increased risk of HPV positive head and neck cancer. People can also reduce their risk of HPV linked head and neck cancer by receiving the HPV vaccine series prior to becoming sexually active. Recent evidence suggests HPV related head and neck cancers present with different symptoms than those caused by tobacco. The most popular test for HPV status is the p16 immunohistochemical stain because it is cheap, simple, and studies have shown it to have comparable sensitivity and specificity to the previous standards. It is widely recommended that all cancers of the oropharynx be tested for the presence of HPV, and some recommend it for all head and neck cancers. Overall 2-year and 5-year survival for HPV positive head and neck cancer is significantly greater than for HPV negative cancers, likely due to HPV positive cancers being more responsive to treatment. PMID:26066977

  14. A Phase II Study of Docetaxel, Cisplatin and 5- Fluorouracil (TPF) In Patients with Locally Advanced Head and Neck Carcinomas

    OpenAIRE

    Ansari, M.; Omidvari, S; Mosalaei, A.; Ahmadloo, N; Mosleh-Shirazi, M. A.; Mohammadianpanah, M.

    2011-01-01

    Background The combination of cisplatin and 5-fluorouracil (PF) is currently considered a standard and effective regimen for the treatment of advanced head and neck carcinomas. The aim of this study was to evaluate the efficacy and safety of docetaxel, cisplatin and 5-fluorouracil (TPF) in patients with unresectable head and neck carcinomas. Methods Forty-six patients with previously untreated non-metastatic stage IV head and neck carcinomas were enrolled. All patients received three cycles o...

  15. Head and Neck

    DEFF Research Database (Denmark)

    Højgaard, Liselotte; Berthelsen, Anne Kiil; Loft, Annika

    2014-01-01

    Positron emission tomography (PET)/computed tomography with FDG of the head and neck region is mainly used for the diagnosis of head and neck cancer, for staging, treatment evaluation, relapse, and planning of surgery and radio therapy. This article is a practical guide of imaging techniques...

  16. The treatment of cancer in the head and neck

    International Nuclear Information System (INIS)

    1,438 cases of head and neck tumors were seen in our clinic during the period from 1965 - 1978. Under our multidisciplinary treatment, average dosage of radiation for nasal-paranasal tumors was 200 rad, for oral-mesopharyngeal tumors 1,800 rad, for nasopharyngeal tumors 2,400 rad, for laryngeal tumors 3,400 rad and for hypopharyngeal tumors 4,400 rad. After reduction of tumor mass and topical cleaning procedure, 1) a dosage of radiation-number of patients curve shifted to lower left, 2) repeated surgeries for recurrences became less frequent, 3) extended surgeries were unnecessary and 4) social rehabilitation of patients was obtained much easier even in aged. Principles of our treatment were simple: short hospitalization and careful long term follow-up. Treatment plan should be decided according to clinical finding and course of illness in each cases. (author)

  17. Analysis of free flaps in head and neck cancer reconstruction

    International Nuclear Information System (INIS)

    Approximately 107 patients have received free tissue transfer in head and neck reconstruction since our center opened in April, 2007 (until March, 2010). We examined the relationship between the postoperative complication rate and past history (high blood pressure, diabetes, cerebro-vascular disease, radiation exposure to the head cervix. chemotherapy career and head cervix operation career). The mean patient age was 62.2 years old (range 15 to 90), and there were 77 males (72.0%) and 30 females (28.0%). Among the patients who developed postoperative complications, total necroses occurred in 3 cases (2.8%). In addition to these cases of total necrosis, 8 patients needed a re-operation, 5 of whom received preoperative radiotherapy. Preoperative radiotherapy was related to the development of complications when we performed multiplex logistics analysis. (author)

  18. Pre- and postirradiation care of the mouth in head and neck cancer patients

    International Nuclear Information System (INIS)

    Radiotherapy plays an important role in the treatment of head and neck cancer. The effects of radiotherapy on the oral hard and soft tissues may range from a mild mucositis to severe caries and osteoradionecrosis. It is the responsibility of the dentist to treat and prevent the severe sequelae which may arise. This paper outlines the effects of radiotherapy on the oral structures and discusses the dental treatment of the patient during radiotherapy. Emphasis is placed on the prevention of complications. The head and neck cancer patient must be thoroughly examined by the dentist and treatment planning may then be divided into pre-irradiaton treatment, treatment during irradiation and post-irradiation treatment. The dentist thus forms an essential member of the team treating patients with head and neck cancer

  19. Value of PET/CT in the approach to head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Curioni, Otavio Alberto; Amar, Ali; Viana, Debora [Hospital Heliopolis, Sao Paulo, SP (Brazil). Service of Head and Neck Surgery and Otorhynolaryngology; Souza, Ricardo Pires de [Hospital Heliopolis, Sao Paulo, SP (Brazil). Service of Radiology; Rapoport, Abrao [Hospital Heliopolis, Sao Paulo, SP (Brazil); Dedivitis, Rogerio Aparecido [Universidade de Sao Paulo (HC-FMUSP), SP (Brazil). Hospital das Clinicas. Group of Larynx and Hypopharynx; Cernea, Claudio Roberto; Brandao, Lenine Garcia [Universidade de Sao Paulo (FMUSP), SP (Brazil). Fac. de Medicina. Dept. of Head and Neck Surgery

    2012-11-15

    Objective: To evaluate the role of PET/CT in the approach to patients with head and neck cancer. Materials and Methods: Retrospective study of medical records and PET/CT images of 63 patients with head and neck cancer. Results: Alterations were observed in 76% of the cases. Out of these cases, 7 (11%) were considered as false-positive, with SUV < 5.0. PET/CT demonstrated negative results in 15 cases (24%). Among the 14 cases where the method was utilized for staging, 3 (22%) had their stages changed. Conclusion: PET/CT has shown to be of potential value in the routine evaluation of patients with head and neck cancer, but further studies of a higher number of cases are required to define a protocol for utilization of the method. (author)

  20. Piperlongumine selectively kills cancer cells and increases cisplatin antitumor activity in head and neck cancer

    OpenAIRE

    Roh, Jong-Lyel; Kim, Eun Hye; Park, Jin Young; Kim, Ji Won; Kwon, Minsu; Lee, Byung-Heon

    2014-01-01

    Adaptation to cellular stress is not a vital function of normal cells but is required of cancer cells, and as such might be a sensible target in cancer therapy. Piperlongumine is a naturally occurring small molecule selectively toxic to cancer cells. This study assesses the cytotoxicity of piperlongumine and its combination with cisplatin in head-and-neck cancer (HNC) cells in vitro and in vivo. The effect of piperlongumine, alone and in combination with cisplatin, was assessed in human HNC c...

  1. Oral Mucositis Prevention and Management by Therapeutic Laser in Head and Neck Cancers

    OpenAIRE

    Fekrazad, Reza; Chiniforush, Nasim

    2014-01-01

    Introduction: Oral mucositis is considered a severe complication in cancer patients receiving radiotherapy or chemotherapy for head and neck cancer. The aim of this review study was to assess the effect of low level laser therapy for prevention and management of oral mucositis in cancer patients.

  2. Sequence variants and the risk of head and neck cancer: pooled analysis in the INHANCE consortium

    Directory of Open Access Journals (Sweden)

    Shu-ChunChuang

    2011-07-01

    Full Text Available Previous molecular epidemiological studies on head and neck cancer have examined various single nucleotide polymorphisms, but there are very few documented associations. In the International Head and Neck Cancer Epidemiology (INHANCE consortium, we evaluated associations between SNPs in the metabolism, cell cycle, and DNA repair pathways and the risk of head and neck cancer. We analyzed individual-level pooled data from 14 European, North American, Central American and Asia case-control studies (5,915 head and neck cancer cases and 10,644 controls participating in the INHANCE consortium. Unconditional logistic regression was used to estimate odds ratios (OR and 95% confidence intervals (CI for SNP effects, adjusting for age, sex, race, and country. We observed an association between head and neck cancer risk and MGMT Leu84Phe heterozygotes (OR=0.79, 95% CI=0.68-0.93, XRCC1 Arg194Trp rare homozygotes (OR=2.3, 95% CI=1.1-4.7, ADH1B Arg48His homozygotes Arg/Arg (OR=2.7, 95% CI=1.9-4.0, ADH1C Ile350Val homozygotes Ile/Ile (OR=1.2, 95% CI=1.1-1.4, and the GSTM1 null genotype (OR=1.1, 95% CI=1.0-1.2. Among these results, MGMT Leu84Phe, ADH1B Arg48His, ADH1C Ile350Arg, and the GSTM1 null genotype had fairly low false positive report probabilities (<20%. We observed associations between ADH1B Arg48His, ADH1C Ile350Arg, and GSTM1 null genotype and head and neck cancer risk. No functional study currently supports the observed association for MGMT Leu84Phe, and the association with XRCC1 Arg194Trp may be a chance finding.

  3. DNA-based immunotherapy for HPV-associated head and neck cancer.

    Science.gov (United States)

    Aggarwal, Charu

    2016-10-01

    Squamous cell carcinoma of the head and neck (SCCHN) accounts for 3% of all cancers. Most patients present with locally advanced disease, where multimodality therapies are used with curative intent. Despite favorable early local treatment results, about one third of the patients will eventually develop metastatic disease. Immunotherapy offers a novel therapeutic strategy beyond cytotoxic chemotherapy, with initial approvals in melanoma and non-small-cell lung cancer. HPV-associated SCCHN is a distinct subset, with unique epidemiology and treatment outcomes. Both subsets of SCCHN (HPV-related or not) are particularly favorable for immunotherapy, as immune evasion and dysregulation have been shown to play a key role in the initiation and progression of disease. This review focuses on the latest developments in immunotherapy in SCCHN, with a particular focus on DNA-based approaches including vaccine and adoptive cellular therapies. PMID:27605067

  4. Cephalic vein: Saviour in the microsurgical reconstruction of breast and head and neck cancers

    Directory of Open Access Journals (Sweden)

    Vinay K Shankhdhar

    2012-01-01

    Full Text Available Background: Reconstruction with microvascular free flaps is considered the reconstructive option of choice in cancer of the head and neck regions and breast. Rarely, there is paucity of vessels, especially the veins, at the recipient site. The cephalic vein with its good caliber and constant anatomy is a reliable recipient vein available in such situations. Materials and Methods: It is a retrospective study from January 2010 to July 2012 and includes 26 patients in whom cephalic vein was used for free-flap reconstruction in head and neck (3 cases and breast cancers (23 cases. Results: All flaps in which cephalic vein was used survived completely. Conclusion: Cephalic vein can be considered as a reliable source of venous drainage when there is a non-availability/unusable of veins during free-flap reconstruction in the head and neck region and breast and also when additional source of venous drainage is required in these cases.

  5. Current clinical immunotherapeutic approaches for head and neck cancer [version 1; referees: 2 approved

    OpenAIRE

    Carolina Soto Chervin; Bruce Brockstein

    2016-01-01

    It was estimated that 59,340 new cases of head and neck cancer would be diagnosed in the US alone in 2015 and that 12,290 deaths would be attributed to the disease. Local and regional recurrences may be treated with chemotherapy and radiation; however, metastatic head and neck cancer is fatal and is treated with chemotherapy for palliation. Recent successful treatment of a variety of solid and hematological malignancies by immunotherapeutic approaches (i.e. harnessing the body’s own immune sy...

  6. Determining Adequate Margins in Head and Neck Cancers: Practice and Continued Challenges.

    Science.gov (United States)

    Williams, Michelle D

    2016-09-01

    Margin assessment remains a critical component of oncologic care for head and neck cancer patients. As an integrated team, both surgeons and pathologists work together to assess margins in these complex patients. Differences in method of margin sampling can impact obtainable information and effect outcomes. Additionally, what distance is an "adequate or clear" margin for patient care continues to be debated. Ultimately, future studies and potentially secondary modalities to augment pathologic assessment of margin assessment (i.e., in situ imaging or molecular assessment) may enhance local control in head and neck cancer patients. PMID:27469263

  7. Effect of cepharanthin to prevent radiation induced xerostomia in head and neck cancer

    International Nuclear Information System (INIS)

    We retrospectively examined the effect of Cepharanthin to prevent radiation xerostomia in 37 cases of head and neck cancer. In the Cepharanthin group, the degree of xerostomia was milder than in the non-Cepharanthin group in spite of higher normal tissue complication probability (NTCP) and mean dose (MD) of parotid glands. In the non-Cepharanthin group, the degree of xerostomia was significantly correlated with NTCP and MD of parotid glands. MD of parotid glands and use of Cepharanthin were significantly related to more severe xerostomia by multivariate analysis with logistic regression. Cepharanthin may prevent radiation xerostomia after radiotherapy for head and neck cancer. (author)

  8. Cytotoxicity and genotoxicity of capecitabine in head and neck cancer and normal cells

    OpenAIRE

    Wisniewska-Jarosinska, Maria; Sliwinski, Tomasz; Kasznicki, Jacek; Kaczmarczyk, Dariusz; Krupa, Renata; Bloch, Karolina; Drzewoski, Jozef; Chojnacki, Jan; Blasiak, Janusz; Morawiec-Sztandera, Alina

    2010-01-01

    The interaction between a chemical and a cell may strongly depend on whether this cell is normal or pathological. Side effects of anticancer drugs may sometimes overcome their benefit action, so it is important to investigate their effect in both the target and normal cells. Capecitabine (Xeloda, CAP), a prodrug of 5-fluorouracil, is mainly used in colon cancer, but little is known about its action in head and neck cancer. We compared the cyto- and genotoxicity of CAP in head and neck HTB-43 ...

  9. American Head and Neck Society

    Science.gov (United States)

    American Head & Neck Society Head and Neck Cancer Research & Education American Head & Neck Society | AHNS Head and Neck Cancer Research & Education About AHNS ... and Announcements Copyright ©2016 · American Head and Neck Society · Privacy and Return Policy Managed by BSC Management, ...

  10. Profiling Invasiveness in Head and Neck Cancer: Recent Contributions of Genomic and Transcriptomic Approaches

    Energy Technology Data Exchange (ETDEWEB)

    Nisa, Lluís, E-mail: lluis.nisa@dkf.unibe.ch [Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern 3010 (Switzerland); Department of Clinical Research, Inselspital, Bern University Hospital, and University of Bern, MEM-E807, Murtenstrasse 35, Bern 3010 (Switzerland); Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern 3010 (Switzerland); Aebersold, Daniel Matthias [Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern 3010 (Switzerland); Department of Clinical Research, Inselspital, Bern University Hospital, and University of Bern, MEM-E807, Murtenstrasse 35, Bern 3010 (Switzerland); Giger, Roland; Caversaccio, Marco Domenico; Borner, Urs [Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern 3010 (Switzerland); Medová, Michaela; Zimmer, Yitzhak, E-mail: lluis.nisa@dkf.unibe.ch [Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern 3010 (Switzerland); Department of Clinical Research, Inselspital, Bern University Hospital, and University of Bern, MEM-E807, Murtenstrasse 35, Bern 3010 (Switzerland)

    2015-03-31

    High-throughput molecular profiling approaches have emerged as precious research tools in the field of head and neck translational oncology. Such approaches have identified and/or confirmed the role of several genes or pathways in the acquisition/maintenance of an invasive phenotype and the execution of cellular programs related to cell invasion. Recently published new-generation sequencing studies in head and neck squamous cell carcinoma (HNSCC) have unveiled prominent roles in carcinogenesis and cell invasion of mutations involving NOTCH1 and PI3K-patwhay components. Gene-expression profiling studies combined with systems biology approaches have allowed identifying and gaining further mechanistic understanding into pathways commonly enriched in invasive HNSCC. These pathways include antigen-presenting and leucocyte adhesion molecules, as well as genes involved in cell-extracellular matrix interactions. Here we review the major insights into invasiveness in head and neck cancer provided by high-throughput molecular profiling approaches.

  11. Normal tissue effects of the radiotherapy of head and neck cancer

    International Nuclear Information System (INIS)

    The radiation responses of several normal tissues in the treatment of tumors of the head and neck have been discussed. The severity of damage to normal tissues can vary considerably according to the quantity and quality of the radiation, amounts of tissue irradiated, temporal aspects of treatment as well as numerous biological factors. The radiation effects of several normal tissues including bone, larynx, spinal cord, ear and eye, have not been addressed in this report, but nevertheless are important in the treatment of a variety of head and neck tumors. Attention to potential normal tissue complications in the radiotherapy of head and neck cancer must be considered an integral part of the therapy. Proper management of complications may improve response to therapy and improve the quality of life

  12. Second primary malignant neoplasm following radiation therapy for head and neck cancer

    International Nuclear Information System (INIS)

    This retrospective analysis reports the results of radiotherapy in 8272 patients with cancer who were treated at Tokyo Women's Medical College between 1966 and 1984. One thousand one hundred and four cases were irradiated for head and neck tumor during this period. Twenty-nine of the total number of patients (0.35 %) were found to have second primary malignant neoplasms following radiotherapy according to the criteria of radiation-induced or related cancers. Twenty of these were head and neck tumors with an incidence of 1.81 % among all head and neck cancer patients. If recurrence of highly suspected cases was excluded, the incidence of radiation-induced or -related cancer was 0.18 % among all malignancies and 0.63 % among all head and neck tumors. Cases of multiple primary malignant neoplasm have been increasing in number and second cancer following radiotherapy has gradually become a big problem. However, the mechanisms of cancer etiology on which radiation and many other factors have an influence are not clear at this time, as there are many risks to human life. It is important not to underestimate the value of radiotherapy in cancer treatment today. (author)

  13. The Cancer Stem Cell Concept in Progression of Head and Neck Cancer

    OpenAIRE

    Zhuo Chen

    2009-01-01

    Human head and neck cancer (HNC) is a highly heterogeneous disease. Understanding the biology of HNC progression is necessary for the development of novel approaches to its prevention, early detection, and treatment. A current evolutional progression model has limitations in explaining the heterogeneity observed in a single tumor nest. Accumulating evidence supports the existence of cancer stem cells (CSCs) as small subpopulations in solid tumors, including HNC. These CSCs can be selected by ...

  14. In vitro chemosensitivity of head and neck cancer cell lines

    Directory of Open Access Journals (Sweden)

    Schuler PJ

    2010-08-01

    Full Text Available Abstract Background Systemic treatment of head and neck squamous cell carcinoma (HNSCC includes a variety of antineoplastic drugs. However, drug-resistance interferes with the effectiveness of chemotherapy. Preclinical testing models are needed in order to develop approaches to overcome chemoresistance. Methods Ten human cell lines were obtained from HNSCC, including one with experimentally-induced cisplatin resistance. Inhibition of cell growth by seven chemotherapeutic agents (cisplatin, carboplatin, 5- fluorouracil, methotrexate, bleomycin, vincristin, and paclitaxel was measured using metabolic MTT-uptake assay and correlated to clinically-achievable plasma concentrations. Results All drugs inhibited cell growth in a concentration-dependent manner with an IC50 comparable to that achievable in vivo. However, response curves for methotrexate were unsatisfactory and for paclitaxel, the solubilizer cremophor EL was toxic. Cross-resistance was observed between cisplatin and carboplatin. Conclusion Chemosensitivity of HNSCC cell lines can be determined using the MTT-uptake assay. For DNA-interfering cytostatics and vinca alkaloids this is a simple and reproducible procedure. Determined in vitro chemosensitivity serves as a baseline for further experimental approaches aiming to modulate chemoresistance in HNSCC with potential clinical significance.

  15. Fractionation and delivery schedules in combined radiotherapy-cisplatin for head and neck cancer

    International Nuclear Information System (INIS)

    Full text: Since Rosenberg's initial discovery, cisplatin has become one of the most effective anticancer drugs, with particular significance in head and neck cancer. For advanced disease, where the tumour is unresectable, radiotherapy and chemotherapy, either singularly or combined, remain the possible therapeutic modalities. The majority of the trials using a combination of cisplatin and radiation obtained much better results than the single-agent trials. But the best schedule, dosage and timing between radiation and drug administration are still unknown. Many positive steps were however made to eliminate the cisplatin-produced side effects, as much as possible. The tendency in current trials is to fractionate the drug dose by daily administration and also to hyperfractionate the radiation. In this way the long-term benefits are improved and the toxicity is better tolerated

  16. Characterization of HPV and host genome interactions in primary head and neck cancers

    Science.gov (United States)

    Parfenov, Michael; Pedamallu, Chandra Sekhar; Gehlenborg, Nils; Freeman, Samuel S.; Danilova, Ludmila; Bristow, Christopher A.; Lee, Semin; Hadjipanayis, Angela G.; Ivanova, Elena V.; Wilkerson, Matthew D.; Protopopov, Alexei; Yang, Lixing; Seth, Sahil; Song, Xingzhi; Tang, Jiabin; Ren, Xiaojia; Zhang, Jianhua; Pantazi, Angeliki; Santoso, Netty; Xu, Andrew W.; Mahadeshwar, Harshad; Wheeler, David A.; Haddad, Robert I.; Jung, Joonil; Ojesina, Akinyemi I.; Issaeva, Natalia; Yarbrough, Wendell G.; Hayes, D. Neil; Grandis, Jennifer R.; El-Naggar, Adel K.; Meyerson, Matthew; Park, Peter J.; Chin, Lynda; Seidman, J. G.; Hammerman, Peter S.; Kucherlapati, Raju; Ally, Adrian; Balasundaram, Miruna; Birol, Inanc; Bowlby, Reanne; Butterfield, Yaron S.N.; Carlsen, Rebecca; Cheng, Dean; Chu, Andy; Dhalla, Noreen; Guin, Ranabir; Holt, Robert A.; Jones, Steven J.M.; Lee, Darlene; Li, Haiyan I.; Marra, Marco A.; Mayo, Michael; Moore, Richard A.; Mungall, Andrew J.; Robertson, A. Gordon; Schein, Jacqueline E.; Sipahimalani, Payal; Tam, Angela; Thiessen, Nina; Wong, Tina; Protopopov, Alexei; Santoso, Netty; Lee, Semin; Parfenov, Michael; Zhang, Jianhua; Mahadeshwar, Harshad S.; Tang, Jiabin; Ren, Xiaojia; Seth, Sahil; Haseley, Psalm; Zeng, Dong; Yang, Lixing; Xu, Andrew W.; Song, Xingzhi; Pantazi, Angeliki; Bristow, Christopher; Hadjipanayis, Angela; Seidman, Jonathan; Chin, Lynda; Park, Peter J.; Kucherlapati, Raju; Akbani, Rehan; Casasent, Tod; Liu, Wenbin; Lu, Yiling; Mills, Gordon; Motter, Thomas; Weinstein, John; Diao, Lixia; Wang, Jing; Fan, You Hong; Liu, Jinze; Wang, Kai; Auman, J. Todd; Balu, Saianand; Bodenheimer, Tom; Buda, Elizabeth; Hayes, D. Neil; Hoadley, Katherine A.; Hoyle, Alan P.; Jefferys, Stuart R.; Jones, Corbin D.; Kimes, Patrick K.; Marron, J.S.; Meng, Shaowu; Mieczkowski, Piotr A.; Mose, Lisle E.; Parker, Joel S.; Perou, Charles M.; Prins, Jan F.; Roach, Jeffrey; Shi, Yan; Simons, Janae V.; Singh, Darshan; Soloway, Mathew G.; Tan, Donghui; Veluvolu, Umadevi; Walter, Vonn; Waring, Scot; Wilkerson, Matthew D.; Wu, Junyuan; Zhao, Ni; Cherniack, Andrew D.; Hammerman, Peter S.; Tward, Aaron D.; Pedamallu, Chandra Sekhar; Saksena, Gordon; Jung, Joonil; Ojesina, Akinyemi I.; Carter, Scott L.; Zack, Travis I.; Schumacher, Steven E.; Beroukhim, Rameen; Freeman, Samuel S.; Meyerson, Matthew; Cho, Juok; Chin, Lynda; Getz, Gad; Noble, Michael S.; DiCara, Daniel; Zhang, Hailei; Heiman, David I.; Gehlenborg, Nils; Voet, Doug; Lin, Pei; Frazer, Scott; Stojanov, Petar; Liu, Yingchun; Zou, Lihua; Kim, Jaegil; Lawrence, Michael S.; Sougnez, Carrie; Lichtenstein, Lee; Cibulskis, Kristian; Lander, Eric; Gabriel, Stacey B.; Muzny, Donna; Doddapaneni, HarshaVardhan; Kovar, Christie; Reid, Jeff; Morton, Donna; Han, Yi; Hale, Walker; Chao, Hsu; Chang, Kyle; Drummond, Jennifer A.; Gibbs, Richard A.; Kakkar, Nipun; Wheeler, David; Xi, Liu; Ciriello, Giovanni; Ladanyi, Marc; Lee, William; Ramirez, Ricardo; Sander, Chris; Shen, Ronglai; Sinha, Rileen; Weinhold, Nils; Taylor, Barry S.; Aksoy, B. Arman; Dresdner, Gideon; Gao, Jianjiong; Gross, Benjamin; Jacobsen, Anders; Reva, Boris; Schultz, Nikolaus; Sumer, S. Onur; Sun, Yichao; Chan, Timothy; Morris, Luc; Stuart, Joshua; Benz, Stephen; Ng, Sam; Benz, Christopher; Yau, Christina; Baylin, Stephen B.; Cope, Leslie; Danilova, Ludmila; Herman, James G.; Bootwalla, Moiz; Maglinte, Dennis T.; Laird, Peter W.; Triche, Timothy; Weisenberger, Daniel J.; Van Den Berg, David J.; Agrawal, Nishant; Bishop, Justin; Boutros, Paul C.; Bruce, Jeff P; Byers, Lauren Averett; Califano, Joseph; Carey, Thomas E.; Chen, Zhong; Cheng, Hui; Chiosea, Simion I.; Cohen, Ezra; Diergaarde, Brenda; Egloff, Ann Marie; El-Naggar, Adel K.; Ferris, Robert L.; Frederick, Mitchell J.; Grandis, Jennifer R.; Guo, Yan; Haddad, Robert I.; Hammerman, Peter S.; Harris, Thomas; Hayes, D. Neil; Hui, Angela BY; Lee, J. Jack; Lippman, Scott M.; Liu, Fei-Fei; McHugh, Jonathan B.; Myers, Jeff; Ng, Patrick Kwok Shing; Perez-Ordonez, Bayardo; Pickering, Curtis R.; Prystowsky, Michael; Romkes, Marjorie; Saleh, Anthony D.; Sartor, Maureen A.; Seethala, Raja; Seiwert, Tanguy Y.; Si, Han; Tward, Aaron D.; Van Waes, Carter; Waggott, Daryl M.; Wiznerowicz, Maciej; Yarbrough, Wendell; Zhang, Jiexin; Zuo, Zhixiang; Burnett, Ken; Crain, Daniel; Gardner, Johanna; Lau, Kevin; Mallery, David; Morris, Scott; Paulauskis, Joseph; Penny, Robert; Shelton, Candance; Shelton, Troy; Sherman, Mark; Yena, Peggy; Black, Aaron D.; Bowen, Jay; Frick, Jessica; Gastier-Foster, Julie M.; Harper, Hollie A.; Lichtenberg, Tara M.; Ramirez, Nilsa C.; Wise, Lisa; Zmuda, Erik; Baboud, Julien; Jensen, Mark A.; Kahn, Ari B.; Pihl, Todd D.; Pot, David A.; Srinivasan, Deepak; Walton, Jessica S.; Wan, Yunhu; Burton, Robert; Davidsen, Tanja; Demchok, John A.; Eley, Greg; Ferguson, Martin L.; Shaw, Kenna R. Mills; Ozenberger, Bradley A.; Sheth, Margi; Sofia, Heidi J.; Tarnuzzer, Roy; Wang, Zhining; Yang, Liming; Zenklusen, Jean Claude; Saller, Charles; Tarvin, Katherine; Chen, Chu; Bollag, Roni; Weinberger, Paul; Golusiński, Wojciech; Golusiński, Paweł; Ibbs, Matthiew; Korski, Konstanty; Mackiewicz, Andrzej; Suchorska, Wiktoria; Szybiak, Bartosz; Wiznerowicz, Maciej; Burnett, Ken; Curley, Erin; Gardner, Johanna; Mallery, David; Penny, Robert; Shelton, Troy; Yena, Peggy; Beard, Christina; Mitchell, Colleen; Sandusky, George; Agrawal, Nishant; Ahn, Julie; Bishop, Justin; Califano, Joseph; Khan, Zubair; Bruce, Jeff P; Hui, Angela BY; Irish, Jonathan; Liu, Fei-Fei; Perez-Ordonez, Bayardo; Waldron, John; Boutros, Paul C.; Waggott, Daryl M.; Myers, Jeff; Lippman, Scott M.; Egea, Sophie; Gomez-Fernandez, Carmen; Herbert, Lynn; Bradford, Carol R.; Carey, Thomas E.; Chepeha, Douglas B.; Haddad, Andrea S.; Jones, Tamara R.; Komarck, Christine M.; Malakh, Mayya; McHugh, Jonathan B.; Moyer, Jeffrey S.; Nguyen, Ariane; Peterson, Lisa A.; Prince, Mark E.; Rozek, Laura S.; Sartor, Maureen A.; Taylor, Evan G.; Walline, Heather M.; Wolf, Gregory T.; Boice, Lori; Chera, Bhishamjit S.; Funkhouser, William K.; Gulley, Margaret L.; Hackman, Trevor G.; Hayes, D. Neil; Hayward, Michele C.; Huang, Mei; Rathmell, W. Kimryn; Salazar, Ashley H.; Shockley, William W.; Shores, Carol G.; Thorne, Leigh; Weissler, Mark C.; Wrenn, Sylvia; Zanation, Adam M.; Chiosea, Simion I.; Diergaarde, Brenda; Egloff, Ann Marie; Ferris, Robert L.; Romkes, Marjorie; Seethala, Raja; Brown, Brandee T.; Guo, Yan; Pham, Michelle; Yarbrough, Wendell G.

    2014-01-01

    Previous studies have established that a subset of head and neck tumors contains human papillomavirus (HPV) sequences and that HPV-driven head and neck cancers display distinct biological and clinical features. HPV is known to drive cancer by the actions of the E6 and E7 oncoproteins, but the molecular architecture of HPV infection and its interaction with the host genome in head and neck cancers have not been comprehensively described. We profiled a cohort of 279 head and neck cancers with next generation RNA and DNA sequencing and show that 35 (12.5%) tumors displayed evidence of high-risk HPV types 16, 33, or 35. Twenty-five cases had integration of the viral genome into one or more locations in the human genome with statistical enrichment for genic regions. Integrations had a marked impact on the human genome and were associated with alterations in DNA copy number, mRNA transcript abundance and splicing, and both inter- and intrachromosomal rearrangements. Many of these events involved genes with documented roles in cancer. Cancers with integrated vs. nonintegrated HPV displayed different patterns of DNA methylation and both human and viral gene expressions. Together, these data provide insight into the mechanisms by which HPV interacts with the human genome beyond expression of viral oncoproteins and suggest that specific integration events are an integral component of viral oncogenesis. PMID:25313082

  17. ICF Core Set for Head and Neck Cancer: Do the Categories Discriminate Among Clinically Relevant Subgroups of Patients?

    Science.gov (United States)

    Tschiesner, Uta; Oberhauser, Cornelia; Cieza, Alarcos

    2011-01-01

    The multidisciplinary assessment of functioning in patients with head and neck cancer (HNC) according to the "ICF Core Set for Head and Neck Cancer" (ICF-HNC) was developed in an international and multi-disciplinary approach. The ICF-HNC is an application of the ICF that was adopted by the World Health Organization. The objective of this study was…

  18. Critical weight loss in head and neck cancer - prevalence and risk factors at diagnosis : an explorative study

    NARCIS (Netherlands)

    Jager-Wittenaar, H.; Dijkstra, P.U.; Vissink, A.; van der Laan, B.F.A.M.; van Oort, R.P.; Roodenburg, J.L.N.

    2007-01-01

    Goals of work Critical weight loss (>= 5% in 1 month or >= 10% in 6 months) is a common phenomenon in head and neck cancer patients. It is unknown which complaints are most strongly related to critical weight loss in head and neck cancer patients at the time of diagnosis. The aim of this explorative

  19. L-glutamine decreases the severity of mucositis induced by chemoradiotherapy in patients with locally advanced head and neck cancer: A double-blind, randomized, placebo-controlled trial

    OpenAIRE

    TSUJIMOTO, TAKAE; Yamamoto, Yoshifumi; WASA, MASAFUMI; Takenaka, Yukinori; Nakahara, Susumu; TAKAGI, TASTUYA; TSUGANE, MAMIKO; Hayashi, Noriyuki; Maeda, Kazuhisa; Inohara, Hidenori; Uejima, Etsuko; Ito, Toshinori

    2014-01-01

    The incidence of severe mucositis in the oral cavity, pharynx and larynx is high among patients with head and neck cancer (HNC) receiving chemoradiotherapy (CRT), resulting in significant pain and impairment of quality of life. The present study investigated whether L-glutamine (glutamine) decreases the severity of mucositis in the oral cavity, pharynx and larynx induced by CRT. This double-blind, randomized, placebo-controlled trial included 40 untreated patients with squamous cell carcinoma...

  20. Differential Diagnosis of Pulmonary Carcinoma Following Head and Neck Cancer by Genetic Analysis

    NARCIS (Netherlands)

    T.W. Geurts; M.L.F. van Velthuysen; F. Broekman; T. Hooft van Huysduynen; M.W.M. van den Brekel; N. van Zandwijk; H. van Tinteren; P. Nederlof; A.J.M. Balm; R.H. Brakenhoff

    2009-01-01

    Purpose: Patients with head and neck cancer often develop a lung tumor that can be diagnosed as distant metastasis (DM) or second primary tumor (SPT). In this study, we use TP53 mutation analysis for validation of an allelic loss marker panel and a decision algorithm for distinguishing between DM an

  1. Radiation dose, driving performance, and cognitive function in patients with head and neck cancer

    International Nuclear Information System (INIS)

    Seven head and neck cancer patients participated in a driving evaluation in a driving simulator. Radiation dose on the temporal lobes was moderately associated with time to complete a cognitive test and with driving performance. Results indicated that incidental irradiation may contribute to a decrease in cognition and in unsafe driving performance, which seems to be time-dependent

  2. Justification of routine WB FDG PET with dual phase contrast CT in head and neck cancers

    International Nuclear Information System (INIS)

    The aim of the study is to demonstrate the justification of routine WB FDG positron emission tomograph (PET) with dual phase contrast CT and to know the significant contribution of them to evaluate in all stage of the primary head and neck cancers (HNC)

  3. Quality of life related to oral function in edentulous head and neck cancer patients posttreatment

    NARCIS (Netherlands)

    Schoen, Pieter J.; Reintsema, Harry; Bouma, Jelte; Roodenburg, Jan L. N.; Vissink, Arjan; Raghoebar, Gerry M.

    2007-01-01

    Purpose: Surgical treatment of malignancies in the oral cavity and subsequent radiotherapy often result in an oral condition unfavorable for prosthodontic rehabilitation. This study assessed the quality of life related to oral function in edentulous head and neck cancer patients following oncology t

  4. Expression profiling in head and neck cancer: Predicting response to chemoradiation

    OpenAIRE

    Pramana, J.

    2014-01-01

    The goal of this thesis was to find biomarkers through gene expression profiling, using microarray techniques, which can predict outcome after concurrent chemoradiation in head and neck cancer. The main endpoints for outcome were local control, locoregional control and disease free survival.

  5. A case of septic-shock-induced bacterial translocation during chemoradiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Combination therapy such as chemotherapy and radiotherapy is often used for head and neck cancer to maintain potency, but may trigger undesirable adverse effects. A 60-year-old man suddenly developing shock and multiple organ failure during chemoradiotherapy for hypopharyngeal carcinoma required intensive treatment. Bacterial translocation was thought to have caused shock. We discuss clinical features and the diagnostic process. (author)

  6. TheraBite exercises to treat trismus secondary to head and neck cancer

    NARCIS (Netherlands)

    Kamstra, Jolanda I.; Roodenburg, Jan L. N.; Beurskens, Carien H. G.; Reintsema, Harry; Dijkstra, Pieter U.

    2013-01-01

    The aim of this study was to evaluate the effect of TheraBite exercises on mouth opening and to analyze factors influencing this effect in a patient record evaluation. Effect of exercises with a TheraBite to treat trismus was evaluated in 69 head and neck cancer patients of two university medical ce

  7. Multidisciplinary teamwork in the treatment and rehabilitation of the head and neck cancer patient.

    Science.gov (United States)

    King, G E; Lemon, J C; Martin, J W

    1992-06-01

    The advantages of multidisciplinary treatment planning of head and neck cancer patients is described. Planning rehabilitation concurrently with curing the malignancy results in the most effective application of treatment modalities coordinated with rehabilitative care. Concentrated multidisciplinary treatment reduces post treatment morbidity by shortening recovery and rehabilitation time. PMID:1631776

  8. Concomitant radiotherapy and chemotherapy in head and neck cancer - theoretical rationale and clinical experience

    International Nuclear Information System (INIS)

    Concomitant radiotherapy and chemotherapy in head and neck cancer aims at an interaction between the two modalities which results in improved therapeutic index. Several mechanisms by which this benefit can be achieved are presented. Reviewed are also conclusive randomized trials in which this option has been compared with radiotherapy alone as well as the reasons for difficulties in interpretation of clinical results. (author)

  9. Complementary medicine use in patients with head and neck cancer in Ireland.

    LENUS (Irish Health Repository)

    Amin, Mohamed

    2010-08-01

    The objectives of the study were: first, to determine the prevalence of traditional medicine (TM) and complementary and alternative medicine (CAM) use in head and neck cancer patients in Ireland; second, to educate ourselves on the plethora of CAM\\/TM options available to patients outside the dominion of conventional medicine. The study design consisted of a cross-sectional survey carried out in three head and neck cancer centres. Self-administered questionnaires were distributed to 110 head and neck cancer patients attending the three cancer centres and data were collected for statistical analysis. A total of 106 patients completed the questionnaire; 21.7% of the participants used CAM\\/TM since their diagnosis with head and neck cancer. CAM\\/TM usage was higher in female (34.3%) than in male patients (16.2%). CAM\\/TM use was more common in the 41-50-year age group, in patients with higher educational levels and those holding strong religious beliefs, and also in married than single patients. The most common types of CAM\\/TM used were spiritual and laying on of hands. The most common reasons reported for using CAM\\/TM were to counteract the ill effects of treatment and increase the body\\'s ability to fight cancer. Sources of information on CAM\\/TM were friends (65%), family (48%) and media (21%). This survey reveals a high prevalence of CAM\\/TM use in head and neck cancer patients, hence emphasising the need for otolaryngologists to educate themselves on the various therapies available to be able to provide informative advice. There is an urgent need for evidence-based investigation of various CAM\\/TM therapies currently offered to patients.

  10. Stereotactic Body Radiotherapy as Primary Treatment for Elderly Patients with Medically-Inoperable Head-and-Neck Cancer

    Directory of Open Access Journals (Sweden)

    DwightEHeron

    2014-08-01

    Full Text Available Purpose: With a growing elderly population, elderly patients with head-and-neck cancers represent an increasing challenge with limited prospective data to guide management. The complex interplay between advanced age, associated comorbidities, and conventional local therapies such as surgery and external beam radiotherapy ± chemotherapy, can significantly impact elderly patients’ quality-of-life (QOL. SBRT is a well-established curative strategy for medical-inoperable early-stage lung cancers even in elderly populations; however there is limited data examining SBRT as primary therapy in head-and-neck cancer. Material/Methods: Twelve patients with medically-inoperable head-and-neck cancer treated with SBRT ± cetuximab from 2002 through 2013 were retrospectively reviewed. SBRT consisted of primarily 44Gy in 5 fractions delivered on alternating days over 1-2 weeks. Concurrent cetuximab was administer at a dose of 400mg/m2 on day -7 followed by 250mg/m2 on day 0 and +7 in n=3 (25%. Patient reported quality-of-life (PRQoL was prospectively recorded using the previously-validated University-of-Washington Quality-of-Life Revised (UW-QoL-R. Results: Median clinical follow-up was 6-months (range: 0.5 – 29 months. The 1-year actuarial local progression-free survival, distant progression-free survival, progression-free survival, and overall survival for definitively treated patients were 69%, 100%, 69% and 64%, respectively. One patient (8% experienced acute grade 3 dysphagia and one patient (8% experienced late grade 3 mucositis; there were no grade 4-5 toxicities. Prospective collection of patient report quality-of-life as assessed by UW-QoL-R was preserved across domains. Conclusion: SBRT shows encouraging survival and relatively low toxicity in elderly patients with unresectable head-and-neck cancer; which may provide an aggressive potentially curative local therapy while maintaining quality-of-life.

  11. Dental problems of the patients with head and neck cancer after radiation therapy

    International Nuclear Information System (INIS)

    The purpose of this study is to demonstrate dental problems such as changes of saliva flow rates (ml/min), taste sensation and DMF-teeth (D: decay, M: missing, F: filling) after radiation therapy for the patients with head and neck cancer. Between January 1990 and April 1995, a total of 56 patients with head and neck cancer after radiation therapy was reviewed to demonstrate dental problems at the Department of Oral Radiology, Osaka Dental University Hospital. The results were as follows. In the case of 7 inpatients with head and neck cancer (nasopharynx: 3, mouth floor: 2, tongue: 2), non-stimulating saliva flow rates for 5 minutes was nearly equal to 0 ml at the level of 60 Gy/6 weeks to 80 Gy/8 weeks. In the scoring system of the taste sensation after radiation therapy for 23 patients with oral cancer (tongue: 18, mouth floor: 5), distribution of the patients with 3 points (3 points stand for patients feel good as well as pretreatment) was 91% for sweetness, 78% for sharpness, 96% for bitterness and 96% for acidity, respectively. Concerning DMF-teeth after radiation therapy for 26 patients with head and neck cancer (nasopharynx: 10, oropharynx: 8, tongue: 8), changes of DMF-Teeth of the group of nasopharynx and oropharynx was more higher than that of the group of tongue comparing to report on the survey of dental diseases in Japan, 1993 as control. We emphasize that these data are more effective to improve their oral environments and to up their recognition for oral cavity in the patients with head and neck cancer pre or post-irradiation. (author)

  12. Anticancer activity of drug conjugates in head and neck cancer cells.

    Science.gov (United States)

    Majumdar, Debatosh; Rahman, Mohammad Aminur; Chen, Zhuo Georgia; Shin, Dong M

    2016-01-01

    Sexually transmitted oral cancer/head and neck cancer is increasing rapidly. Human papilloma virus (HPV) is playing a role in the pathogenesis of a subset of squamous cell carcinoma of head and neck (SCCHN). Paclitaxel is a widely used anticancer drug for breast, ovarian, testicular, cervical, non-small cell lung, head and neck cancer. However, it is water insoluble and orally inactive. We report the synthesis of water soluble nanosize conjugates of paclitaxel, branched PEG, and EGFR-targeting peptide by employing native chemical ligation. We performed a native chemical ligation between the N-hydroxy succinimide (NHS) ester of paclitaxel succinate and cysteine at pH 6.5 to give the cysteine-conjugated paclitaxel derivative. The thiol functionality of cysteine was activated and subsequently conjugated to multiarm thiol-PEG to obtain the paclitaxel branched PEG conjugate. Finally, we conjugated an EGFR-targeting peptide to obtain conjugates of paclitaxel, branched PEG, and EGFR-targeting peptide. These conjugates show anticancer activity against squamous cell carcinoma of head and neck cells (SCCHN, Tu212). PMID:27100344

  13. Treatment, patient and tumor characteristics impact quality of life (QOL) in patients with locally advanced head and neck cancer: Report of the radiation therapy oncology group (RTOG) trial 90-03

    International Nuclear Information System (INIS)

    Purpose: To determine factors that effect QOL in patients with locally advanced squamous cell cancer of the head and neck randomized to standard fractionation radiotherapy (SFX), hyperfractionation (HFX), Accelerated Fractionation with Split (AFX-S) and Accelerated Fractionation with Concomitant Boost (AFX-C). Materials and Methods: RTOG 90-03 used the Head and Neck Performance Status Scale (HNPSS) and the Functional Assessment of Cancer Therapy (FACT-H and N), version 2 to assess QOL. The HNPSS has three components Normalcy of Diet, Eating in Public, and Understandability of Speech. The FACT-H and N has two components: a global QOL questionnaire (FACT-G) consisting of 4 domains; Physical Well Being (PWB), Social Well Being (SWB), Emotional Well Being (EWB), Functional Well Being (FWB), and an additional H and N specific questionnaire (AC). Between 3/92 and 8/97, 1113 pts. were randomized; 718 completed a pretreatment FACT-H and N. Pts. completed the HNPSS and FACT-H and N; pretreatment, 4 weeks post-RT, every 3 months for 1 year. Results: Prior to the start of radiotherapy (RT) 48% of pts had normal diets, 64% had normal public eating, and 77% had normal speech. Age (60), KPS, tumor site (oral cavity vs. other), T-stage (T3+T4 vs. T1+T2+TX), N-stage (N0 vs. other), Race (Non-White vs. White), and marital status (single vs. married), FACT-G, PWB, EWB, FWB, AC, use of oral nutrient supplements, feeding tube, and parenteral nutrition predicted for pretreatment diet, public eating, and speech. During the acute toxicity phase diet, eating, and speech were related to the intensity of RT (HFX or AFX-C), marital status (single), tumor site (oral cavity), use of oral nutrient supplements, and feeding tube. At one-year oral cavity tumors, AFX-C, oral nutrient supplements, feeding tube, and single patients had worse diet, eating, and speech. Conclusion: Pretreatment patient and tumor characteristics impact on QOL prior to the initiation of therapy. Intensification of

  14. Referral pattern for neoadjuvant chemotherapy in the head and neck cancers in a tertiary care center

    OpenAIRE

    V M Patil; V Noronha; Joshi, A; V M Krishna; S Dhumal; Chaudhary, V.; Juvekar, S; P S Pai; C Pankaj; Chaukar, D.; A K Dcruz; Prabhash, K

    2014-01-01

    Background: Use of any treatment modality in cancer depends not only on the effectiveness of the modality, but also on other factors such as local expertise, tolerance of the modality, cost and prevalence of the disease. Oropharyngeal and laryngeal cancer are the major subsites in which majority of neoadjuvant chemotherapy (NACT) literature in the head and neck cancers is available. However, oral cancers form a major subsite in India. Materials And Methods: This is an analysis of a prospectiv...

  15. Natural vitamin C intake and the risk of head and neck cancer: A pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.

    Science.gov (United States)

    Edefonti, Valeria; Hashibe, Mia; Parpinel, Maria; Turati, Federica; Serraino, Diego; Matsuo, Keitaro; Olshan, Andrew F; Zevallos, Jose P; Winn, Deborah M; Moysich, Kirsten; Zhang, Zuo-Feng; Morgenstern, Hal; Levi, Fabio; Kelsey, Karl; McClean, Michael; Bosetti, Cristina; Galeone, Carlotta; Schantz, Stimson; Yu, Guo-Pei; Boffetta, Paolo; Amy Lee, Yuan-Chin; Chuang, Shu-Chun; La Vecchia, Carlo; Decarli, Adriano

    2015-07-15

    Evidence of associations between single nutrients and head and neck cancer (HNC) is still more limited and less consistent than that for fruit and vegetables. However, clarification of the protective mechanisms of fruit and vegetables is important to our understanding of HNC etiology. We investigated the association between vitamin C intake from natural sources and cancer of the oral cavity/pharynx and larynx using individual-level pooled data from ten case-control studies (5,959 cases and 12,248 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. After harmonization of study-specific exposure information via the residual method, adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using unconditional multiple logistic regression models on quintile categories of 'non-alcohol energy-adjusted' vitamin C intake. In the presence of heterogeneity of the estimated ORs among studies, we derived those estimates from generalized linear mixed models. Higher intakes of vitamin C were inversely related to oral and pharyngeal (OR = 0.54, 95% CI: 0.45-0.65, for the fifth quintile category versus the first one, p for trendconsistently observed for the anatomical subsites of oral and pharyngeal cancer, and across strata of age, sex, education, body mass index, tobacco, and alcohol, for both cancer sites. The inverse association of vitamin C intake from foods with HNC may reflect a protective effect on these cancers; however, we cannot rule out other explanations. PMID:25627906

  16. Initial adjuvant weekly high dose methotrexate with leucovorin rescue in advanced squamous carcinoma of the head and neck

    International Nuclear Information System (INIS)

    Despite aggressive local therapy, advanced head and neck cancer continues to have a poor prognosis. In an attempt to improve survival in this disease, the Joint Center for Radiation Therapy and the Sidney Farber Cancer Institute instituted a pilot study employing high dose methotrexate with leucovorin rescue (3.5 to 7.5 g/m2) as an adjuvant to aggressive radiotherapy and surgery. A high response rate of 60 percent (9/15) with no compromise of definitive therapy indicates such cooperation multimodality trials may hold promise for an increase in cure rates in these patients

  17. Role of infectious agents in the carcinogenesis of brain and head and neck cancers

    Directory of Open Access Journals (Sweden)

    Alibek Kenneth

    2013-02-01

    Full Text Available Abstract This review concentrates on tumours that are anatomically localised in head and neck regions. Brain cancers and head and neck cancers together account for more than 873,000 cases annually worldwide, with an increasing incidence each year. With poor survival rates at late stages, brain and head and neck cancers represent serious conditions. Carcinogenesis is a multi-step process and the role of infectious agents in this progression has not been fully identified. A major problem with such research is that the role of many infectious agents may be underestimated due to the lack of or inconsistency in experimental data obtained globally. In the case of brain cancer, no infection has been accepted as directly oncogenic, although a number of viruses and parasites are associated with the malignancy. Our analysis of the literature showed the presence of human cytomegalovirus (HCMV in distinct types of brain tumour, namely glioblastoma multiforme (GBM and medulloblastoma. In particular, there are reports of viral protein in up to 100% of GBM specimens. Several epidemiological studies reported associations of brain cancer and toxoplasmosis seropositivity. In head and neck cancers, there is a distinct correlation between Epstein-Barr virus (EBV and nasopharyngeal carcinoma (NPC. Considering that almost every undifferentiated NPC is EBV-positive, virus titer levels can be measured to screen high-risk populations. In addition there is an apparent association between human papilloma virus (HPV and head and neck squamous cell carcinoma (HNSCC; specifically, 26% of HNSCCs are positive for HPV. HPV type 16 was the most common type detected in HNSCCs (90% and its dominance is even greater than that reported in cervical carcinoma. Although there are many studies showing an association of infectious agents with cancer, with various levels of involvement and either a direct or indirect causative effect, there is a scarcity of articles covering the role of

  18. Feasibility of Primary Tumor Culture Models and Preclinical Prediction Assays for Head and Neck Cancer: A Narrative Review

    International Nuclear Information System (INIS)

    Primary human tumor culture models allow for individualized drug sensitivity testing and are therefore a promising technique to achieve personalized treatment for cancer patients. This would especially be of interest for patients with advanced stage head and neck cancer. They are extensively treated with surgery, usually in combination with high-dose cisplatin chemoradiation. However, adding cisplatin to radiotherapy is associated with an increase in severe acute toxicity, while conferring only a minor overall survival benefit. Hence, there is a strong need for a preclinical model to identify patients that will respond to the intended treatment regimen and to test novel drugs. One of such models is the technique of culturing primary human tumor tissue. This review discusses the feasibility and success rate of existing primary head and neck tumor culturing techniques and their corresponding chemo- and radiosensitivity assays. A comprehensive literature search was performed and success factors for culturing in vitro are debated, together with the actual value of these models as preclinical prediction assay for individual patients. With this review, we aim to fill a gap in the understanding of primary culture models from head and neck tumors, with potential importance for other tumor types as well

  19. Feasibility of Primary Tumor Culture Models and Preclinical Prediction Assays for Head and Neck Cancer: A Narrative Review

    Energy Technology Data Exchange (ETDEWEB)

    Dohmen, Amy J. C., E-mail: a.dohmen@nki.nl [Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX (Netherlands); Department of Cell Biology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX (Netherlands); Swartz, Justin E. [Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3508 GA (Netherlands); Van Den Brekel, Michiel W. M. [Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX (Netherlands); Willems, Stefan M. [Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3508 GA (Netherlands); Spijker, René [Medical library, Academic Medical Center, Amsterdam 1100 DE (Netherlands); Dutch Cochrane Centre, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3508 GA (Netherlands); Neefjes, Jacques [Department of Cell Biology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX (Netherlands); Zuur, Charlotte L. [Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX (Netherlands)

    2015-08-28

    Primary human tumor culture models allow for individualized drug sensitivity testing and are therefore a promising technique to achieve personalized treatment for cancer patients. This would especially be of interest for patients with advanced stage head and neck cancer. They are extensively treated with surgery, usually in combination with high-dose cisplatin chemoradiation. However, adding cisplatin to radiotherapy is associated with an increase in severe acute toxicity, while conferring only a minor overall survival benefit. Hence, there is a strong need for a preclinical model to identify patients that will respond to the intended treatment regimen and to test novel drugs. One of such models is the technique of culturing primary human tumor tissue. This review discusses the feasibility and success rate of existing primary head and neck tumor culturing techniques and their corresponding chemo- and radiosensitivity assays. A comprehensive literature search was performed and success factors for culturing in vitro are debated, together with the actual value of these models as preclinical prediction assay for individual patients. With this review, we aim to fill a gap in the understanding of primary culture models from head and neck tumors, with potential importance for other tumor types as well.

  20. The past and future impact of next-generation sequencing in head and neck cancer

    OpenAIRE

    N. Sethi; MacLennan, K; Wood, HM; Rabbitts, P

    2016-01-01

    Progress in sequencing technology is intrinsically linked to progress in understand cancer genomics. This review aims to discuss the development from Sanger sequencing to next generation sequencing (NGS) technology. We highlight the technical considerations for understanding reports using NGS. We discuss the findings of studies in head and neck cancer using NGS as well as the Cancer Genome Atlas. Finally we discuss future routes for research utilising this methodology and the potential impact...

  1. Morphine mouthwash for the management of oral mucositis in patients with head and neck cancer

    OpenAIRE

    Mostafa Sarvizadeh; Simin Hemati; Mohsen Meidani; Moghtada Ashouri; Mahnaz Roayaei; Armindokht Shahsanai

    2015-01-01

    Background: Oral mucositis is a debilitating side effect of cancer treatment for which there is not much successful treatments at yet. We evaluated the effectiveness of topical morphine compared with a routine mouthwash in managing cancer treatment-induced mucositis. Materials and Methods: Thirty head and neck cancer patients with severe mucositis (World Health Organization Grade III or IV) were randomized into the morphine and magic mouthwash groups. Patients received morphine sulfate 2%...

  2. Integrating genomics in head and neck cancer treatment: Promises and pitfalls.

    Science.gov (United States)

    Thariat, Juliette; Vignot, Stéphane; Lapierre, Ariane; Falk, Alexander T; Guigay, Joel; Van Obberghen-Schilling, Ellen; Milano, Gerard

    2015-09-01

    Head and neck squamous cell carcinomas (HNSCC) represent a multifactorial disease of poor prognosis. They have lagged behind other cancers in terms of personalized therapy. With expansion and high throughput sequencing methods, recent landmark exonic studies and Cancer Genome Atlas data have identified genes relevant to carcinogenesis and cancer progression. Mutational profiles and rates vary widely depending on exposure to carcinogens, anatomic subsites and human papilloma virus (HPV) infection. Tumors may exhibit specific, tissue-specific, not exclusively HPV-related, gene alterations, such those observed in oral cavity cancers in Asia or Occident. Except for the PI3K pathway, the rate of mutations in HPV+ cancers is much lower than in tobacco/alcohol-related cancers. Somatic driver mutation analyses show that relatively few driver genes are druggable in HNSCC and that tumor suppressor gene alterations prevail. More mature for therapeutic applications is the oncogenic PI3K pathway, with preclinical human xenograft models suggesting that PI3KCA pathway mutations may be used as predictive biomarkers and clinical data showing efficacy of mTOR/Akt inhibitors. Therapeutic guidance, to date, relies on classical histoprognostic factors, anatomic subsite and HPV status, with integration of hierarchized supervised mutational profiling to provide additional therapeutic options in advanced HNSCC in a near future. Unsupervised controlled genomic analyses remain necessary to unravel potentially relevant genes. PMID:25979769

  3. Usefulness of C-arm CT during superselective infusion chemotherapy for advanced head and neck carcinoma

    International Nuclear Information System (INIS)

    To evaluate the usefulness of C-arm computed tomography (CT) during superselective intra-arterial infusion chemotherapy for advanced head and neck carcinoma. C-arm CT was performed during superselective intra-arterial infusion chemotherapy for 11 patients with advanced head and neck carcinoma located in the hypopharynx (n = 3), maxillary sinus (n = 3), oropharynx (n = 1), larynx (n = 1), extra-auditory canal (n = 1), tonsil (n = 1) and tongue (n = 1). The usefulness of C-arm CT during superselective catheterisation was evaluated. On arteriography, nine tumours showed tumour stains and two in the oropharynx or tonsil showed no obvious tumour stains. C-arm CT was performed one to four times (mean ± standard deviation, 2.5 ± 0.8) in each patient during a single procedure. C-arm CT clearly showed not only the vascular territory of the selected branch but also the tumour itself in all patients. Intra-arterial infusion chemotherapy was performed through one to three branches (mean, 1.7 ± 0.9) according to C-arm CT findings without any complications. C-arm CT during superselective intra-arterial infusion chemotherapy was useful to determine the arterial supply of head and neck carcinoma. C-arm CT may replace conventional CT during superselective arteriography in this procedure.

  4. Supportive Management of Mucositis and Metabolic Derangements in Head and Neck Cancer Patients

    OpenAIRE

    Marcelo Bonomi; Katharine Batt

    2015-01-01

    Oral mucositis (OM) is among the most undesirable, painful, and expensive toxicities of cytotoxic cancer therapy, and is disheartening for patients and frustrating for caregivers. Accurate assessment of the incidence of OM has been elusive, but accumulating data suggests that reported OM frequency is significantly less than its actual occurrence. It has been suggested that over 90% of head and neck cancer (HNC) patients receiving radiotherapy (RT) with concurrent cisplatin experience severe O...

  5. Dental care during and after radiotherapy in head and neck cancer

    OpenAIRE

    Devi, Seema; Singh, Nimisha

    2014-01-01

    Head and neck cancer is a major health problem. Oral cancer is increasing in Indian subcontinent mainly due to lack of hygiene, tobacco use, chewing tobacco, smoking, and many other factors. Radiation therapy is the most common form of treatment along with surgery and chemotherapy. There are 2 types of complication that occurs during and after radiotherapy, that occur because of effects on normal tissue. Radiotherapy-induced effects occur on the oral mucosa salivary glands, bone, teeth, and m...

  6. RUNX3 Has an Oncogenic Role in Head and Neck Cancer

    OpenAIRE

    Tsunematsu, Takaaki; Kudo, Yasusei; Iizuka, Shinji; Ogawa, Ikuko; Fujita, Tsuyoshi; Kurihara, Hidemi; Abiko, Yoshimitsu; Takata, Takashi

    2009-01-01

    Background Runt-related transcription factor 3 (RUNX3) is a tumor suppressor of cancer and appears to be an important component of the transforming growth factor-beta (TGF-ß)-induced tumor suppression pathway. Surprisingly, we found that RUNX3 expression level in head and neck squamous cell carcinoma (HNSCC) tissues, which is one of the most common types of human cancer, was higher than that in normal tissues by a previously published microarray dataset in our preliminary study. Therefore, he...

  7. Matrix Metalloproteinases: The Gene Expression Signatures of Head and Neck Cancer Progression

    OpenAIRE

    Shinji Iizuka; Naozumi Ishimaru; Yasusei Kudo

    2014-01-01

    Extracellular matrix degradation by matrix metalloproteinases (MMPs) plays a pivotal role in cancer progression by promoting motility, invasion and angiogenesis. Studies have shown that MMP expression is increased in head and neck squamous cell carcinomas (HNSCCs), one of the most common cancers in the world, and contributes to poor outcome. In this review, we examine the expression pattern of MMPs in HNSCC by microarray datasets and summarize the current knowledge of MMPs, specifically MMP-1...

  8. Effects of radiation therapy on T-lymphocyte subpopulations in patients with head and neck cancer

    International Nuclear Information System (INIS)

    Cellular immunity was assessed in 85 patients with head and neck cancer with monoclonal antibodies to lymphocyte surface antigens that identify total T cells, helper cells, and suppressor cells. The control group consisted of 22 healthy volunteers. Nine patients who had surgical procedures for benign diseases were also studied. Compared with the controls, the patients with cancer who received radiation therapy had a significant decrease in total lymphocytes, T cells, helper cells, suppressor cells, and decreased helper/suppressor cell ratio. Significant decreases in lymphocyte subpopulations were not detected in patients tested before treatment or in patients treated with surgery alone. The immune deficits observed were prolonged in duration, with some present in the patients studied up to 11 years after radiation therapy. This long-lasting immune depression may have relevance to tumor recurrences and second primaries in patients with head and neck cancer treated by radiation therapy and to attempts at increasing cure rates with adjuvant agents that improve immune reactivity

  9. Unilateral Cervical Polyneuropathies following Concurrent Bortezomib, Cetuximab, and Radiotherapy for Head and Neck Cancer

    Science.gov (United States)

    Elghouche, Alhasan; Shokri, Tom; Qin, Yewen; Wargo, Susannah; Citrin, Deborah; Van Waes, Carter

    2016-01-01

    We report a constellation of cervical polyneuropathies in a patient treated with concurrent bortezomib, cetuximab, and cisplatin alongside intensity modulated radiotherapy for carcinoma of the tonsil with neck metastasis. The described deficits include brachial plexopathy, cervical sensory neuropathy, and oculosympathetic, recurrent laryngeal, and phrenic nerve palsies within the ipsilateral radiation field. Radiation neuropathy involving the brachial plexus is typically associated with treatment of breast or lung cancer; however, increased awareness of this entity in the context of investigational agents with potential neuropathic effects in head and neck cancer has recently emerged. With this report, we highlight radiation neuropathy in the setting of investigational therapy for head and neck cancer, particularly since these sequelae may present years after therapy and entail significant and often irreversible morbidity. PMID:27088023

  10. Combined radiotherapy with cis- or carboplatin in advanced head and neck tumours

    International Nuclear Information System (INIS)

    This report reviews the treatment results of 111 patients with stage T3-4, N0-3, M0, biopsy proven squamous cell carcinoma of the oropharynx and oral cavity. All patients were treated by primary irradiation with 1.8 to 2 Gy per day for five days a week up to a target volume dose of 39,6 or 40 Gy. Simultaneously 20 mg/m2 cisplatin was given under hyperhydration and mannitol diuresis on days 1 to 5. In case of partial tumour regression radiotherapy was continued up to 70 Gy with another course of cisplatin. In case of minor response surgery was interposed followed by subsequent irradiation with 30 Gy and a second course of cisplatin. 67% of the patients showed an initial complete tumour involution and 27% a partial response. The five year actuarial survival rate with a minimum follow-up of two years is 47,6%. More than 96% of the long term survivors showed a complete response after the end of treatment. Carboplatin (CBDCA) is a second generation platinum analogon and has shown comparable antitumour activity but less nephro- and neurotoxicity than cisplatin in head and neck cancer. In order to determine the feasibility and efficacy of simultaneous application of CBDCA and radiotherapy a phase I-II study is going on. Patients with advanced squamous carcinoma of the head and neck were separated into three groups which received 60 mg/m2, 70 mg/m2 and 80 mg/m2 CBDCA from days 1 to 5 and 28 to 32. Radiotherapy was administrated up to a target absorbed dose of 70 Gy, 5x2 Gy/week in shrinking field technique. The group which received 80 mg/m2 CBDCA reached the myelotoxicity limit so that subsequent patients were treated with 70 mg/m2. Among 30 patients who completed the treatment, 22 showed a complete (CR) and eight a partial remission (PR). (orig./MG)

  11. Advancements in the Management of HPV-Associated Head and Neck Squamous Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Ross Zeitlin

    2015-04-01

    Full Text Available Head and neck carcinomas have long been linked to alcohol and tobacco abuse; however, within the last two decades, the human papillomavirus (HPV has emerged as a third etiology and is specifically associated with head and neck squamous cell carcinomas (HNSCC. In this anatomical region, the oncogenic HPV-16 mediates transformation and immortalization of epithelium, most commonly in the oropharynx. Nevertheless, the recent identification of novel HPV mechanisms thought to be specific to oropharyngeal carcinogenesis has coincided with observations that HPV-associated HNSCC has differing clinical behavior—in terms of natural history, therapeutic response, and prognosis—than HPV-negative head and neck tumors. Taken together with the growing incidence of HPV transmission in younger populations, these discoveries have sparked a rapid expansion in both laboratory and clinical studies on the infection and disease. Herein, we review the clinical characteristics of HPV-associated HNSCC, with particular emphasis on recent advancements in our understanding of the management of this infectious malignancy.

  12. Stepwise Progress in Epidermal Growth Factor Receptor/Radiation Studies for Head and Neck Cancer

    International Nuclear Information System (INIS)

    The U.S. Food and Drug Administration approval of four new epidermal growth factor receptor (EGFR) inhibitors for cancer therapy (cetuximab, panitumumab, gefitinib, and erlotinib) over the last 3 years is a remarkable milestone in oncology. Indeed, molecular inhibition of EGFR signaling represents one of the most promising current arenas for the development of molecular-targeted cancer therapies. Epidermal growth factor receptor inhibitors from both the monoclonal antibody and tyrosine kinase inhibitor class have demonstrated clinical activity in the treatment of a broad spectrum of common human malignancies. For the discipline of radiation oncology, the 2006 report of a phase III trial demonstrating a survival advantage for advanced head and neck cancer patients with the addition of weekly cetuximab during a 7-week course of radiation is particularly gratifying. Indeed, this is the first phase III trial to confirm a survival advantage with the addition of a molecular-targeted agent to radiation. Furthermore, this result seems to have been achieved with only a modest increment in overall treatment toxicity and with very high compliance to the prescribed treatment regimen. Nevertheless, much remains to be learned regarding the rational integration of EGFR inhibitors into cancer treatment regimens, as well as methods to optimize the selection of patients most likely to benefit from EGFR inhibitor strategies

  13. HPV and high-risk gene expression profiles predict response to chemoradiotherapy in head and neck cancer, independent of clinical factors.

    NARCIS (Netherlands)

    Jong, M.C.J. de; Pramana, J.; Knegjens, J.L.; Balm, A.J.; Brekel, M.W. van den; Hauptmann, M.; Begg, A.C.; Rasch, C.R.

    2010-01-01

    PURPOSE: The purpose of this study was to combine gene expression profiles and clinical factors to provide a better prediction model of local control after chemoradiotherapy for advanced head and neck cancer. MATERIAL AND METHODS: Gene expression data were available for a series of 92 advanced stage

  14. Effect of Pretreatment Anemia on Treatment Outcome of Concurrent Radiochemotherapy in Patients With Head and Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: To investigate the effect of anemia on outcome of treatment with radiochemotherapy in patients with head-and-neck cancer. Methods and Materials: The data of 196 patients with Stage II-IV head-and-neck cancer treated with concomitant cisplatin-based radiochemotherapy were retrospectively reviewed. Anemia was defined according to World Health Organization criteria as hemoglobin 140 g/L. Conclusions: Anemia was strongly associated with local control and survival in this cohort of patients with head-and-neck cancer receiving radiochemotherapy

  15. Split-course accelerated therapy in head and neck cancer: an analysis of toxicity

    International Nuclear Information System (INIS)

    Purpose: To retrospectively assess a protocol of split-course accelerated radiation therapy (SCAT) for selected head and neck cancers. Methods and Materials: SCAT consisted of 1.8 Gy per fraction administered twice daily with a minimum gap between fractions of 6 h. The treatment protocol prescribed an initial 16 fractions followed by a planned 5 to 12 day break, and then a further 20 to 22 fractions for a total dose ranging from 64.8 to 72 Gy delivered in 5 to 6 weeks. Results: Twenty-eight patients received SCAT for histologically confirmed head and neck cancer between January 1987 and August 1991. All patients were followed up until December 1, 1993. The mean potential follow-up time was 4.2 years (range: 2.9-6.2 years). All patients completed the treatment protocol. Thirteen tumors were laryngeal in origin, eight hypopharyngeal, four paranasal sinus, and three oropharyngeal. There were no Stage I, three Stage II, nine Stage III, and 12 Stage IV tumors. Four tumors were not staged (two paranasal sinus cancers and two surgical recurrences). Early and late toxicities were moderate to severe. Confluent mucositis was experienced by 27 of the 28 patients (96%). One patient required a prolonged midtreatment break of 24 days. Nine patients (32%) required narcotic analgesia for pain relief. Eleven patients (39%) required hospitalization for nasogastric feeding or pain control. The median length of hospital stay was 14 days (range 7-98 days). The actuarial rate of severe late toxicity at 3 years was 47% (standard error (SE) = 13%). A complete tumor response was achieved in 86% of patients. The actuarial local control rate at 3 years was 43% (SE = 11%) and the actuarial survival rate at 3 years was 25% (SE = 8%). Conclusion: Given the encouraging complete response rate and local control for such advanced tumors, SCAT for locoregionally advanced tumors merits further investigation. However, because of the significant late toxicity observed, the total dose, interfraction

  16. A randomised multicentre trial of CHART versus conventional radiotherapy in head and neck cancer

    International Nuclear Information System (INIS)

    Background and purpose: Continuous, hyperfractionated, accelerated radiotherapy (CHART) has shown promise of improved tumour control and reduced late morbidity in pilot studies and has now been tested in a multicentre randomised controlled clinical trial. Material and methods: Patients with squamous cell cancer in the main sites within the head and neck region with the general exception of early T1 N0 tumours were entered into the study by 11 centres. There was a 3:2 randomisation to either CHART, where a dose of 54 Gy was given in 36 fractions over 12 days, or to conventional therapy where 66 Gy was given in 33 fractions over 6.5 weeks. A total of 918 patients were included over a 5 year period from March 1990. Results: Acute Morbidity: Acute radiation mucositis was more severe with CHART, occurred earlier but settled sooner and was in nearly all cases healed by 8 weeks in both arms. Skin reactions were less severe and settled more quickly in the CHART treated patients. Tumour control and survival: Life table analyses of loco-regional control, primary tumour control, nodal control, disease-free interval, freedom from metastasis and survival showed no evidence of differences between the two arms. In exploratory subgroup analyses there was evidence of a greater response to CHART in younger patients (P = 0.041) and poorly differentiated tumours appeared to fare better with conventional radiotherapy (P = 0.030). In the larynx there was evidence of a trend towards increasing benefit with more advanced T stage (P = 0.002). Late treatment related morbidity: Osteoradionecrosis occurred in 0.4% of patients after CHART and 1.4% of patients after conventional radiotherapy. The incidence of chondritis or cartilage necrosis was similar in both arms. Life table analysis showed evidence of reduced severity in a number of late morbidities in favour of CHART. These were most striking for skin telangiectasia, superficial and deep ulceration of the mucosa and laryngeal oedema

  17. The current status and future perspectives of the combined chemo-radiotherapy for locoregionally advanced squamous cell head and neck cancer%局部或区域晚期头颈鳞癌放化疗联合治疗现状和展望

    Institute of Scientific and Technical Information of China (English)

    李志勇; 张艳清; 郑艳群; 朱步东

    2013-01-01

    头颈部鳞状细胞癌的全身治疗包括细胞毒药物治疗(简称化疗)、靶向治疗和支持治疗;而局部治疗主要包括放射治疗和手术。放化疗联合是局部晚期或区域晚期头颈部鳞癌主要治疗模式,包括同步化放疗、诱导化疗、序贯化放疗。本文综述了原发于口腔、口咽、下咽、喉的鳞癌的化放疗联合治疗现状和进展。%The systemic treatments of locoregionally advanced squamous cell head and neck cancer include cytotoxic therapy (referred to chemotherapy), targeted therapies and supportive care, in addition to local therapy consisted of surgery and/or radiation therapy (RT). Approaches combining chemotherapy and radiation therapy is primarily treatment modalities in patients with locoregionally advanced head and neck cancer, comprising of concurrent chemoradiotherapy, induction chemotherapy and sequential chemoradiotherapy. This article reviews the current status and progress in the combined chemo-radiotherapy approaches to patients with locoregionally advanced head and neck cancer arising in the oral cavity, oropharynx, hypopharynx, and larynx.

  18. Dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Nam P. [Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, VA North Texas Health Care System, Radiation Oncology Service (140), 4500 S, Lancaster Road, Dallas, TX 72516 (United States)]. E-mail: NamPhong.Nguyen@med.va.gov; Moltz, Candace C. [Audiology and Speech Pathology Service (126), VA North Texas Health Care System, Dallas, TX 75216 (United States); Frank, Cheryl [Audiology and Speech Pathology Service (126), VA North Texas Health Care System, Dallas, TX 75216 (United States); Karlsson, Ulf [Department of Radiation Oncology, East Carolina University, Greenville, NC 27858 (United States); Nguyen, Phuc D. [Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, VA North Texas Health Care System, Radiation Oncology Service (140), 4500 S, Lancaster Road, Dallas, TX 72516 (United States); Vos, Paul [Department of Biostatistics, East Carolina University, Greenville, NC 27858 (United States); Smith, Herbert J. [Radiology Service, VA North Texas Health Care System, Dallas, TX 75216 (United States); Dutta, Suresh [Department of Radiation Oncology, University of Southern California, Los Angeles, CA 90033 (United States); Nguyen, Ly M. [Public Health School, University of Michigan, Ann Arbor, MI 48109 (United States); Lemanski, Claire [Department of Radiation Oncology, Val D' Aurelle, Montpellier (France); Chan, Wayne [Radiation Oncology Service, VAMC, Jackson, MS 39216 (United States); Sallah, Sabah [Division of Hematology/Oncology Research, Novo Nordisk, Athens (Greece)

    2006-09-15

    Objective: The purpose of the study is to evaluate dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer, and particularly the aspiration risk because of its potential life-threatening consequence. Materials and methods: We reviewed retrospectively the modified barium swallow (MBS) results in 110 patients who complained of dysphagia following chemoradiation (57) and postoperative radiation (53) of their head and neck cancer. Patients were selected if they were cancer free at the time of the swallowing study. Dysphagia severity was graded on a scale of 1-7. Patients were grouped according to the dysphagia severity: mild (grades 2-3), moderate (grades 4-5), and severe (grades 6-7). Results: Mean and median dysphagia grades were 4.84/5 and 4.12/4 for chemoradiation and postoperative radiation respectively. The mean difference between the two groups is statistically significant (p = 0.02). Mild dysphagia occurred in 13 patients (22%) of the chemoradiation group and 17 (32%) of the postoperative group. Corresponding number for the moderate group was 25 (43%) and 25 (48%), respectively. Severe dysphagia was significant in the chemoradiation group (34%) compared to the postoperative group (19%). However, the difference was not statistically significant (p = 0.29). There was a higher proportion of patients with large tumor (T3-T4) in the chemoradiation group who developed severe dysphagia. Conclusion: Dysphagia remained a significant morbidity of chemoradiation and postoperative radiation for head and neck cancer. Dysphagia may be more severe in the chemoradiation group because of the higher proportion of patients with large tumor, the high radiation dose, and a high number of oropharyngeal tumors. Aspiration occurred in both groups. Diagnostic studies such as MBS should be part of future head and neck cancer prospective studies to assess the prevalence of aspiration, as it may be silent.

  19. Endothelial derived factors inhibit anoikis of head and neck cancer stem cells

    Science.gov (United States)

    Campos, Marcia S.; Neiva, Kathleen G.; Meyers, Kristy A.; Krishnamurthy, Sudha; Nör, Jacques E.

    2011-01-01

    Recent evidence demonstrated that cancer stem cells reside in close proximity to blood vessels in human head and neck squamous cell carcinomas (HNSCC). These findings suggest the existence of a supporting perivascular niche for cancer stem cells. Objective The purpose of this study was to evaluate the effect of endothelial cell-secreted factors on the behavior of head and neck cancer stem-like cells (HNCSC). Materials and methods HNCSC were identified by sorting UM-SCC-22A (cell line derived from a primary squamous cell carcinoma of the oropharynx) and UM-SCC-22B (derived from the metastatic lymph node of the same patient) for CD44 expression and ALDH (aldehyde dehydrogenase) activity. HNCSC (ALDH+CD44+) and control (ALDH−CD44−) cells were cultured in ultra-low attachment plates in presence of conditioned medium from primary human endothelial cells. Results ALDH+CD44+ generated more orospheres than control cells when cultured in suspension. The growth factor milieu secreted by endothelial cells protected HNCSC against anoikis. Mechanistic studies revealed that endothelial cell-secreted vascular endothelial growth factor (VEGF) induces proliferation of HNCSC derived from primary UM-SCC-22A, but not from the metastatic UM-SCC-22B. Likewise, blockade of VEGF abrogated endothelial cell-induced Akt phosphorylation in HNCSC derived from UM-SCC-22A while it had a modest effect in Akt phosphorylation in HNCSC from UM-SCC-22B. Conclusion This study revealed that endothelial cells initiate a crosstalk that protect head and neck cancer stem cells against anoikis, and suggest that therapeutic interference with this crosstalk might be beneficial for patients with head and neck cancer. PMID:22014666

  20. Dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer

    International Nuclear Information System (INIS)

    Objective: The purpose of the study is to evaluate dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer, and particularly the aspiration risk because of its potential life-threatening consequence. Materials and methods: We reviewed retrospectively the modified barium swallow (MBS) results in 110 patients who complained of dysphagia following chemoradiation (57) and postoperative radiation (53) of their head and neck cancer. Patients were selected if they were cancer free at the time of the swallowing study. Dysphagia severity was graded on a scale of 1-7. Patients were grouped according to the dysphagia severity: mild (grades 2-3), moderate (grades 4-5), and severe (grades 6-7). Results: Mean and median dysphagia grades were 4.84/5 and 4.12/4 for chemoradiation and postoperative radiation respectively. The mean difference between the two groups is statistically significant (p = 0.02). Mild dysphagia occurred in 13 patients (22%) of the chemoradiation group and 17 (32%) of the postoperative group. Corresponding number for the moderate group was 25 (43%) and 25 (48%), respectively. Severe dysphagia was significant in the chemoradiation group (34%) compared to the postoperative group (19%). However, the difference was not statistically significant (p = 0.29). There was a higher proportion of patients with large tumor (T3-T4) in the chemoradiation group who developed severe dysphagia. Conclusion: Dysphagia remained a significant morbidity of chemoradiation and postoperative radiation for head and neck cancer. Dysphagia may be more severe in the chemoradiation group because of the higher proportion of patients with large tumor, the high radiation dose, and a high number of oropharyngeal tumors. Aspiration occurred in both groups. Diagnostic studies such as MBS should be part of future head and neck cancer prospective studies to assess the prevalence of aspiration, as it may be silent

  1. Aspiration rate following chemoradiation for head and neck cancer: An underreported occurrence

    International Nuclear Information System (INIS)

    Background and purpose: We would like to assess the prevalence of aspiration before and following chemoradiation for head and neck cancer. Patients and methods: We reviewed retrospectively the Modified Barium Swallow (MBS) in 63 patients who underwent concurrent chemotherapy and radiation for head and neck cancer. MBS was performed prior to treatment to determine the need for immediate gastrostomy tube placement. MBS was repeated following treatment to assess the safety of oral feeding prior to removal of tube feeding. All patients were cancer free at the time of the swallowing study. No patient had surgery. Dysphagia severity was graded on a scale of 1-7. Tube feedings were continued if patients were diagnosed to have severe aspiration (grade 6-7) or continued weight loss. Patients with abnormal swallow (grade 3-7) received swallowing therapy following MBS. Results: Before treatment, there were 18 grade 1, 18 grade 2, 9 grade 3, 8 grade 4, 3 grade 5, 3 grade 6, and 4 grade 7. Following chemoradiation, at a median follow-up of 2 months (1-10 months), one patient had grade 1, eight patients had grade 2, nine patients had grade 3, eight patients had grade 4, 13 patients had grade 5, seven patients had grade 6, and 11 patients had grade 7. Six patients died from aspiration pneumonia (one before, three during, and two post-treatment), and did not have the second MBS. Overall, 37/63 (59%) patients developed aspiration, six of them (9%) fatal. If we excluded the 10 patients who had severe aspiration at diagnosis and the six patients who died from pneumonia, the prevalence of severe aspiration was 33% (21/63). Conclusions: Aspiration remained a significant morbidity following chemoradiation for head and neck cancer. Its prevalence is underreported in the literature because of its often silent nature. Diagnostic studies such as MBS should be part of future head and neck cancer prospective studies to assess the prevalence of aspiration, and for rehabilitation

  2. Soothing and balmy, cure without disfigurement: Benjamin Bye, false promises, and head and neck cancer.

    Science.gov (United States)

    Xu, Jennifer; Shuman, Andrew G

    2015-04-01

    One century ago, patients dreaded a diagnosis of head and neck cancer, fearing not only the progression of the disease but also the prospect of surgery. A cadre of charlatans preyed upon these fears to make a profit. We unearth the tale of Benjamin Bye, an Indianapolis doctor peddling the Combination Oil Cure. His collection of creams applied to the face offered unsuspecting patients a painless cure of their head and neck cancer. Bye eventually came under the fire of muckrakers as well as the federal government. Not long thereafter, Bye's practice was declared fraudulent, and the US Postmaster General refused to send his products. Bye's story recalls a time in which curative options were few and fear of malignancy was pervasive. Today, as our treatment armamentarium grows, we are reminded to critically assess efficacy, honestly discuss options with patients, and ensure that charlatanism remains a shadow of the past. PMID:25338669

  3. Pain management in head and neck cancer patients undergoing chemo-radiotherapy: Clinical practical recommendations.

    Science.gov (United States)

    Mirabile, A; Airoldi, M; Ripamonti, C; Bolner, A; Murphy, B; Russi, E; Numico, G; Licitra, L; Bossi, P

    2016-03-01

    Pain in head and neck cancer represents a major issue, before, during and after the oncological treatments. The most frequent cause of pain is chemo/radiation related oral mucositis, which involves 80% of the patients and worsens their quality of life inhibiting speaking, eating, drinking or swallowing and sometimes reducing the treatment compliance, the maximum dose intensity and thus the potential efficacy of treatment. Nevertheless pain is still often under estimated and undertreated. An Italian multidisciplinary group of head and neck cancer specialists met with the aim of reaching a consensus on pain management in this setting. The Delphi Appropriateness method was used for the consensus. External expert reviewers evaluated the final statements. The paper contains 30 consensus-reached statements about pain management in HNC patients and offers a review of recent literature in these topics. PMID:26712589

  4. Psychosocial aspects of head and neck cancer--a review of the literature.

    Science.gov (United States)

    Pruyn, J F; de Jong, P C; Bosman, L J; van Poppel, J W; van Den Borne, H W; Ryckman, R M; de Meij, K

    1986-12-01

    This study is a systematic analysis of the literature on psychosocial aspects in head and neck cancer patients. Patients with head and neck cancer experience a variety of physical as well as psychosocial problems. Physical problems include swallowing or chewing, speech and physical appearance. Psychosocial problems include anxiety, depression, loss of self-esteem and uncertainty about the future. Because of these problems, isolation from friends typically occurs, re-employment is difficult, and there are social and sexual tensions within families. Information and support by professionals, partners and/or fellow patients are related to positive rehabilitation outcomes such as the acquisition of speech, increases in constructive social functioning and decreases in depression. PMID:3545557

  5. Proton therapy for head and neck cancer: Rationale, potential indications, practical considerations, and current clinical evidence

    International Nuclear Information System (INIS)

    There is a strong rationale for potential benefits from proton therapy (PT) for selected cancers of the head and neck because of the opportunity to improve the therapeutic ratio by improving radiation dose distributions and because of the significant differences in radiation dose distribution achievable with x-ray-based radiation therapy (RT) and PT. Comparisons of dose distributions between x-ray-based and PT plans in selected cases show specific benefits in dose distribution likely to translate into improved clinical outcomes. However, the use of PT in head and neck cancers requires special considerations in the simulation and treatment planning process, and currently available PT technology may not permit realization of the maximum potential benefits of PT. To date, few clinical data are available, but early clinical experiences in sinonasal tumors in particular suggest significant improvements in both disease control and radiation-related toxicity

  6. The Univ. of Florida experience with two fractions per day for head and neck cancer

    International Nuclear Information System (INIS)

    Based on early promising results, a twice-a-day fractionation scheme similar to that reported from Dijon, France and M.D. Anderson Hospital was introduced at the University of Florida in 1978 for the treatment of patients with moderately advanced and advanced squamous cell cancers of the head and neck. The majority of patients treated by twice-a-day irradiation at the University of Florida have had primary lesions of the oropharynx, hypopharynx, or larynx. Patients with T1 lesions at any site continued to receive once-a-day treatment, as did patients with T2 lesions of the glottic larynx, floor of mouth, and oral tongue; beginning in 1986, T2 glottic tumors have also been managed with twice-a-day treatment. Only 2 patients with cancers of the nasal cavity, paranasal sinuses, or nasopharynx were treated by twice-a-day irradiation during the study period, and they are not included in the present report. Also, a number of patients with small-volume, superficial oropharyngeal lesions that were staged T2 or T3 only on the basis of size criteria were treated by once-a-day irradiation. The following is an update of the University of Florida experience with this technique

  7. Daily amifostine given concomitantly to chemoradiation in head and neck cancer. A pilot study

    International Nuclear Information System (INIS)

    Background: In patients with loco-regionally advanced head and neck cancer conventionally fractionated radiotherapy alone results in poor loco-regional control and survival rates. Treatment intensification by simultaneous administration of cytotoxic drugs produces higher acute morbidity. Therefore chemical radioprotection of normal tissues may be of clinical benefit. Patients and Methods: In a pilot study patients with advanced nonresectable head neck cancer treated with conventionally fractionated radical radiotherapy (60 to 66 Gy total doses) and concomitantly given 5-fluorouracil as protracted venous infusion, 250 mg/sqm/24 h over the entire treatment period were given amifostine 300 mg absolutely before each fraction. Acute treatment related mobidity was scored according to CTC classification and loco-regional control and survival rates were estimated. Comparison was made with a historical control group of identical chemoradiation but without amifostine application. Results: Chemoradiation induced oral mucositis was delayed and showed significant lower degrees at all 10 Gy increments (p0.05). No significant toxicity was recorded with respect to blood pressure, serum calcium, potassium, hematologic parameters, emesis, nausea or body weight loss. Progression free survival and overall survival probability at 2 years were not statistically different in both cohorts. Conclusion: Amifostine given before each fraction of radiotherapy over 6 weeks has no cumulative toxicity, was well tolerated and may reduce treatment induced oral mucositis. No tumor protective effect was observed. (orig.)

  8. Chlorinated pesticides and cancer of the head and neck: a retrospective case series.

    Science.gov (United States)

    Govett, Gregg; Genuis, Stephen John; Govett, Hannah E; Beesoon, Sanjay

    2011-07-01

    Cancer of the head and neck is a pervasive problem with recognized determinants including tobacco use, alcohol consumption, and earlier radiation exposure. Organochlorine pesticides (OCPs) have been shown to have carcinogenic potential in both animals and humans. OCPs have previously been widely used in the agricultural industry of rural Oklahoma. Seven patients from rural Oklahoma with head and neck cancer and without any of the usual risk factors were tested for the presence of OCPs in their adipose tissue. Clinical and toxicological data on each of these patients are presented for consideration. Results were compared with (i) levels from five individuals not experiencing cancer but who lived in the same area, and (ii) adipose tissue OCP levels in other population groups. Each of the seven patients tested had markedly elevated levels of some OCPs in their adipose tissue compared with the cohort of noncancer patients. Further research is required to confirm whether there is a causative link between OCP bioaccumulation and head and neck cancer as suggested by this case series. PMID:21633202

  9. Oral care for patients with head and neck cancer in Hokkaido University Hospital

    International Nuclear Information System (INIS)

    We have been providing oral care for patients with head and neck cancer in Hokkaido University Hospital since 2007. In this paper, we report clinical statistics of the 254 head and neck cancer patients who received oral care. About 80 percent of these patients were treated with radiation therapy, so it is important to cope with adverse events related to such therapy. Oral care is helpful for cancer patients when it is started as soon as possible (at least 1 week before radiation therapy is started). The percentage of patients who could start oral care 4 days before radiation therapy gradually increased to about 60 percent by fiscal 2009. In fiscal 2010, the percentage decreased to its lowest level of 37.9 percent. To start oral care for all patients 7 days before irradiation, we are going to change our system and start oral care in the outpatient period. In their hometowns, oral care was continued for only 19 (27.0 percent) of the 74 patients who could not visit our hospital. An important task for our project is to establish a medical cooperation system for discharged patients treated for head and neck cancer. (author)

  10. Cancer-related trauma, stigma and growth: the 'lived' experience of head and neck cancer.

    Science.gov (United States)

    Threader, J; McCormack, L

    2016-01-01

    Head and neck cancer is associated with multiple layers of distress including stigma. Stigma attraction or devalued social identity is twofold: (1) it is a cancer associated with lifestyle risk factors and (2) treatment often results in confronting facial disfigurement. Subjective interpretations from nine head and neck cancer patients were analysed using Interpretative Phenomenological Analysis. An overarching superordinate theme--Distress, Stigma and Psychological Growth--encompassed four subordinate themes. Two themes captured the expressed trauma and terror as a result of diagnosis and treatment, and two the redefining of self despite stigma through meaning making. Distress was interpreted as a catalyst for awakening new life interpretations and combined with social support to facilitate two distinct pathways of growth: (1) psychological growth without support; (2) psychological and relational growth with support. Previously unfelt empathetic understanding and altruism for others with cancer emerged from the impact of stigma on 'self'. Acceptance allowed a new sense of identity that recognised cancer-related traumatic distress as integral to growth for these participants. The present study offers a unique insight into cancer-related trauma and stigma and the potential to redefine a more accepting, empathic and altruistic 'self' for psychological growth. Implications are discussed. PMID:25899673

  11. Rick Factors Associated with Aspiration in Patients with Head and Neck Cancer

    OpenAIRE

    Jung, Soo Jin; Kim, Deog Young; Joo, So Young

    2011-01-01

    Objective To determine the major risk factors and abnormal videofluoroscopic swallowing study (VFSS) findings associated with aspiration in patients with head and neck cancer (HNC). Method Risk factors associated with aspiration were investigated retrospectively in 241 patients with HNC using medical records and pre-recorded VFSS. Age, gender, lesion location and stage, treatment factors, and swallowing stage abnormalities were included. Results Aspiration occurred in 50.2% of patients. A uni...

  12. Cisplatin Induces Bmi-1 and Enhances the Stem Cell Fraction in Head and Neck Cancer12

    OpenAIRE

    Nör, Carolina; Zhang, Zhaocheng; Warner, Kristy A.; Bernardi, Lisiane; Visioli, Fernanda; Helman, Joseph I.; Roesler, Rafael; Jacques E Nör

    2014-01-01

    Recent evidence has unveiled a subpopulation of highly tumorigenic, multipotent cells capable of self-renewal in head and neck squamous cell carcinomas (HNSCCs). These unique cells, named here cancer stem cells (CSCs), proliferate slowly and might be involved in resistance to conventional chemotherapy. We have shown that CSCs are found in perivascular niches and rely on endothelial cell-secreted factors [particularly interleukin-6 (IL-6)] for their survival and self-renewal in HNSCC. Here, we...

  13. Cisplatin Induces Bmi-1 and Enhances the Stem Cell Fraction in Head and Neck Cancer

    OpenAIRE

    Carolina Nör; Zhaocheng Zhang; Warner, Kristy A.; Lisiane Bernardi; Fernanda Visioli; Helman, Joseph I.; Rafael Roesler; Jacques E Nör

    2014-01-01

    Recent evidence has unveiled a subpopulation of highly tumorigenic, multipotent cells capable of self-renewal in head and neck squamous cell carcinomas (HNSCCs). These unique cells, named here cancer stem cells (CSCs), proliferate slowly and might be involved in resistance to conventional chemotherapy. We have shown that CSCs are found in perivascular niches and rely on endothelial cell-secreted factors [particularly interleukin-6 (IL-6)] for their survival and self-renewal in HNSCC. Here, we...

  14. Lymph node ratio as a prognostic factor in head and neck cancer patients

    International Nuclear Information System (INIS)

    Lymph node status is one prognostic factor in head and neck cancer. The purpose of this study is to investigate the prognostic value of lymph node ratio (LNR) in head and neck cancer patients who received surgery plus postoperative chemoradiotherapy. From May 1991 to December 2012, a total of 117 head and neck cancer patients who received surgery plus postoperative chemoradiotherapy were analyzed. The primary sites were oral cavity (93), oropharynx (13), hypopharynx (6), and larynx (5). All patients had pathologically confirmed squamous cell carcinoma and 63 patients had neck lymph nodes metastasis. LNR was calculated for each patient. The endpoints were overall survival (OS), local failure-free survival (LFFS), and distant metastasis-free survival (DMFS). The median follow up time was 36 months, with a range from 3.4 to 222 months. The 3-year rates of OS, LFFS, and DMFS were 59.7, 70.3, and 81.8 %, respectively. The median value of LNR for lymph nodes positive patients was 0.1. In univariate analysis, patients with an LNR value less than 0.1 had better 3-year OS (67.0 % vs.41.0 %, p = 0.004), 3-year LFFS (76.1 % vs. 54.9 %, p = 0.015) and 3-year DMFS (87.2 % vs. 66.4 %, p = 0.06). Multivariate analysis revealed that LNR was an independent prognostic factor for OS (hazard ratio [HR] = 2.92; 95 % confidence interval [CI] = 1.367–6.242; p = 0.006) and LFFS (HR = 4.12; 95 % CI = 1.604–10.59; p = 0.003). LNR is an important prognosis factor for OS and LFFS in head and neck cancer patients. The online version of this article (doi:10.1186/s13014-015-0490-9) contains supplementary material, which is available to authorized users

  15. Periodontal Disease and Risk of Head and Neck Cancer: A Meta-Analysis of Observational Studies

    OpenAIRE

    ZENG, XIAN-TAO; Deng, Ai-Ping; Li, Cheng; Xia, Ling-Yun; Niu, Yu-Ming; Leng, Wei-Dong

    2013-01-01

    Background Many epidemiological studies have found a positive association of periodontal disease (PD) with risk of head and neck cancer (HNC), but the findings are varied or even contradictory. In this work, we performed a meta-analysis to ascertain the relationship between PD and HNC risk. Methods We searched the PubMed, Embase, and Cochrane Library databases for relevant observational studies on the association between PD and HNC risk published up to March 23, 2013. Data from the included s...

  16. Age most significant predictor of requiring enteral feeding in head-and-neck cancer patients

    OpenAIRE

    Sachdev, Sean; Refaat, Tamer; Bacchus, Ian D; Sathiaseelan, Vythialinga; Mittal, Bharat B

    2015-01-01

    Background A significant number of patients treated for head and neck squamous cell cancer (HNSCC) undergo enteral tube feeding. Data suggest that avoiding enteral feeding can prevent long-term tube dependence and disuse of the swallowing mechanism which has been linked to complications such as prolonged dysphagia and esophageal constriction. We examined detailed dosimetric and clinical parameters to better identify those at risk of requiring enteral feeding. Methods One hundred patients with...

  17. Decreased Lymphangiogenesis and Lymph Node Metastasis by mTOR Inhibition in Head and Neck Cancer

    OpenAIRE

    Patel, Vyomesh; Marsh, Christina A.; Dorsam, Robert T.; Mikelis, Constantinos M.; Masedunskas, Andrius; Amornphimoltham, Panomwat; Nathan, Cherie Ann; Singh, Bhuvanesh; Weigert, Roberto; Molinolo, Alfredo A.; Gutkind, J. Silvio

    2011-01-01

    Despite our improved understanding of cancer, the 5-year survival rate for head and neck squamous cell carcinomas (HNSCC) patients remains relatively unchanged at 50% for the past three decades. HNSCC often metastasize to locoregional lymph nodes, and lymph node involvement represents one of the most important prognostic factors of poor clinical outcome. Among the multiple dysregulated molecular mechanism in HNSCC, emerging basic, preclinical, and clinical findings support the importance of t...

  18. Head and Neck Cancers May Be Linked to Hepatitis C

    Science.gov (United States)

    ... and Neck Cancers May Be Linked to Hepatitis C Researcher sees need for improved screening, treatment To ... 2016 WEDNESDAY, April 13, 2016 (HealthDay News) -- Hepatitis C may increase the risk for certain types of ...

  19. CELECOXIB - Chemoradiation therapy for reducing mucositis and other acute side effects in advance head and neck carcinoma

    Directory of Open Access Journals (Sweden)

    Izadi Sh

    2009-02-01

    Full Text Available "nBackground: Chemo-radiotherapy-induced oral mucositis represents a therapeutic challenge frequently encountered in cancer patients. This side effect causes significant morbidity and may delay or interruption of treatment plan, cyclo-oxygenase 2 (COX2 is an inducible enzyme primarily expressed in inflamed and tumoral tissues. COX-2 inhibitors have shown promise to reduce chemoradiation induce toxicities. We conducted a phase III, randomized double blind clinical trial to evaluate the toxicity and efficacy of celecoxib, a selective COX2 inhibitor, administered concurrently with chemoradiation for locally advanced head and neck cancer. Here in we report the first report about the role of COX-2 inhibitor in acute toxicicities. "nMethods: Patients with stage III/IV (locally advance head and neck carcinoma who referred to department of radiation-oncology were eligible. Patients were treated with chemotherapy with cisplatin concurrently with radiation (60-70Gy. Celecoxib (100mg qid was started at the first day of radiotherapy and was given for a total of 8 weeks. Acute toxicities were evaluated every week by WHO scale. "nResults: One hundred twenty two patients were enrolled into the study, (61 patients for each group. In repeated mesurment analysis of variance there is a significant difference in the time of onset of grade II acute toxicities between the two groups; The mucositis, dysphagia, epidermitis and oral pain score changed significantly over the typical five weeks in two groups but these changes were more sever in placebo group (p=0.0001. In the analysis of the overall changes in the following laboratory parame-ters: WBC, hemoglobin and platelet showed that these parameters decreased over time in both groups without a significant difference between groups. "nConclusion: The results of these study showed that the use of a COX-2 inhibitor (celecoxib that is a safe and inexpensive drug may reduce acute toxicities of chemoradiation specially

  20. Radiobiological modeling of interplay between accelerated repopulation and altered fractionation schedules in head and neck cancer

    Directory of Open Access Journals (Sweden)

    Marcu Loredana

    2009-01-01

    Full Text Available Head and neck cancer represents a challenge for radiation oncologists due to accelerated repopulation of cancer cells during treatment. This study aims to simulate, using Monte Carlo methods, the response of a virtual head and neck tumor to both conventional and altered fractionation schedules in radiotherapy when accelerated repopulation is considered. Although clinical trials are indispensable for evaluation of novel therapeutic techniques, they are time-consuming processes which involve many complex and variable factors for success. Models can overcome some of the limitations encountered by trials as they are able to simulate in less complex environment tumor cell kinetics and dynamics, interaction processes between cells and ionizing radiation and their outcome. Conventional, hyperfractionated and accelerated treatment schedules have been implemented in a previously developed tumor growth model which also incorporates tumor repopulation during treatment. This study focuses on the influence of three main treatment-related parameters, dose per fraction, inter fraction interval and length of treatment gap and gap timing based on RTOG trial data on head and neck cancer, on tumor control. The model has shown that conventionally fractionated radiotherapy is not able to eradicate the stem population of the tumor. Therefore, new techniques such as hyperfractionated/ accelerated radiotherapy schedules should be employed. Furthermore, the correct selection of schedule-related parameters (dose per fraction, time between fractions, treatment gap scheduling is crucial in overcoming accelerated repopulation. Modeling of treatment regimens and their input parameters can offer better understanding of the radiobiological interactions and also treatment outcome.

  1. Concurrent chemoradiotherapy with daily low dose CDDP/5FU for locally unresectable head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kohno, Naoyuki; Kitahara, Satoshi; Tamura, Etsuyo; Tanabe, Tetsuya [Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine; Murata, Yasuhiro [National Defence Medical Coll., Tokorozawa, Saitama (Japan)

    2002-07-01

    To improve the local control rate and the prognosis of locally unresectable head and neck cancer patients, we studied the concurrent chemoradiotherapy. Between September 1996 and September 2000, thirty-eight patients with locally unresectable head and neck cancer were administered concurrent chemoradiotherapy consisting of low-dose and long-term treatment with cisplatin (CDDP) plus 5-fluorouracil (5FU), or (L-CF); the L-CF regimen consisted of CDDP, 3 mg/m{sup 2} on 5 days of the week and 5FU, 150 mg/m{sup 2} as a 24-hour infusion on 5 days of the week. Concurrently, conventional radiotherapy was given up to total dose of around 60 Gy. In the 36 patients evaluable for response, 19 complete and 10 partial responses were noted, with an overall response rate of 81%. Oral mucositis and myelosuppression were the major side effects and dose limiting toxicity. This study demonstrates increase in survival among the responders (complete+partial) in the concurrent chemoradiotherapy setting. We concluded that this treatment strategy was beneficial. Further studies for patients with locally unresectable head and neck cancer are warranted. (author)

  2. Novel targets in HPV-negative head and neck cancer: overcoming resistance to EGFR inhibition.

    Science.gov (United States)

    Burtness, Barbara; Bauman, Julie E; Galloway, Thomas

    2013-07-01

    Cancers of the head and neck that arise from habitual exposure to carcinogens have lower cure rates than those that arise from infection with human papillomavirus (HPV), and intensification of cytotoxic chemotherapy and radiation has not improved outcomes. HPV-negative head and neck cancers abundantly express EGFR, and the monoclonal antibody cetuximab, directed against EGFR, is the only targeted therapy that has improved disease survival so far. However, response rates to single-agent cetuximab are lower than 15%, and cetuximab given with chemotherapy or radiation leads to only a modest effect on survival. Thus, investigating the mechanisms of resistance to EGFR inhibition in HPV-negative head and neck cancer might help identify novel and active therapies. In this Review, we focus on therapies in development that target redundant receptor tyrosine kinases (eg, HER2 and MET), reduce or abrogate nuclear functions of EGFR, affect cellular trafficking by inhibition of histone deacetylase, or treatments that might address resistance that arises in the EGFR signalling stream (eg, aurora-kinase inhibitors and STAT decoys). PMID:23816296

  3. Detection of recurrence of head and neck cancer with 18F-FDG PET

    International Nuclear Information System (INIS)

    Objective: To evaluate 18F-FDG PET in detection of suspected recurrence of head and neck cancer after treatment, in comparison with CT imaging. Methods: Thirty-eight patients with clinically suspected recurrence of head and neck cancer underwent 18F-FDG PET, twenty-eight of them also underwent CT imaging. The images were interpreted visually and semiquantitatively as tumor-to-normal (T/N). The accumulation of radioactivity in tumor was graded as follows: grade 0 (no FDG uptake), grade I (slight uptake), grade II (moderate uptake), grade III (intensive uptake). The accumulation of grade II or grade III was defined as recurrence, the final diagnoses of recurrence were based on histological examine or clinical follow up. Results: The sensitivity and specificity of visual interpretation of PET for recurrence were 90.6% (29/32), 83.3%(5/6), respectively; and those of CT were 63,6% (14/22), 50% (3/6), respectively. The ratio of T/N of recurrent tumors was much higher than that of benign ones. Conclusions: Compared with CT imaging, PET has a higher accuracy in detection of recurrent head and neck cancer after treatment

  4. Head and neck cancer information on the internet: type, accuracy and content.

    LENUS (Irish Health Repository)

    Ni Riordain, Richeal

    2009-08-01

    This study aimed to determine the type, accuracy and content of information available on the internet regarding head and neck cancer. The search engine Google was used to generate a list of the top 100 websites about head and neck cancer. The websites were evaluated using the DISCERN instrument and the JAMA benchmarks and whether the site displayed the Health on the Net seal was also recorded. The search yielded 1,650,000 sites on the Google website. Of the top 100 sites, a total of 33 sites were suitable for analysis due to duplicate links, non-functioning links and irrelevant website. 45% achieved all four JAMA benchmarks and 18% achieved only 1 benchmark. No website receiving the maximum mark on the overall score and four websites received the lowest overall score regarding the DISCERN instrument. The question with the poorest response score was \\'Does it describe how the treatment choices affect overall quality of life?\\' 39% of the websites displayed the Health on the Net (HON) seal. A wide variety of types of information are available on the internet regarding head and neck cancer with variable accuracy levels based on both Journal of the American Medical Association (JAMA) benchmarks and DISCERN. The onus lies with the practitioner to guide the patient regarding scientific reliability of information and to direct the patient in filtering the information sourced. The inclusion of quality of life related information is currently lacking and should be addressed to ensure a more comprehensive understanding for patients of treatment options.

  5. Melanoma-associated antigen expression and the efficacy of tyrosine kinase inhibitors in head and neck cancer

    DEFF Research Database (Denmark)

    Hartmann, Stefan; Brands, Roman C; Küchler, Nora; Fuchs, Andreas; Linz, Christian; Kübler, Alexander C; Müller-Richter, Urs D A

    2015-01-01

    Melanoma-associated antigen (MAGE) has been identified in a variety of types of cancer. The expression of several MAGE subgroups is correlated with poor prognosis and chemotherapeutic resistance. One target of chemotherapeutic treatment in head and neck cancer is the epidermal growth factor recep...... between MAGE-A5 and -A11 and lower efficacy of EGFR TKIs. Pretreatment analysis of MAGE-A status may therefore aid improvement of chemoprevention using erlotinib and gefitinib in head and neck cancer....

  6. Hyperbaric oxygen in the radiation treatment of head and neck cancers

    Energy Technology Data Exchange (ETDEWEB)

    Sealy, R. (Mersey Regional Centre for Radiotherapy and Oncology, Merseyside (United Kingdom))

    1991-01-01

    Published report on the use of hyperbaric oxygen in the radiation therapy of head and neck cancer are reviewed. The weight of evidence, from randomized trials, is that it is of clinical value in the control of medium sized head and neck tumours. It is also of value in the treatment of lymph node disease. Four attempts to improve the results of the treatment, by various physiological measures,are reviewed. It is concluded that hyperbaric oxygen may be of use when combined with nitro- imidazoles as a radiation sensitizer and warrants further study when combined with induced anaemia, aimed to reduce the tumour cord and prevent repopulation between fractions. (author). 21 refs.; 2 tabs.

  7. In vivo dosimetry using thermoluminescent detector in cancer therapy of head and neck

    International Nuclear Information System (INIS)

    The viability and implementation of a routine in vivo dosimetry, using thermoluminescent dosemeters (TLD), at the radiotherapy section of the National Institute of Cancer in Brazil, in the case of head and neck treatment is shown. In order to reach that aim, the characteristics of the response of the LiF:Mg;Ti (TLD-100) thermoluminescent detectors in powder form were determined. The performed of this detector for in vivo dosimetry was testes using an RANDO Alderson anthropomorphic phantom and, once their adequability proved for the kind of measurements proposed , it was used for dose assessment in the case of tumour treatments in the head and neck regions, for Cobalt-60 irradiations. (author)

  8. Dental and nutritional management of the head and neck cancer patient

    International Nuclear Information System (INIS)

    This course will examine the expected acute and late normal tissue toxicities associated with the delivery of high dose radiation therapy to the head and neck region. The purpose of this course will be to identify strategies to reduce radiotherapy-related toxicity without compromising adequate tumor treatment. A multidisciplinary approach will be emphasized and the following topics will be addressed: 1) Appropriate dental evaluation prior to the institution of treatment, oral care during radiation therapy and management of dental complications following completion of treatment. 2) Treatment techniques that accurately localize the target tissue, displace normal tissues from high dose volume and reduce the volume of normal tissue included in the radiation portals. 3) The investigative use of radioprotective agents. 4) The nutritional management of head and neck cancer patients including enteral and parenteral nutrition. 5) The use of medications to reduce the severity of acute symptomatology before, during and after radiation therapy

  9. Preliminary results of SIB-IMRT in head and neck cancers: Report from a regional cancer center in northern India

    Directory of Open Access Journals (Sweden)

    Chakraborty Santam

    2009-01-01

    Full Text Available Background : Intensity-modulated radiotherapy using simultaneous integrated boost (SIB-IMRT is an attractive method for the treatment of head and neck cancers with sparing of the salivary function. Aims : To assess the feasibility, toxicity, and tumor control using SIB-IMRT in locally advanced head and neck cancers in the Indian setting. Settings and Design : The study was conducted in a regional cancer center in northern India. A review of the treatment result of the first 20 patients is presented. Methods and Materials : SIB-IMRT was planned for 20 patients-14 patients were treated with the SIB-72 schedule delivering a dose of 72 Gy, 66 Gy, and 57 Gy to the PTV GTV , PTV CTV1 , and PTV CTV2 in 33 fractions. Six patients were treated with the SIB-66 schedule delivering 66 Gy, 60 Gy, and 54 Gy to the above-mentioned volumes in 30 fractions. Patients were monitored for toxicity using the CTCAE v 3.0 criteria. Descriptive analysis of toxicity and actuarial estimates of the loco-regional control and survival are presented. Results : Grade III mucositis was seen in 65% patients. None of the patients had Grade III dermatitis. The projected 2-year overall survival was 95%. Conclusion : SIB-IMRT schedules evaluated were found to be safe and effective and are being subjected to further prospective studies.

  10. Supportive Management of Mucositis and Metabolic Derangements in Head and Neck Cancer Patients.

    Science.gov (United States)

    Bonomi, Marcelo; Batt, Katharine

    2015-01-01

    Oral mucositis (OM) is among the most undesirable, painful, and expensive toxicities of cytotoxic cancer therapy, and is disheartening for patients and frustrating for caregivers. Accurate assessment of the incidence of OM has been elusive, but accumulating data suggests that reported OM frequency is significantly less than its actual occurrence. It has been suggested that over 90% of head and neck cancer (HNC) patients receiving radiotherapy (RT) with concurrent cisplatin experience severe OM with symptoms of extreme pain, mucosal ulceration and consequent limitations in swallowing and achieving adequate nutritional intake. This panoply of symptoms inevitably impacts a patients' quality of life and their willingness to continue treatment. In spite of all the advances made in understanding the pathophysiology of OM, there is still no prophylactic therapy with proven efficacy. Strategies to limit the extent of OM and to manage its symptomatology include basic oral care, supportive medications, nutritional support and targeting aggressive treatments to high-risk patients. This review focuses on OM recognition, preventive measurements, and symptom-management strategies. PMID:26404378

  11. Treatment modalities of oral mucositis after radiation of head and neck cancers

    International Nuclear Information System (INIS)

    Acute mucositis is common after radiotherapy for head and neck cancers. During the past 3 decades, there was a gradual evolution in the treatment modalities for locally advanced carcinomas (concomitant radio-chemotherapy, accelerated radiotherapy). These new strategies are accompanied by an increase in early mucosal reactions. At the present time, there is no widely accepted prophylaxis or effective treatment. Many traditional remedies or new agents seem ineffective (Sucralfate, Chlorhexidine, GM-CSF, Silver nitrate, Prostaglandin, anti-oxidants, Benzydamine hydrochloride), while others seem promising (Povidone-iodine, nonabsorbable antibiotic lozenges and anti-fungal, local GM-CSF, Glutamide, Low-energy laser, corticosteroids). Radioprotectors are controversial and should be only used in experimental protocols and not in routine practice. However, some recommendations can be proposed: general prevention and global care before cancer therapy should be systematic (oral hygiene, dental and periodontal treatment, advice to avoid the use of tobacco and alcohol); frequent oral rinsing with a bland mouthwash (Povidone-iodine or others) should be used at the start of treatment because there are significant modifications of the oral microflora increased by a disturbed salivary flow; these mouthwashes could be associated with nonabsorbable antibiotic lozenges or anti-fungal topical (bicarbonates, Amphotericine B); Systematic percutaneous fluoroscopic gastrostomy should be decided before any aggressive treatments (concomitant radio-chemotherapy, accelerated radiotherapy); pain should be controlled; finally, the radiation technique should be optimized (mucosal sparing block, conformal radiotherapy and intensity modulated radiation therapy). (authors)

  12. Supportive Management of Mucositis and Metabolic Derangements in Head and Neck Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Bonomi, Marcelo, E-mail: mbonomi@wakehealth.edu; Batt, Katharine [Section of Hematology and Medical Oncology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 (United States)

    2015-09-03

    Oral mucositis (OM) is among the most undesirable, painful, and expensive toxicities of cytotoxic cancer therapy, and is disheartening for patients and frustrating for caregivers. Accurate assessment of the incidence of OM has been elusive, but accumulating data suggests that reported OM frequency is significantly less than its actual occurrence. It has been suggested that over 90% of head and neck cancer (HNC) patients receiving radiotherapy (RT) with concurrent cisplatin experience severe OM with symptoms of extreme pain, mucosal ulceration and consequent limitations in swallowing and achieving adequate nutritional intake. This panoply of symptoms inevitably impacts a patients’ quality of life and their willingness to continue treatment. In spite of all the advances made in understanding the pathophysiology of OM, there is still no prophylactic therapy with proven efficacy. Strategies to limit the extent of OM and to manage its symptomatology include basic oral care, supportive medications, nutritional support and targeting aggressive treatments to high-risk patients. This review focuses on OM recognition, preventive measurements, and symptom-management strategies.

  13. Supportive Management of Mucositis and Metabolic Derangements in Head and Neck Cancer Patients

    International Nuclear Information System (INIS)

    Oral mucositis (OM) is among the most undesirable, painful, and expensive toxicities of cytotoxic cancer therapy, and is disheartening for patients and frustrating for caregivers. Accurate assessment of the incidence of OM has been elusive, but accumulating data suggests that reported OM frequency is significantly less than its actual occurrence. It has been suggested that over 90% of head and neck cancer (HNC) patients receiving radiotherapy (RT) with concurrent cisplatin experience severe OM with symptoms of extreme pain, mucosal ulceration and consequent limitations in swallowing and achieving adequate nutritional intake. This panoply of symptoms inevitably impacts a patients’ quality of life and their willingness to continue treatment. In spite of all the advances made in understanding the pathophysiology of OM, there is still no prophylactic therapy with proven efficacy. Strategies to limit the extent of OM and to manage its symptomatology include basic oral care, supportive medications, nutritional support and targeting aggressive treatments to high-risk patients. This review focuses on OM recognition, preventive measurements, and symptom-management strategies

  14. Supportive Management of Mucositis and Metabolic Derangements in Head and Neck Cancer Patients

    Directory of Open Access Journals (Sweden)

    Marcelo Bonomi

    2015-09-01

    Full Text Available Oral mucositis (OM is among the most undesirable, painful, and expensive toxicities of cytotoxic cancer therapy, and is disheartening for patients and frustrating for caregivers. Accurate assessment of the incidence of OM has been elusive, but accumulating data suggests that reported OM frequency is significantly less than its actual occurrence. It has been suggested that over 90% of head and neck cancer (HNC patients receiving radiotherapy (RT with concurrent cisplatin experience severe OM with symptoms of extreme pain, mucosal ulceration and consequent limitations in swallowing and achieving adequate nutritional intake. This panoply of symptoms inevitably impacts a patients’ quality of life and their willingness to continue treatment. In spite of all the advances made in understanding the pathophysiology of OM, there is still no prophylactic therapy with proven efficacy. Strategies to limit the extent of OM and to manage its symptomatology include basic oral care, supportive medications, nutritional support and targeting aggressive treatments to high-risk patients. This review focuses on OM recognition, preventive measurements, and symptom-management strategies.

  15. FDG PET/MR for lymph node staging in head and neck cancer

    International Nuclear Information System (INIS)

    Objective: To assess the diagnostic value of PET/MR (positron emission tomography/magnetic resonance imaging) with FDG (18F-fluorodeoxyglucose) for lymph node staging in head and neck cancer. Materials and methods: This prospective study was approved by the local ethics committee; all patients signed informed consent. Thirty-eight patients with squamous cell carcinoma of the head and neck region underwent a PET scan on a conventional scanner and a subsequent PET/MR on a whole-body hybrid system after a single intravenous injection of FDG. The accuracy of PET, MR and PET/MR for lymph node metastases were compared using receiver operating characteristic (ROC) analysis. Histology served as the reference standard. Results: Metastatic disease was confirmed in 16 (42.1%) of 38 patients and 38 (9.7%) of 391 dissected lymph node levels. There were no significant differences between PET/MR, MR and PET and MR (p > 0.05) regarding accuracy for cervical metastatic disease. Based on lymph node levels, sensitivity and specificity for metastatic involvement were 65.8% and 97.2% for MR, 86.8% and 97.0% for PET and 89.5% and 95.2% for PET/MR. Conclusions: In head and neck cancer, FDG PET/MR does not significantly improve accuracy for cervical lymph node metastases in comparison to MR or PET

  16. Radiosensitization of head and neck cancer cells by the phytochemical agent sulforaphane

    International Nuclear Information System (INIS)

    Sulforaphane is a naturally occurring compound found in broccoli and other cruciferous vegetables. Recently it gained attention because of its antiproliferative properties in many cancer cell lines. The aim of this study was to investigate whether sulforaphane could act as a radiosensitizer in head and neck squamous cell carcinoma cell lines. Four head and neck squamous cell carcinoma cell lines (i.e., (HNSCC) SCC9, SCC25, CAL27, and FADU) were treated with sulforaphane and subsequently irradiated. Then proliferation and clonogenic assays were performed. Apoptosis was detected by flow cytometry. Possible regulation of Akt and Mcl-1 was investigated by western blotting. Sulforaphane and radiation in combination leads to stronger inhibition of cell proliferation and of clonogenic survival than each treatment method alone. Western blot analysis of Akt and Mcl-1 showed no changed expression. Sulforaphane is a promising agent in the treatment of head and neck cancer due to its antiproliferative and radio-sensitizing properties. A combination of sulforaphane and radiation decreases clonogenic survival. Apoptosis is not regulated through Akt or the Mcl-1 protein. (orig.)

  17. Investigating Patient and Physician Delays in the Diagnosis of Head and Neck Cancers: a Canadian Perspective.

    Science.gov (United States)

    Lee, Jonghun John; Dhepnorrarat, Chris; Nyhof-Young, Joyce; Witterick, Ian

    2016-03-01

    Diagnostic delays for head and neck cancer (HNC) patients are common. Patients often disregard symptoms for long periods before seeking help, and some family physicians may not be alert to the warning symptoms and signs of HNCs. This study evaluated the factors associated with length of delays in the diagnosis of HNCs in a Canadian population. This was a mixed-method study consisting of patient interviews and surveys in an academic health center. A questionnaire requesting demographic and disease information was completed by HNC patients followed by a 30 min semi-structured interview in a private setting. Interviews were audio recorded, transcribed, anonymized, and descriptively coded for emergent themes. Twenty-eight head and neck cancer patients participated in the study. More patients experienced physician delay (71 %) than patient delay (36 %). The median physician delay and patient delay were 108 and 31 days, respectively. Two main themes regarding these delays were (1) physician lack of knowledge and (2) lack of patient awareness. Results indicate that physician delay needs to be focused on compared to patient delay, as it is more common and has longer delays. More comprehensive training in head and neck clinical examination skills during undergraduate and residency training is recommended to reduce physician delay. Patient delay could be targeted by public education programs via both physicians and dentists. PMID:25566764

  18. CT-guided iodine-125 seed permanent implantation for recurrent head and neck cancers

    International Nuclear Information System (INIS)

    To investigate the feasibility, and safety of 125I seed permanent implantation for recurrent head and neck carcinoma under CT-guidance. A retrospective study on 14 patients with recurrent head and neck cancers undergone 125I seed implantation with different seed activities. The post-plan showed that the actuarial D90 of 125I seeds ranged from 90 to 218 Gy (median, 157.5 Gy). The follow-up was 3 to 60 months (median, 13 months). The median local control was 18 months (95% CI, 6.1-29.9 months), and the 1-, 2-, 3-, and 5- year local controls were 52%, 39%, 39%, and 39%, respectively. The 1-, 2-, 3-, and 5- survival rates were 65%, 39%, 39% and 39%, respectively, with a median survival time of 20 months (95% CI, 8.7-31.3 months). Of all patients, 28.6% (4/14) died of local recurrence, 7.1% (1/14) died of metastases, one patient died of hepatocirrhosis, and 8 patients are still alive to the date of data analysis. CT-guided 125I seed implantation is feasible and safe as a salvage or palliative treatment for patients with recurrent head and neck cancers

  19. FDG PET/MR for lymph node staging in head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Platzek, Ivan, E-mail: ivan.platzek@uniklinikum-dresden.de [Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden (Germany); Beuthien-Baumann, Bettina, E-mail: bettina.beuthien-baumann3@uniklinikum-dresden.de [Dresden University Hospital, Department of Nuclear Medicine, Fetscherstr. 74, 01307 Dresden (Germany); Schneider, Matthias, E-mail: m.schneider@mkgdresden.de [Dresden University Hospital, Department of Oral and Maxillofacial Surgery, Fetscherstr. 74, 01307 Dresden (Germany); Gudziol, Volker, E-mail: volker.gudziol@uniklinikum-dresden.de [Dresden University Hospital, Department of Otolaryngology, Fetscherstr. 74, 01307 Dresden (Germany); Kitzler, Hagen H., E-mail: hagen.kitzler@uniklinikum-dresden.de [Dresden University Hospital, Department of Neuroradiology, Fetscherstr. 74, 01307 Dresden (Germany); Maus, Jens, E-mail: j.maus@hzdr.de [Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Bautzner Landstr. 400, 01328 Dresden (Germany); Schramm, Georg, E-mail: g.schramm@hzdr.de [Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Bautzner Landstr. 400, 01328 Dresden (Germany); Popp, Manuel, E-mail: manuel.popp@praxisklinik-dresden.de [Dresden University Hospital, Department of Nuclear Medicine, Fetscherstr. 74, 01307 Dresden (Germany); Laniado, Michael, E-mail: michael.laniado@uniklinikum-dresden.de [Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden (Germany); Kotzerke, Jörg, E-mail: Joerg.Kotzerke@uniklinikum-dresden.de [Dresden University Hospital, Department of Nuclear Medicine, Fetscherstr. 74, 01307 Dresden (Germany); Hoff, Jörg van den, E-mail: j.van_den_hoff@hzdr.de [Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Bautzner Landstr. 400, 01328 Dresden (Germany)

    2014-07-15

    Objective: To assess the diagnostic value of PET/MR (positron emission tomography/magnetic resonance imaging) with FDG (18F-fluorodeoxyglucose) for lymph node staging in head and neck cancer. Materials and methods: This prospective study was approved by the local ethics committee; all patients signed informed consent. Thirty-eight patients with squamous cell carcinoma of the head and neck region underwent a PET scan on a conventional scanner and a subsequent PET/MR on a whole-body hybrid system after a single intravenous injection of FDG. The accuracy of PET, MR and PET/MR for lymph node metastases were compared using receiver operating characteristic (ROC) analysis. Histology served as the reference standard. Results: Metastatic disease was confirmed in 16 (42.1%) of 38 patients and 38 (9.7%) of 391 dissected lymph node levels. There were no significant differences between PET/MR, MR and PET and MR (p > 0.05) regarding accuracy for cervical metastatic disease. Based on lymph node levels, sensitivity and specificity for metastatic involvement were 65.8% and 97.2% for MR, 86.8% and 97.0% for PET and 89.5% and 95.2% for PET/MR. Conclusions: In head and neck cancer, FDG PET/MR does not significantly improve accuracy for cervical lymph node metastases in comparison to MR or PET.

  20. Postradiotherapy quality of life for head-and-neck cancer patients is independent of xerostomia

    International Nuclear Information System (INIS)

    Purpose: To determine the relationship between quality of life (QOL) and xerostomia over time for patients undergoing radiotherapy (RT) for head-and-neck cancer in a prospective clinical trial. Methods and materials: Patients with head-and-neck cancer were randomized to pilocarpine (n = 65) vs. placebo (n = 65) during RT. QOL was measured using the McMaster Head and Neck Radiotherapy Questionnaire (HNRQ). Xerostomia was measured on a linear analog scale. No statistically significant differences were observed between arms; all 130 patients were analyzed together. Results: Baseline QOL data were obtained for 98.5% of participants. The baseline HNRQ score of 5.7 declined significantly to 4.0 (p <0.0001) by RT Week 6 and returned to baseline (5.8) by 6 months after treatment. This represents a large, clinically important change of 1.7 of 7 (24%; effect size 1.34). The decline in HNRQ score during RT paralleled the onset of xerostomia on the linear analog scale (r = 0.36 at 1 month). After treatment, the QOL scores recovered without improvement in xerostomia. The trajectory of the linear analog scale score resembled that of the HNRQ's single xerostomia question (r = 0.75 at 1 month). Conclusion: Quality of life recovers to baseline after RT, despite persistent xerostomia. Either a response shift occurs or xerostomia in the absence of acute mucositis has a relatively small influence on overall QOL

  1. Current oncologic concepts and emerging techniques for imaging of head and neck squamous cell cancer [

    Directory of Open Access Journals (Sweden)

    Sadick, Haneen

    2012-12-01

    Full Text Available [english] The incidence of head and neck squamous cell carcinoma (HNSCC is increasing and currently they account for 5% of all malignancies worldwide. Inspite of ongoing developments in diagnostic imaging and new therapeutic options, HNSCC still represents a multidisciplinary challenge.One of the most important prognostic factors in HNSCC is the presence of lymph node metastases. Patients with confirmed nodal involvement have a considerable reduction of their 5-year overall survival rate. In the era of individually optimised surgery, chemotherapy and intensity modulated radiotherapy, the main role of pre- and posttherapeutic imaging remains cancer detection at an early stage and accurate follow-up. The combined effort of early diagnosis and close patient monitoring after surgery and/or radio-chemotherapy influences disease progression and outcome predicition in patients with HNSCC.This review article focuses on currrent oncologic concepts and emerging tools in imaging of head and neck squamous cell cancer. Besides the diagnostic spectrum of the individual imaging modalities, their limitations are also discussed. One main part of this article is dedicated to PET-CT which combines functional and morphological imaging. Furthermore latest developments in MRI are presented with regard to lymph node staging and response prediction. Last but not least, a clinical contribution in this review explains, which information the head and neck surgeon requires from the multimodality imaging and its impact on operation planning.

  2. Radiosensitization of head and neck cancer cells by the phytochemical agent sulforaphane

    Energy Technology Data Exchange (ETDEWEB)

    Kotowski, Ulana; Heiduschka, Gregor; Brunner, Markus; Fahim, Tammer; Thurnher, Dietmar [Medical University of Vienna (Austria). Dept. of Otorhinolaryngology, Head and Neck Surgery; Czembirek, Cornelia; Eder-Czembirek, Christina [Medical University of Vienna (Austria). Dept. of Cranio-, Maxillofacial and Oral Surgery; Schmidt, Rainer [Medical University of Vienna (Austria). Dept. of Radiotherapy and -biology

    2011-09-15

    Sulforaphane is a naturally occurring compound found in broccoli and other cruciferous vegetables. Recently it gained attention because of its antiproliferative properties in many cancer cell lines. The aim of this study was to investigate whether sulforaphane could act as a radiosensitizer in head and neck squamous cell carcinoma cell lines. Four head and neck squamous cell carcinoma cell lines (i.e., (HNSCC) SCC9, SCC25, CAL27, and FADU) were treated with sulforaphane and subsequently irradiated. Then proliferation and clonogenic assays were performed. Apoptosis was detected by flow cytometry. Possible regulation of Akt and Mcl-1 was investigated by western blotting. Sulforaphane and radiation in combination leads to stronger inhibition of cell proliferation and of clonogenic survival than each treatment method alone. Western blot analysis of Akt and Mcl-1 showed no changed expression. Sulforaphane is a promising agent in the treatment of head and neck cancer due to its antiproliferative and radio-sensitizing properties. A combination of sulforaphane and radiation decreases clonogenic survival. Apoptosis is not regulated through Akt or the Mcl-1 protein. (orig.)

  3. Nonrigid Image Registration for Head and Neck Cancer Radiotherapy Treatment Planning With PET/CT

    International Nuclear Information System (INIS)

    Purpose: Head and neck radiotherapy planning with positron emission tomography/computed tomography (PET/CT) requires the images to be reliably registered with treatment planning CT. Acquiring PET/CT in treatment position is problematic, and in practice for some patients it may be beneficial to use diagnostic PET/CT for radiotherapy planning. Therefore, the aim of this study was first to quantify the image registration accuracy of PET/CT to radiotherapy CT and, second, to assess whether PET/CT acquired in diagnostic position can be registered to planning CT. Methods and Materials: Positron emission tomography/CT acquired in diagnostic and treatment position for five patients with head and neck cancer was registered to radiotherapy planning CT using both rigid and nonrigid image registration. The root mean squared error for each method was calculated from a set of anatomic landmarks marked by four independent observers. Results: Nonrigid and rigid registration errors for treatment position PET/CT to planning CT were 2.77 ± 0.80 mm and 4.96 ± 2.38 mm, respectively, p = 0.001. Applying the nonrigid registration to diagnostic position PET/CT produced a more accurate match to the planning CT than rigid registration of treatment position PET/CT (3.20 ± 1.22 mm and 4.96 ± 2.38 mm, respectively, p = 0.012). Conclusions: Nonrigid registration provides a more accurate registration of head and neck PET/CT to treatment planning CT than rigid registration. In addition, nonrigid registration of PET/CT acquired with patients in a standardized, diagnostic position can provide images registered to planning CT with greater accuracy than a rigid registration of PET/CT images acquired in treatment position. This may allow greater flexibility in the timing of PET/CT for head and neck cancer patients due to undergo radiotherapy

  4. [Head and neck cancer treatment in the elderly].

    Science.gov (United States)

    Dulguerov, N; Caparrotti, F; Mach, N; Dulguerov, P

    2015-09-30

    We compared the treatment modalities as well as the oncologic outcome between young elderly (65-79 years old), elderly (>80 years old) and the reference population (<65 years old.) We reviewed 1047 patients treated between 2002 and 2012. Tumor sites, TNM stages, type of treatment, and the oncologic results are compared with survival statistics. The elderly group was associated with an increase in palliative treatment, more women and advanced T stages. For the 947 patients treated with curative intent, 5 year recurrence free survival was comparable. The overall-survival decreases with the age because of intercurrent deaths. Nevertheless, the treatment efficacy is similar. In conclusion, an advanced age is associated with worse survival, without a decrease in loco-regional control. The chronological age should not be used as a predictive factor for treatment response. PMID:26619703

  5. Lessons Learned from Unfavorable Microsurgical Head and Neck Reconstruction: Japan National Cancer Center Hospital and Okayama University Hospital.

    Science.gov (United States)

    Kimata, Yoshihiro; Matsumoto, Hiroshi; Sugiyama, Narusi; Onoda, Satoshi; Sakuraba, Minoru

    2016-10-01

    The risk of surgical site infection (SSI) remains high after major reconstructive surgery of the head and neck. Clinical data regarding SSI in microsurgical tongue reconstruction are described at National Cancer Hospital in Japan, including discussions of unfavorable representative cases, the relationship between SSI and preoperative irradiation at Okayama University Hospital in Japan, and strategies for SSI control in head and neck reconstruction. Local complications are inevitable in patients undergoing reconstruction in the head and neck areas. The frequency of major complications can be decreased, and late postoperative complications can be prevented with the help of appropriate methods. PMID:27601396

  6. Teeth and irradiation in head and neck cancer

    International Nuclear Information System (INIS)

    Pre-irradiation dental care depends on teeth health, fields and dose of irradiation, compliance to fluorides, cessation of tobacco and psycho-social cofactors. Dental care aims at preventing complications and preserving the quality of life (eating, speech and aesthetics). Approximately 11% of patients do not require any pre-irradiation dental care. Dental complications vary from slight colorations of the teeth to major complication such as osteoradionecrosis. Osteoradionecrosis rates vary from 1 to 9%, and may be decreased by using a 21-day delay between extractions and irradiation, provided that it does not postpone cancer treatment, with a dose-dependent risk (60 Gy). Osteoradionecrosis occurs spontaneously (35%), mostly involves the mandible (85%). (authors)

  7. A Phase 1 Study of Everolimus + Weekly Cisplatin + Intensity Modulated Radiation Therapy in Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Fury, Matthew G. [Department of Medicine, Head and Neck Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Department of Medicine, Weill Cornell Medical College, New York, New York (United States); Lee, Nancy Y. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Sherman, Eric; Ho, Alan L. [Department of Medicine, Head and Neck Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Department of Medicine, Weill Cornell Medical College, New York, New York (United States); Rao, Shyam [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Heguy, Adriana [Department of Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Shen, Ronglai [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Korte, Susan; Lisa, Donna [Department of Medicine, Head and Neck Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Ganly, Ian; Patel, Snehal; Wong, Richard J.; Shaha, Ashok; Shah, Jatin [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Haque, Sofia [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Katabi, Nora [Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Pfister, David G. [Department of Medicine, Head and Neck Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Department of Medicine, Weill Cornell Medical College, New York, New York (United States)

    2013-11-01

    Purpose: Elevated expression of eukaryotic protein synthesis initiation factor 4E (eIF4E) in histologically cancer-free margins of resected head and neck squamous cell carcinomas (HNSCCs) is mediated by mammalian target of rapamycin complex 1 (mTORC1) and has been associated with increased risk of disease recurrence. Preclinically, inhibition of mTORC1 with everolimus sensitizes cancer cells to cisplatin and radiation. Methods and Materials: This was single-institution phase 1 study to establish the maximum tolerated dose of daily everolimus given with fixed dose cisplatin (30 mg/m{sup 2} weekly × 6) and concurrent intensity modulated radiation therapy for patients with locally and/or regionally advanced head-and-neck cancer. The study had a standard 3 + 3 dose-escalation design. Results: Tumor primary sites were oral cavity (4), salivary gland (4), oropharynx (2), nasopharynx (1), scalp (1), and neck node with occult primary (1). In 4 of 4 cases in which resected HNSCC surgical pathology specimens were available for immunohistochemistry, elevated expression of eIF4E was observed in the cancer-free margins. The most common grade ≥3 treatment-related adverse event was lymphopenia (92%), and dose-limiting toxicities (DLTs) were mucositis (n=2) and failure to thrive (n=1). With a median follow up of 19.4 months, 2 patients have experienced recurrent disease. The maximum tolerated dose was everolimus 5 mg/day. Conclusions: Head-and-neck cancer patients tolerated everolimus at therapeutic doses (5 mg/day) given with weekly cisplatin and intensity modulated radiation therapy. The regimen merits further evaluation, especially among patients who are status post resection of HNSCCs that harbor mTORC1-mediated activation of eIF4E in histologically negative surgical margins.

  8. Head and Neck Sarcomas: A Comprehensive Cancer Center Experience

    Directory of Open Access Journals (Sweden)

    Margaret von Mehren

    2013-07-01

    Full Text Available Head/neck sarcomas are rare, accounting for about 1% of head/neck malignancies and 5% of sarcomas. Outcomes have historically been worse in this group, due to anatomic constraints leading to difficulty in completely excising tumors, with high rates of local recurrence. We retrospectively analyzed cases of head/neck soft tissue sarcomas (STS and osteogenic sarcomas managed in a multi-disciplinary setting at Fox Chase Cancer Center from 1999–2009 to describe clinicopathologic characteristics, treatment, outcomes, and prognostic factors for disease control and survival. Thirty patients with STS and seven patients with osteogenic sarcoma were identified. Most STS were high grade (23 and almost all were localized at presentation (28. Common histologies were synovial cell (6, rhabdomyosarcoma (5, angiosarcoma (4, liposarcoma (4 and leiomyosarcoma (3. The type of primary therapy and disease outcomes were analyzed. Cox proportional hazards regression analysis was performed to identify predictors of disease-free survival (DFS and overall survival (OS. The HR and 95% CI for Cox model and median DFS/OS analyzed by Kaplan-Meier curves were calculated.

  9. Prophylactic treatment of mycotic mucositis in radiotherapy of patients with head and neck cancers

    Energy Technology Data Exchange (ETDEWEB)

    Koc, M.; Aktas, E. [Ataturk Univ., Erzurum (Turkey). Medical School

    2003-02-01

    Patients undergoing radiotherapy for head and neck cancer are at increased risk of developing oral candidiasis. The objective of this study was to investigate the clinical Candida mucositis and interruptions in radiotherapy in patients suffering from head and neck cancer, receiving fluconazole in comparison with a control group without specific prophylaxis. Eighty consecutive patients were randomized in a prospective double-blind trial of prophylactic oral fluconazole or treatment with the same drug when mycotic infections appeared. Adult head and neck cancer patients who were undergoing treatment with radiotherapy and/or chemotherapy, radiotherapeutic coverage of the entire oropharynx and oral cavity at least 3 cm anterior to the retromolar trigone and receiving a total dose of more than 6000 cGy and Karnofsky Performance Status (KPS) >70 were included in the study. Group A received radiation therapy plus fluconazole (Fluzole 100 mg/day) starting from the sixth irradiation session throughout the treatment; 40 patients in group B received the same baseline treatment, but were given fluconazole only when mycotic infections appeared. We evaluated 37 patients in group A and the first 37 patients were evaluated in group B. Three of the patients in group A (8.1%) and 14 of the patients in group B (37.8%) demonstrated clinical candidasis. Radiotherapy was interrupted in all of these patients. The differences between the two groups were statistically significant with respect to clinical candidiasis (P=0.005). The median discontinuation time was 5 days (range, 3-7 days) in group A and 7 days (range, 4-10 days) in group B. The median dose resulting in clinical candidiasis was 3200 cGy (range, 2200-5800 cGy) in all groups. In the fluconazole group it was 4200 cGy and in the control group 2800 cGy. These results suggest that patients undergoing head and neck radiation therapy are at risk of developing candidiasis and that fluconazole may be used to reduce the frequency of

  10. Prophylactic treatment of mycotic mucositis in radiotherapy of patients with head and neck cancers

    International Nuclear Information System (INIS)

    Patients undergoing radiotherapy for head and neck cancer are at increased risk of developing oral candidiasis. The objective of this study was to investigate the clinical Candida mucositis and interruptions in radiotherapy in patients suffering from head and neck cancer, receiving fluconazole in comparison with a control group without specific prophylaxis. Eighty consecutive patients were randomized in a prospective double-blind trial of prophylactic oral fluconazole or treatment with the same drug when mycotic infections appeared. Adult head and neck cancer patients who were undergoing treatment with radiotherapy and/or chemotherapy, radiotherapeutic coverage of the entire oropharynx and oral cavity at least 3 cm anterior to the retromolar trigone and receiving a total dose of more than 6000 cGy and Karnofsky Performance Status (KPS) >70 were included in the study. Group A received radiation therapy plus fluconazole (Fluzole 100 mg/day) starting from the sixth irradiation session throughout the treatment; 40 patients in group B received the same baseline treatment, but were given fluconazole only when mycotic infections appeared. We evaluated 37 patients in group A and the first 37 patients were evaluated in group B. Three of the patients in group A (8.1%) and 14 of the patients in group B (37.8%) demonstrated clinical candidasis. Radiotherapy was interrupted in all of these patients. The differences between the two groups were statistically significant with respect to clinical candidiasis (P=0.005). The median discontinuation time was 5 days (range, 3-7 days) in group A and 7 days (range, 4-10 days) in group B. The median dose resulting in clinical candidiasis was 3200 cGy (range, 2200-5800 cGy) in all groups. In the fluconazole group it was 4200 cGy and in the control group 2800 cGy. These results suggest that patients undergoing head and neck radiation therapy are at risk of developing candidiasis and that fluconazole may be used to reduce the frequency of

  11. The Evolving Concepts of Cancer Stem Cells in Head and Neck Squamous Cell Carcinoma

    OpenAIRE

    Amit Shah; Shilpa Patel; Jigna Pathak; Niharika Swain; Shwetha Kumar

    2014-01-01

    There is increasing evidence that the growth and spread of cancers is driven by a small subpopulation of cancer stem cells (CSCs)—the only cells that are capable of long-term self-renewal and generation of the phenotypically diverse tumor cell population. CSCs have been identified and isolated in a variety of human cancers including head and neck squamous cell carcinoma (HNSCC). The concept of cancer stem cells may have profound implications for our understanding of tumor biology and for the ...

  12. Head and neck cancers in France: an analysis of the hospital medical information system (PMSI) database

    OpenAIRE

    Lacau St Guily, Jean; Borget, Isabelle; Vainchtock, Alexandre; Rémy, Vanessa; Takizawa, Claire

    2010-01-01

    Background With 16,005 new cases and 5,406 related deaths in 2005, France is particularly concerned by Head and Neck (H&N) cancers. In addition to tobacco and alcohol, Human Papillomavirus (HPV) has been reported as a risk factor for H&N cancers. The literature on the burden of these cancers in Europe is scarce. This study was performed to assess the medical and economical burden of hospitalisations for H&N cancers in France. Methods The French national hospital database (PMSI), in which admi...

  13. CT and MRI matching for radiotherapy planning in head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Rasch, C.; Keus, R.; Touw, A.; Lebesque, J.; Van Herk, M. [Nederlands Kanker Inst. `Antoni van Leeuwenhoekhuis`, Amsterdam (Netherlands)

    1995-12-01

    The objective of this study was to evaluate the impact of matched CT and MRI information on target delineation in radiotherapy planning for head and neck tumors. MRI images of eight patients with head and neck cancer in supine position, not necessarily obtained in radiotherapy treatment position were matched to the CT scans made in radiotherapy position using automatic three-dimensional chamfer-matching of bony structures. Four independent observers delineated the Gross Tumor Volume (GTV) in CT scans and axial and sagittal MR scans. The GTV`s were compared, overlapping volumes and non-overlapping volumes between the different datasets and observers were determined. In all patients a good match of CT and MRI information was accomplished in the head region. The combined information provided a better visualisation of the GTV, oedema and normal tissues compared with CT or MRI alone. Determination of overlapping and non-overlapping volumes proved to be a valuable tool to measure uncertainties in the determination of the GTV. CT-MRI matching in patients with head and neck tumors is feasible and makes a more accurate irradiation with higher tumor doses and less normal tissue complications possible. Remaining uncertainties in the determination of the GTV can be quantified using the combined information of MRI and CT.

  14. ACR Appropriateness Criteria Retreatment of Recurrent Head and Neck Cancer After Prior Definitive Radiation

    International Nuclear Information System (INIS)

    Recurrent and second primary head-and-neck squamous cell carcinomas arising within or in close proximity to previously irradiated fields are a common clinical challenge. Whereas surgical salvage therapy is recommended for resectable disease, randomized data support the role of postoperative reirradiation in high-risk patients. Definitive reirradiation is an established approach for patients with recurrent disease who are medically or technically inoperable or decline radical surgery. The American College of Radiology Expert Panel on Head and Neck Cancer reviewed the relevant literature addressing re-treatment after prior definitive radiation and developed appropriateness criteria for representative clinical scenarios. Examples of unresectable recurrent disease and microscopic residual disease after salvage surgery were addressed. The panel evaluated the appropriateness of reirradiation, the integration of concurrent chemotherapy, radiation technique, treatment volume, dose, and fractionation. The panel emphasized the importance of patient selection and recommended evaluation and treatment at tertiary-care centers with a head-and-neck oncology team equipped with the resources and experience to manage the complexities and toxicities of re-treatment.

  15. Radiotherapy with carbogen breathing and nicotinamide in head and neck cancer: feasibility and toxicity

    International Nuclear Information System (INIS)

    The feasibility and early toxicity of radiotherapy with carbogen breathing and nicotinamide was tested in 74 head and neck cancer patients. Forty patients with laryngeal and hypopharyngeal tumors were treated with an accelerated schedule combined with carbogen alone (16) or with carbogen and nicotinamide (24). Thirty-four patients with far advanced unresectable tumors of the oral cavity and oropharynx received conventional radiotherapy with carbogen [16] or with carbogen and nicotinamide (18). Some enhancement of skin reaction was observed with nicotinamide but this remained well within limits of tolerance. With the accelerated regimen there was increased severity of mucosal damage expressed as confluent mucositis in 95% of patients which required healing times of 3-4 months in four patients. Eventually restoration of the mucosal lining was complete in all cases. Nausea and vomiting are the most frequent side effects of nicotinamide and were reported by 60% and 36% of the subjects, respectively. In 26% this was reason to discontinue drug intake. Severe renal dysfunction was associated with nicotinamide intake in two patients of this study and in one other patient who presented later. It is our conclusion that radiotherapy combined with carbogen and nicotinamide is a safe treatment with manageable side effects. We recommend not to give nicotinamide concomitantly with nephrotoxic medication or to patients who have impaired renal function. Preliminary tumor control rates are encouraging and clinical testing will be continued

  16. Indication and possibility of boron neutron capture therapy in head and neck cancer

    International Nuclear Information System (INIS)

    Background: Boron neutron capture therapy (BNCT) is a targeted type of radiotherapy that has a number of significant advantages over conventional external beam photon irradiation, especially in that radiation can be selectively delivered to tumor cells. We had, first in the world, treated with BNCT for a patient with recurrent head and neck cancer (HNC) in 2001. Methods : From December, 2001 to February, 2013, we had treated 37 patients with recurrent HNC by means of 54 applications of BNCT at Kyoto University Research Reactor Institute (KURRI) and Japan Atomic Energy Agency (JAEA). All of them had received standard therapy and subsequently developed recurrent disease for which there were no other treatment options. Results : All of the (1) Regression rates were complete response (CR) : 19 patients (51%), partial response (PR) : 14(38%), progressive disease (PD) : 3(8%), and not evaluated (NE) : 1(3%) patient. (2) The overall patient response rate was 91%, though all the patients had advanced disease. The 4-year and 7-year OS rates were 42% and 36%, respectively. (3) BNCT improved quality of life (QOL), performance status (PS) and survival times. (4) The primary adverse events were brain necrosis, osteomyelitis and transient mucositis and alopecia. Conclusions : Our results indicate that we could make sure that safety and effectiveness of BNCT, and BNCT represents a new and promising treatment modality in patients for whom there are no other treatment options. (author)

  17. Head and neck squamous cell cancer (stages III and IV) induction chemotherapy assessment: value of FDG volumetric imaging parameters

    International Nuclear Information System (INIS)

    To evaluate whether the change in the metabolic tumour volume (MTV) or total lesion glycolysis (TLG) of the primary tumour, before and after induction chemotherapy, predicts outcome for patients with advanced head and neck squamous cell cancer (SCC). Twenty-eight patients with advanced (American Joint Committee on Cancer stage III and IV) head and neck SCC who underwent positron emission tomography (PET)/CT were included in this retrospective study. Primary tumour MTV and TLG were measured using gradient and fixed percentage threshold segmentations. Outcome endpoint was disease progression or mortality. Pearson correlation, Bland-Altman and receiver operator characteristic analysis were performed. The Pearson's correlation coefficients between percentage changes (pre- and post-induction chemotherapy) from gradient MTV (MTVG) and the 38% SUVmax threshold MTV (MTV38) was 0.96 and between MTVG and the 50% threshold MTV (MTV50) was 0.95 (PG and TLG38 was 0.94 and between TLGG and TLG50 was 0.96 (PG and MTV50. The areas under the curve for predicting progression or mortality were 0.76 (P=0.03) for MTVG and 0.82 for TLGG (P=0.009). Optimum cut points of a 42% reduction in MTVG and a 55% reduction in the TLGG predict event-free survival with a sensitivity of 62.5% and a specificity of 90% and a hazards ratio of 6.25. A reduction in primary tumour MTV of at least 42% or in TLG of at least 55% after induction chemotherapy may predict event-free survival in patients with advanced head and neck SCC.

  18. Nutritional supplement during the treatment with ionizing radiations in patients with head and neck tumors in advanced stages

    International Nuclear Information System (INIS)

    Malnutrition in the patient with advanced cancer favors immunosuppression and implies a low Karnofsky index, poor tolerance and response to the onco specific curative or palliative treatments, high susceptibility to infections and, as a result, a decline of the quality of life. Patients with head and neck tumors in advanced stages (III-IV) are one of the groups of high risk for malnutrition due to the reduction of the intake of nutrients, anorexia, alterations of the deglutition mechanism, and mechanical obstruction of the upper digestive tract, among other causes.Numerous studies show the convenience of the nutritional supplement in these patients during the onco specific treatment. A prospective study that included 15 patients with head and neck neoplasia in advanced stages, and with clinical signs of malnutrition, was conducted in order to evaluate the necessary calorie-energy supplement. All of them were administered an oral nutritional supplement (Adn-22 %) during the radiation treatment to assess the possibility of improving their tolerance and response to the treatment. Of the 15 studied cases, 13 presented complications in connection with the treatment, but most them were mild, and they did not affect in a significant way the time of duration and the total dose of treatment. There was a favorable response in relation to the tumor

  19. Improved VMAT planning for head and neck tumors with an advanced optimization algorithm

    International Nuclear Information System (INIS)

    In this study, the ''Progressive Resolution Optimizer PRO3'' (Varian Medical Systems) is compared to the previous version PRO2'' with respect to its potential to improve dose sparing to the organs at risk (OAR) and dose coverage of the PTV for head and neck cancer patients. Materials and Methods For eight head and neck cancer patients, volumetric modulated arc therapy (VMAT) treatment plans were generated in this study. All cases have 2-3 phases and the total prescribed dose (PD) was 60-72 Gy in the PTV. The study is mainly focused on the phase 1 plans, which all have an identical PD of 54 Gy, and complex PTV structures with an overlap to the parotids. Optimization was performed based on planning objectives for the PTV according to ICRU83, and with minimal dose to spinal cord, and parotids outside PTV. In order to assess the quality of the optimization algorithms, an identical set of constraints was used for both, PRO2 and PRO3. The resulting treatment plans were investigated with respect to dose distribution based on the analysis of the dose volume histograms. Results For the phase 1 plans (PD = 54 Gy) the near maximum dose D2% of the spinal cord, could be minimized to 22±5 Gy with PRO3, as compared to 32±12 Gy with PRO2, averaged for all patients. The mean dose to the parotids was also lower in PRO3 plans compared to PRO2, but the differences were less pronounced. A PTV coverage of V95% = 97±1% could be reached with PRO3, as compared to 86±5% with PRO2. In clinical routine, these PRO2 plans would require modifications to obtain better PTV coverage at the cost of higher OAR doses. Conclusion A comparison between PRO3 and PRO2 optimization algorithms was performed for eight head and neck cancer patients. In general, the quality of VMAT plans for head and neck patients are improved with PRO3 as compared to PRO2. The dose to OARs can be reduced significantly, especially for the spinal cord. These reductions are achieved with better

  20. Improved VMAT planning for head and neck tumors with an advanced optimization algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Klippel, Norbert; Schmuecking, Michael; Terribilini, Dario; Geretschlaeger, Andreas; Aebersold, Daniel M.; Manser, Peter [Bern University Hospital - Inselspital (Switzerland). Div. of Medical Radiation Physics and Dept. of Radiation Oncology

    2015-07-01

    In this study, the ''Progressive Resolution Optimizer PRO3'' (Varian Medical Systems) is compared to the previous version PRO2'' with respect to its potential to improve dose sparing to the organs at risk (OAR) and dose coverage of the PTV for head and neck cancer patients. Materials and Methods For eight head and neck cancer patients, volumetric modulated arc therapy (VMAT) treatment plans were generated in this study. All cases have 2-3 phases and the total prescribed dose (PD) was 60-72 Gy in the PTV. The study is mainly focused on the phase 1 plans, which all have an identical PD of 54 Gy, and complex PTV structures with an overlap to the parotids. Optimization was performed based on planning objectives for the PTV according to ICRU83, and with minimal dose to spinal cord, and parotids outside PTV. In order to assess the quality of the optimization algorithms, an identical set of constraints was used for both, PRO2 and PRO3. The resulting treatment plans were investigated with respect to dose distribution based on the analysis of the dose volume histograms. Results For the phase 1 plans (PD = 54 Gy) the near maximum dose D{sub 2%} of the spinal cord, could be minimized to 22±5 Gy with PRO3, as compared to 32±12 Gy with PRO2, averaged for all patients. The mean dose to the parotids was also lower in PRO3 plans compared to PRO2, but the differences were less pronounced. A PTV coverage of V{sub 95%} = 97±1% could be reached with PRO3, as compared to 86±5% with PRO2. In clinical routine, these PRO2 plans would require modifications to obtain better PTV coverage at the cost of higher OAR doses. Conclusion A comparison between PRO3 and PRO2 optimization algorithms was performed for eight head and neck cancer patients. In general, the quality of VMAT plans for head and neck patients are improved with PRO3 as compared to PRO2. The dose to OARs can be reduced significantly, especially for the spinal cord. These reductions are achieved

  1. Effect of Recombinant Human Deoxyribonuclease on Oropharyngeal Secretions in Patients With Head-and-Neck Cancers Treated With Radiochemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Mittal, Bharat B., E-mail: bmittal@nmh.org [Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (United States); Wang, Edward [Department of Surgery, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (United States); Sejpal, Samir [Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (United States); Agulnik, Mark [Section of Medical Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (United States); Mittal, Amit [Yale University, New Haven, Connecticut (United States); Harris, Kirk [Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado (United States)

    2013-10-01

    Purpose: The current study examined the effect of recombinant human deoxyribonuclease (rhDNase) on quality of life (QOL) measures, clinical improvement, and DNA content of thick oropharyngeal secretions (OPS) in patients with head-and-neck (H and N) cancers. Methods and Materials: Thirty-six patients with local-regional advanced H and N cancer receiving chemoradiationtherapy (CRT) were randomized to receive either placebo or rhDNase. Endpoints included MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) and Functional Assessment of Cancer Therapy–Head and Neck (FACT-NH) scores, along with clinical assessment and DNA concentration of OPS. Results: There were no statistically significant differences in patients' QOL outcomes over the study period. Both groups showed an increase in symptom and interference scores, although patients in the rhDNase group showed a greater decline in both scores during the 3 months posttreatment. Similarly, both groups showed a decline in physical and functional well being but recovered in the 3 months posttreatment follow-up, with the rhDNase group exhibiting speedier recovery. Patients in the rhDNase group exhibited significant clinical improvement in OPS, blindly assessed by a physician, compared with the placebo group (67% vs 27%, respectively; P=.046). The rhDNase group showed no change in OPS-DNA concentration, although the placebo group showed a significant increase in DNA concentration during the drug trial (P=.045). There was no differences in acute toxicities between the 2 groups. Conclusions: Our preliminary data suggest that rhDNase did not significantly improve study primary endpoints of QOL measures compared with the placebo group. However, there was a significant improvement in secondary endpoints of clinically assessed OPS and DNA concentration compared with placebo in H and N cancer patients treated with CRT. Further investigation in larger numbers of patients is warranted.

  2. Matrix Metalloproteinases: The Gene Expression Signatures of Head and Neck Cancer Progression

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    Iizuka, Shinji [Sanford-Burnham Medical Research Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037 (United States); Ishimaru, Naozumi; Kudo, Yasusei, E-mail: yasusei@tokushima-u.ac.jp [Department of Oral Molecular Pathology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-8-15 Kuramoto, Tokushima 770-8504 (Japan)

    2014-02-13

    Extracellular matrix degradation by matrix metalloproteinases (MMPs) plays a pivotal role in cancer progression by promoting motility, invasion and angiogenesis. Studies have shown that MMP expression is increased in head and neck squamous cell carcinomas (HNSCCs), one of the most common cancers in the world, and contributes to poor outcome. In this review, we examine the expression pattern of MMPs in HNSCC by microarray datasets and summarize the current knowledge of MMPs, specifically MMP-1, -3, -7 -10, -12, -13, 14 and -19, that are highly expressed in HNSCCs and involved cancer invasion and angiogenesis.

  3. Matrix Metalloproteinases: The Gene Expression Signatures of Head and Neck Cancer Progression

    International Nuclear Information System (INIS)

    Extracellular matrix degradation by matrix metalloproteinases (MMPs) plays a pivotal role in cancer progression by promoting motility, invasion and angiogenesis. Studies have shown that MMP expression is increased in head and neck squamous cell carcinomas (HNSCCs), one of the most common cancers in the world, and contributes to poor outcome. In this review, we examine the expression pattern of MMPs in HNSCC by microarray datasets and summarize the current knowledge of MMPs, specifically MMP-1, -3, -7 -10, -12, -13, 14 and -19, that are highly expressed in HNSCCs and involved cancer invasion and angiogenesis

  4. Parotid gland sparing IMRT for head and neck cancer improves xerostomia related quality of life

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    Balm AJM

    2008-12-01

    Full Text Available Abstract Background and purpose To assess the impact of intensity modulated radiotherapy (IMRT versus conventional radiation on late xerostomia and Quality of Life aspects in head and neck cancer patients. Patients and nethods Questionnaires on xerostomia in rest and during meals were sent to all patients treated between January 1999 and December 2003 with a T1-4, N0-2 M0 head and neck cancer, with parotid gland sparing IMRT or conventional bilateral neck irradiation to a dose of at least 60 Gy, who were progression free and had no disseminated disease (n = 192. Overall response was 85% (n = 163; 97% in the IMRT group (n = 75 and 77% in the control group (n = 88 the median follow-up was 2.6 years. The prevalence of complaints was compared between the two groups, correcting for all relevant factors at multivariate ordinal regression analysis. Results Patients treated with IMRT reported significantly less difficulty transporting and swallowing their food and needed less water for a dry mouth during day, night and meals. They also experienced fewer problems with speech and eating in public. Laryngeal cancer patients in general had fewer complaints than oropharynx cancer patients but both groups benefited from IMRT. Within the IMRT group the xerostomia scores were better for those patients with a mean parotid dose to the "spared" parotid below 26 Gy. Conclusion Parotid gland sparing IMRT for head and neck cancer patients improves xerostomia related quality of life compared to conventional radiation both in rest and during meals. Laryngeal cancer patients had fewer complaints but benefited equally compared to oropharyngeal cancer patients from IMRT.

  5. Parotid gland sparing IMRT for head and neck cancer improves xerostomia related quality of life

    International Nuclear Information System (INIS)

    To assess the impact of intensity modulated radiotherapy (IMRT) versus conventional radiation on late xerostomia and Quality of Life aspects in head and neck cancer patients. Questionnaires on xerostomia in rest and during meals were sent to all patients treated between January 1999 and December 2003 with a T1-4, N0-2 M0 head and neck cancer, with parotid gland sparing IMRT or conventional bilateral neck irradiation to a dose of at least 60 Gy, who were progression free and had no disseminated disease (n = 192). Overall response was 85% (n = 163); 97% in the IMRT group (n = 75) and 77% in the control group (n = 88) the median follow-up was 2.6 years. The prevalence of complaints was compared between the two groups, correcting for all relevant factors at multivariate ordinal regression analysis. Patients treated with IMRT reported significantly less difficulty transporting and swallowing their food and needed less water for a dry mouth during day, night and meals. They also experienced fewer problems with speech and eating in public. Laryngeal cancer patients in general had fewer complaints than oropharynx cancer patients but both groups benefited from IMRT. Within the IMRT group the xerostomia scores were better for those patients with a mean parotid dose to the 'spared' parotid below 26 Gy. Parotid gland sparing IMRT for head and neck cancer patients improves xerostomia related quality of life compared to conventional radiation both in rest and during meals. Laryngeal cancer patients had fewer complaints but benefited equally compared to oropharyngeal cancer patients from IMRT

  6. SPARC Expression Correlates with Tumor Response to Albumin-Bound Paclitaxel in Head and Neck Cancer Patients

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    Desai, Neil; Trieu, Vuong; Damascelli, Bruno; Soon-Shiong, Patrick

    2009-01-01

    SPARC up-regulation is a poor prognostic factor in head and neck cancer. It was hypothesized that because of a SPARC-albumin interaction, tumoral SPARC facilitates the accumulation of albumin in the tumor and increases the effectiveness of albumin-bound paclitaxel (nab-paclitaxel). This hypothesis was tested by correlating the response to nab-paclitaxel and SPARC tumor expression in a retrospective analysis of a 60-patient clinical study of nab-paclitaxel as monotherapy against head and neck ...

  7. Alterations in plasma lipid profile patterns in head and neck cancer and oral precancerous conditions

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    Patel Prabhudas

    2004-01-01

    Full Text Available BACKGROUND : The changes in lipid profile have long been associated with cancer because lipids play a key role in maintenance of cell integrity. AIMS : The present study evaluated alterations in plasma lipid profile in untreated head and neck cancer patients as well as patients with oral precancerous conditions (OPC and its association with habit of tobacco consumption. MATERIAL AND METHODS : This hospital-based case control study included 184 head and neck cancer patients, 153 patients with OPC and 52 controls. Plasma lipids including: (i Total cholesterol, (ii LDL cholesterol (LDLC, (iii HDL cholesterol (HDLC (iv VLDL cholesterol (VLDLC and (v triglycerides were analysed by spectrophotometric kits. STATISTICAL ANALYSIS USED : Student′s t-test was performed to compare mean values of the parameters. RESULTS : A significant decrease in plasma total cholesterol and HDLC was observed in cancer patients (P=0.008 and P=0.000 respectively as well as in patients with OPC (P=0.014 and P=0.000, respectively as compared to the controls. The plasma VLDL and triglycerides levels were significantly lower in cancer patients as compared to the patients with OPC (P=0.04 and controls (P=0.059. The tobacco habituates showed lower plasma lipid levels than the non-habituates. Our data strengthen the evidence of an inverse relationship between plasma lipid levels and head and neck malignancies as well as OPC. CONCLUSION :The lower levels of plasma cholesterol and other lipid constituents in patients might be due to their increased utilization by neoplastic cells for new membrane biogenesis. The findings strongly warrant an in-depth study of alterations in plasma lipid profile in head neck cancer patients.

  8. The Cancer Stem Cell Concept in Progression of Head and Neck Cancer

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    Zhuo (Georgia Chen

    2009-01-01

    Full Text Available Human head and neck cancer (HNC is a highly heterogeneous disease. Understanding the biology of HNC progression is necessary for the development of novel approaches to its prevention, early detection, and treatment. A current evolutional progression model has limitations in explaining the heterogeneity observed in a single tumor nest. Accumulating evidence supports the existence of cancer stem cells (CSCs as small subpopulations in solid tumors, including HNC. These CSCs can be selected by appropriate cell surface markers, which are cancer type specific and have been confirmed by unique in vitro and in vivo assays. Selected CSC populations maintain a self-renewal capability and show aggressive behaviors, such as chemoresistance and metastasis. In addition to introducing the CSC concept in solid tumors, this short review summarizes current publications in HNC CSC and the prospective development and application of the CSC concept to HNC in the clinic.

  9. A relationship between quality-of-life and head and neck cancer: A systemic review

    Science.gov (United States)

    Parkar, Sujal Mitul; Shah, Mihir N.

    2015-01-01

    Aim: The aim was to identify the literature and to assess the association between quality-of-life (QoL) and head and neck cancer (HNC) related outcomes systemically. Materials and Methods: The full articles published in English language bio-medical journals between 1992 and December 2014 were searched using Medline database. The keywords used for searching the articles include the combination of “health-related of QoL,” “QoL,” “HNC.” The search limited only to the observational studies using questionnaires European Organization for Research and Treatment of Cancer (EORTC) QLQ C 30 and EORTC QLQ H and N 35. Purely psychological studies were excluded. Results: A total of 5055 articles were retrieved, and 16 articles were selected for this review. Of 16 observational studies, 13 (81.25%) were prospective cohort studies while remaining 3 (18.75%) were cross-sectional studies. The main findings of the studies revealed that the treatment of HNC had a statistically significant influence on QoL. Others associated factors like age, female sex, duration of treatment, advance tumor, and site of the tumor has also the impact on QoL on patients suffering from HNC. Conclusion: This review provides evidence for a positive relationship between cancer-related outcomes and QoL. Assessment of QoL in relation to HNC with proper methodology and validated instruments is lacking hence there is a need for further evidence to support the relation between cancer and QoL. PMID:26981509

  10. [Genes associated with tobacco smoke-associated cancer of head and neck].

    Science.gov (United States)

    Szyfter, Krzysztof; Giefing, Maciej; Jarmuz, Małgorzata; Kostrzewska-Poczekaj, Magdalena

    2008-01-01

    The article presents the current techniques used for the identification of genes involved in tobacco smoke-associated cancers. The focus is set on the techniques derived from the conventional cytogenetics and includes fluorescence in situ hybridization (FISH), comparative genomes hybridization (CGH) and its further improvement that is array-CGH, and other aspects of microarray DNA technology. The second part deals with the main findings concerning participation of oncogenes and tumor suppressor genes in development and progression of tobacco smoke-associated head and neck cancers. PMID:19189577

  11. The contribution of cetuximab in the treatment of recurrent and/or metastatic head and neck cancer

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    Mohamedtaki A Tejani

    2010-06-01

    Full Text Available Mohamedtaki A Tejani, Roger B Cohen, Ranee MehraDepartment of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USAAbstract: Recurrent and/or metastatic squamous cell carcinoma of the head and neck (HNSCC continues to be a source of significant morbidity and mortality worldwide. Agents that target the epidermal growth factor receptor (EGFR have demonstrated beneficial effects in this setting. Cetuximab, a monoclonal antibody against the EGFR, improves locoregional control and overall survival when used as a radiation sensitizer in patients with locoregionally advanced HNSCC undergoing definitive radiation therapy with curative intent. Cetuximab is also active as monotherapy in patients whose cancer has progressed on platinum-containing therapy. In the first-line setting for incurable HNSCC, cetuximab added to platinum-based chemotherapy significantly improves overall survival compared with standard chemotherapy alone. These positive results have had a significant impact on the standard of care for advanced HNSCC. In this review, we will discuss the mechanism of action, clinical data and common toxicities that pertain to the use of cetuximab in the treatment of advanced incurable HNSCC.Keywords: cetuximab, squamous cell carcinoma of the head and neck, epidermal growth factor receptor

  12. Antiproliferative study of B. javanica extracts against head and neck cancer cells

    International Nuclear Information System (INIS)

    Brucea javanica or locally known as Meladapahit, are being used in Malaysia as traditional medicine mainly for the treatment of diabetes mellitus and hypertension. In order to study the potential use of this plant for cancer treatment, we have prepared crude extracts of the leaves and fruits, and assessed them for antiproliferative activities against head and neck cancer cell line which is HTB-43. The dried and ground leaves and fruits of the plant were successively extracted using hexane, chloroform, methanol and water, respectively. Inhibition of growth of the cultured cancer cells line was measured using a standard Micro culture Tetrazolium Technique (MTT) assay. The crude extracts were also subjected to toxicity test using brine shrimp lethality assay. Most of the tested crude extracts exhibited significant antiproliferative activities against the HTB-43 cell with IC50 ranging from 8.46 μg/ml to 47.25 μg/ml. The chloroform extract from the leaves gave the highest antiproliferative activity (IC50, 8.46 μg/ml). Hexane extract from the fruits, aqueous and hexane extracts from B. javanica leaves showed low antiproliferative activities to the HTB-43 cell line with an IC50 values >100 μg/ml. The chloroform extracts from fruits and leaves and methanol extract from fruits induced toxicity against brine shrimps with LC50 values of 118.7 μg/ml, 512.44 μg/ml and 75.27 μg/ml respectively. It indicated that bioactive components presence in the crude extracts for its pharmacologic effects against head and neck cancer cells. Methanolic extract of Brucea javanica fruit was selected as the most effective extract to inhibit the growth of head and neck cancer cells (HTB-43) by the two different assays used. (author)

  13. P53 overexpression and outcome of radiation therapy in head and neck cancers

    International Nuclear Information System (INIS)

    Experimental studies have implicated the wild type p53 in cellular response to radiation. Whether altered p53 function can lead to changes in clinical radiocurability remains an area of ongoing study. This study was performed to investigate whether any correlation between change of p53 and outcome of curative radiation therapy in patients with head and neck cancers. Immunohistochemical analysis with a mouse monoclonal antibody (D0-7) specific for human p53 was used to detect to overexpression of protein in formalin fixed, paraffin-embedded tumor sample from 55 head and neck cancer patients treated with curative radiation therapy (median dose of 7020 cGy) from February 1988 to March 1996 at St. Mary's Hospital. Overexpression of p53 was correlated with locoregional control and survival using Kaplan-Meier method. A Cox regression multivariate analysis was performed that included all clinical variables and status of p53 expression. Thirty-seven (67.2%) patients showed overexpression of p53 by immunohistochemical staining in their tumor. One hundred percent of oral cavity, 76% of laryngeal, 66.7% of oropharyngeal, 66.7% of hypopharyngeal cancer showed p53 overexpression (p=0.05). The status of p53 had significant relationship with stage of disease (p=0.03) and history of smoking (p=0.001). The overexpression of p53 was not predictive of response rate to radiation therapy. The locoregional control was not significantly affected by p53 status. Overexpression of p53 didn't have any prognostic implication for disease free survival and overall survival. Primary site and stage of disease were significant prognostic factors for survival. The p53 overexpression as detected by immunohistochemical staining had significant correlation with stage, primary site of disease and smoking habit of patients. The p53 overexpression didn't have any predictive value for outcome of curative radiation therapy in a group of head and neck cancers

  14. Combined image interpretation of computed tomography and hybrid PET in head and neck cancer

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    Zimny, M.; Cremerius, U.; Nowak, B.; Buell, U. [Technische Hochschule Aachen (Germany). Klinik fuer Nuklearmedizin; Wildberger, J.E. [Dept. of Diagnostic Radiology, Univ. of Technology, Aachen (Germany); DiMartino, E. [Dept. of Otorhinolaryngology, Univ. of Technology, Aachen (Germany); Jaenicke, S. [Dept. of Maxillofacial and Facial Plastic Surgery, Univ. of Technology, Aachen (Germany)

    2002-02-01

    Aim: Evaluation of potential synergistic effects of combined image interpretation of FDG PET using a gamma camera modified for coincidence detection (hybrid PET) and computed tomography (CT) and comparison of the diagnostic accuracy of hybrid PET and dedicated PET in patients with head and neck cancer. Methods: Forty-two patient with suspected primary or recurrent cancer were included. Twenty-four patients underwent dedicated PET in addition to attenuation-corrected hybrid PET using a one-day protocol. Results: Sensitivity, specificity and accuracy for detection of primary or recurrent head and neck cancer were 74, 73, and 74% for hybrid PET, 52, 82, and 60% for CT and 77, 82, and 79% for combined reading. With the combination of CT and hybrid PET all cases of recurrent disease were detected. The largest tumour not detected was 1.7 cm in diameter. Sensitivity, specificity and accuracy for the detection of neck sides with lymph node metastases were 69, 88, and 85% for hybrid PET, 62, 88, and 84% for CT, 69, 99, and 94% for combined image interpretation. With combined interpretation four involved neck sides were missed including two cases of microscopic metastases. Hybrid PET revealed concordant results to dedicated PET in all patients with respect to the detection of primary or recurrent tumour and in 45 of 48 neck sides (94%) with the same number of false negative findings. Conclusion: The combination of functional information of hybrid PET and morphological information of CT by the simple approach of combined image interpretation improves the sensitivity for the detection of primary/recurrent head and neck cancer and increases the specificity of lymph node staging compared to CT alone. The accuracy of hybrid PET and dedicated PET was almost identical. (orig.)

  15. The effect of radiotherapy on survival of dental implants in head and neck cancer patients

    Science.gov (United States)

    Al-Shamiri, Hashem-Motahir; Al-Maweri, Sadeq; Tarakji, Bassel

    2016-01-01

    Objectives To explore the current literature of the survival of dental implants in irradiated head and neck cancer patients considering the role of implant location, bone augmentation, dose of radiation and timing of implant placement. Study Design Pubmed search was conducted to identify articles published between January 2000 and December 2014 and presenting data of dental implant survival with radiotherapy in head and neck cancer patients. Studies on animal subjects and craniofacial implants were excluded. Results 18 articles out of 27 were eligible for inclusion in this systematic review. 12 out of 18 studies reported favorable outcome of dental implants and radiotherapy with survival rates between 74.4% and 97%. Seven out of ten studies comparing the survival rates according to site of implant placement reported that implants were found to osseointegrate with greater success in the irradiated mandible than irradiated maxilla. 5 studies which compared implant survival in irradiated native bone versus irradiated grafted bone reported that irradiated grafted bone showed a significantly reduced dental implant survival rate in comparison to irradiated native bone. 6 out of 18studies in which radiation doses exceeded 70 Gy reported lower survival rates of dental implants in comparison to the studies in which radiation doses were ≤70Gy. Higher survival rates were reported in 2 studies in which implants placement was before radiotherapy in comparison to the remaining 16 studies in which implants placement was after radiotherapy. Conclusions Dental implants may be affected by radiotherapy especially when they are placed in maxilla, in grafted bone, or after radiation, however, they remain a functional option for rehabilitation of head and cancer patients. More Prospective cohort studies and randomized controlled trails are still needed to draw more evidence based conclusions. Key words:Dental implants, implant survival, radiotherapy, head and neck cancer. PMID

  16. Intensity modulated radiotherapy for head and neck cancer: evidence for preserved salivary gland function

    International Nuclear Information System (INIS)

    Background and purpose: To investigate the salivary gland function following intensity modulated radiotherapy (IMRT) for head and neck cancer. Patients and methods: Seventeen patients with oropharyngeal (n=11) or nasopharyngeal (n=6) carcinoma located adjacent to the major salivary glands were treated with IMRT with an emphasis to spare the salivary glands from high-dose irradiation and to reduce the risk of postirradiation xerostomy. Three patients had stage 2, 4 stage III, and 10 stage IVA cancer. The total basal and stimulated saliva flow rates were measured before the treatment, and 6 and 12 months after radiotherapy. Results: The median basal saliva flow rate measured before radiation treatment was 0.13 mL/min, and at 6 and 12 months after the completion of IMRT 0.04 mL/min and 0.07 mL/min, respectively. The corresponding median stimulated saliva flow rates were 0.49 mL/min, 0.33 mL/min, and 0.45 mL, respectively. The D 50 for an impaired stimulated parotid gland saliva flow rate was 25.5 Gy. Only two (12%) patients developed grade 3 and none grade 4 xerostomia during a median follow-up of 24 months (range, 12-40 months). No patients had locoregional cancer recurrence following IMRT. Conclusions: The results suggest that much of the salivary gland function can be maintained with IMRT without jeopadizing the local control rate in the treatment of locally advanced oropharynx or nasopharynx carcinoma

  17. Metachronous Second Primary Malignancies after Head and Neck Cancer in a Korean Cohort (1993-2010.

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    Yuh-S Jung

    Full Text Available Second primary malignancy (SPM is the major long-term cause of patient mortality with head and neck squamous cell carcinoma (HNSCC. As the incidence of high-risk human papillomavirus (HPV-related HNSCC is increasing globally, we analyzed the patterns of SPM occurrence, the effect of the index tumor site along with attributes to HPV, and the effect of SPM on survival in South Korean patients with head and neck cancer (HNC. Data were retrieved from the Korea Central Cancer Registry, a nationwide population-based cancer registry, from 1993 to 2010. Standardized incidence ratios were analyzed and compared between index tumor sites, particularly oropharyngeal vs. non-oropharyngeal sites. After adjustment for competing risks, 3- and 5-year SPM rates were calculated using the cumulative incidence function. The effects of SPM occurrence on overall survival (OS were then analyzed. SPM rates were significantly lower for HPV-attributable oropharyngeal sites than for non-oropharyngeal sites, such as the larynx and hypopharynx (p<0.001. SPM rates were also lower for oral cavity first primary sites than for non-oropharyngeal first primary sites (p<0.001. SPMs typically occurred in the esophagus, lungs and the head and neck. Uterine cervical cancers occurred significantly more frequently after index oropharyngeal cancer in women. The 5-year and 10-year OS rates were 57.8 and 45.7% in all HNC patients, respectively. The OS after SPM occurrence was poor (5-year, 31.8%; 10-year, 20.8% compared to after index HNC occurrence (5-year, 68.4%; 10-year, 41.2%. SPM occurrence in the esophagus and lung/bronchus showed a worse OS than SPM localized to the head and neck. South Korean HNC patient, the first primary cancer site affected SPM risk and distribution. The 5- and 10-year OS rates deteriorated after SPM occurrence, particularly in the esophagus and lungs. Further optimization of follow-up strategies for effective surveillance of SPM, particularly in the esophagus

  18. Cold Atmospheric Plasma: A Promising Complementary Therapy for Squamous Head and Neck Cancer.

    Science.gov (United States)

    Welz, Christian; Emmert, Steffen; Canis, Martin; Becker, Sven; Baumeister, Philipp; Shimizu, Tetsuji; Morfill, Gregor E; Harréus, Uli; Zimmermann, Julia L

    2015-01-01

    Head and neck squamous cell cancer (HNSCC) is the 7th most common cancer worldwide. Despite the development of new therapeutic agents such as monoclonal antibodies, prognosis did not change for the last decades. Cold atmospheric plasma (CAP) presents the most promising new technology in cancer treatment. In this study the efficacy of a surface micro discharging (SMD) plasma device against two head and neck cancer cell lines was proved. Effects on the cell viability, DNA fragmentation and apoptosis induction were evaluated with the MTT assay, alkaline microgel electrophoresis (comet assay) and Annexin-V/PI staining. MTT assay revealed that the CAP treatment markedly decreases the cell viability for all tested treatment times (30, 60, 90, 120 and 180 s). IC 50 was reached within maximal 120 seconds of CAP treatment. Comet assay analysis showed a dose dependent high DNA fragmentation being one of the key players in anti-cancer activity of CAP. Annexin-V/PI staining revealed induction of apoptosis in CAP treated HNSCC cell lines but no significant dose dependency was seen. Thus, we confirmed that SMD Plasma technology is definitely a promising new approach on cancer treatment. PMID:26588072

  19. Cold Atmospheric Plasma: A Promising Complementary Therapy for Squamous Head and Neck Cancer.

    Directory of Open Access Journals (Sweden)

    Christian Welz

    Full Text Available Head and neck squamous cell cancer (HNSCC is the 7th most common cancer worldwide. Despite the development of new therapeutic agents such as monoclonal antibodies, prognosis did not change for the last decades. Cold atmospheric plasma (CAP presents the most promising new technology in cancer treatment. In this study the efficacy of a surface micro discharging (SMD plasma device against two head and neck cancer cell lines was proved. Effects on the cell viability, DNA fragmentation and apoptosis induction were evaluated with the MTT assay, alkaline microgel electrophoresis (comet assay and Annexin-V/PI staining. MTT assay revealed that the CAP treatment markedly decreases the cell viability for all tested treatment times (30, 60, 90, 120 and 180 s. IC 50 was reached within maximal 120 seconds of CAP treatment. Comet assay analysis showed a dose dependent high DNA fragmentation being one of the key players in anti-cancer activity of CAP. Annexin-V/PI staining revealed induction of apoptosis in CAP treated HNSCC cell lines but no significant dose dependency was seen. Thus, we confirmed that SMD Plasma technology is definitely a promising new approach on cancer treatment.

  20. Cold Atmospheric Plasma: A Promising Complementary Therapy for Squamous Head and Neck Cancer

    Science.gov (United States)

    Welz, Christian; Emmert, Steffen; Canis, Martin; Becker, Sven; Baumeister, Philipp; Shimizu, Tetsuji; Morfill, Gregor E.; Harréus, Uli; Zimmermann, Julia L.

    2015-01-01

    Head and neck squamous cell cancer (HNSCC) is the 7th most common cancer worldwide. Despite the development of new therapeutic agents such as monoclonal antibodies, prognosis did not change for the last decades. Cold atmospheric plasma (CAP) presents the most promising new technology in cancer treatment. In this study the efficacy of a surface micro discharging (SMD) plasma device against two head and neck cancer cell lines was proved. Effects on the cell viability, DNA fragmentation and apoptosis induction were evaluated with the MTT assay, alkaline microgel electrophoresis (comet assay) and Annexin-V/PI staining. MTT assay revealed that the CAP treatment markedly decreases the cell viability for all tested treatment times (30, 60, 90, 120 and 180 s). IC 50 was reached within maximal 120 seconds of CAP treatment. Comet assay analysis showed a dose dependent high DNA fragmentation being one of the key players in anti-cancer activity of CAP. Annexin-V/PI staining revealed induction of apoptosis in CAP treated HNSCC cell lines but no significant dose dependency was seen. Thus, we confirmed that SMD Plasma technology is definitely a promising new approach on cancer treatment. PMID:26588072

  1. Burden of head and neck cancers in Kamrup urban district cancer registry of Assam, India: a retrospective study

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    Jagannath Dev Sharma

    2014-08-01

    Full Text Available Background: Head and Neck cancers are basically squamous cell carcinomas. It is the fifth most common cancer and the sixth most common cause of cancer mortality in the world. Incidence of cancer as a whole for all sites is fourth highest in Kamrup Urban District (KUD in males (AAR 185.2 and second highest (AAR 156.3 in females out of all Population Based Cancer Registries (PBCR in India. Incidence of head and neck cancers in KUD is quite high both nationally and internationally. This retrospective study was carried out to assess the incidence pattern of head and neck cancers in Kamrup Urban District of Assam, India for the period of 2009-2011. Methods: Cancer is not notifiable in India, so method of collecting information on cancer was active in PBCR Guwahati. A total of 4416 cases were registered during the three years (1st January 2009- 31st December 2011 of which 2508 were male and 1908 female. Statistical analysis used: Age Adjusted Rate (AAR, Crude Rate (CR and Population pyramids are provided by NCRP-ICMR. Results: The relative proportion of head and neck cancers of total cancer cases registered in KUD constitutes 26% (654/2508 and 12% (225/1908 in male and female respectively. In males cancer of hypopharynx (AAR 14.7 was most common followed by tongue (AAR 9.4 and mouth (AAR 7.7. In females cancer of mouth (AAR 7.6 is most common followed by cancer of tongue (AAR 3.2. Conclusion: The pattern and incidence of various head and neck cancers is of utmost importance for primary prevention and early detection to adequately manage these cancers comprehensively in the community. [Int J Res Med Sci 2014; 2(4.000: 1382-1387

  2. Value of f-18 FDG PET/CT in preoperative staging of head and neck cancer

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    Choi, Seung Jin; Byun, Sung Su; Park, Sun Won; Kim, Mi Young; Hyun, In Young [lnha University College of Medicine, lncheon (Korea, Republic of)

    2005-07-01

    The current study examined the value of F-18 FDG PET/CT for preoperative staging of head and neck cancer. Nineteen patients (M/F=17/2, 59{+-}12 yr) with histologically proven head and neck cancer (squamous cell carcinoma:18, adenocarcinoma:1) were studied by F-18 FDG PET/CT imaging before surgery. Preoperative CT/MRI were performed in all patients within 1 months preceding FDG PET/CT. The degree of FDG uptake was scored as grade 1 (no enhanced uptake), grade 2(equal to liver), grade 3(lower than cerebellum, but higher than liver), grade 4 (equal to cerebellum). Grade 3, 4 were considered malignant. Standardized uptake values(SUV) were also calculated. SUV > 2.0 was considered malignant. The diagnostic sensitivity and specificity of FDG PET/CT by visual and semiquantitative methods for the detection of cervical lymph node metastasis were compared with CT/MRI. In the 19 patients, a total of 138 lymph node levels were dissected, 37 of which showed metastatic involvement. On visual analysis, the sensitivity and specificity of F-18 FDG PET/CT were 73% (27/37) and 95% (96/101), those for semiquantitative analysis were 70% (26/37) and 91% (92/101), respectively. The sensitivity and specificity of CT/MRI were 78% (29/37) and 93% (94/101). Visual analysis showed similar diagnostic values compared to semiquantitative analysis. There was no significant difference in detecting cervical lymph node metastasis between FDG PET/CT and CT/MRI (p=0.5). In contrast to CT/MRI, FDG PET/CT detected double primary tumor (hepatocellular carcinoma) and bone metastasis in two patients, respectively. The diagnostic accuracy of F-18 FDG PET/CT in detecting cervical lymph node metastasis in patients with head and neck cancer was similar to CT/MRI. However, F-18 FDG PET/CT provides important additional information in preoperative M staging.

  3. Exosomes Derived from Squamous Head and Neck Cancer Promote Cell Survival after Ionizing Radiation.

    Directory of Open Access Journals (Sweden)

    Lisa Mutschelknaus

    Full Text Available Exosomes are nanometer-sized extracellular vesicles that are believed to function as intercellular communicators. Here, we report that exosomes are able to modify the radiation response of the head and neck cancer cell lines BHY and FaDu. Exosomes were isolated from the conditioned medium of irradiated as well as non-irradiated head and neck cancer cells by serial centrifugation. Quantification using NanoSight technology indicated an increased exosome release from irradiated compared to non-irradiated cells 24 hours after treatment. To test whether the released exosomes influence the radiation response of other cells the exosomes were transferred to non-irradiated and irradiated recipient cells. We found an enhanced uptake of exosomes isolated from both irradiated and non-irradiated cells by irradiated recipient cells compared to non-irradiated recipient cells. Functional analyses by exosome transfer indicated that all exosomes (from non-irradiated and irradiated donor cells increase the proliferation of non-irradiated recipient cells and the survival of irradiated recipient cells. The survival-promoting effects are more pronounced when exosomes isolated from irradiated compared to non-irradiated donor cells are transferred. A possible mechanism for the increased survival after irradiation could be the increase in DNA double-strand break repair monitored at 6, 8 and 10 h after the transfer of exosomes isolated from irradiated cells. This is abrogated by the destabilization of the exosomes. Our results demonstrate that radiation influences both the abundance and action of exosomes on recipient cells. Exosomes transmit prosurvival effects by promoting the proliferation and radioresistance of head and neck cancer cells. Taken together, this study indicates a functional role of exosomes in the response of tumor cells to radiation exposure within a therapeutic dose range and encourages that exosomes are useful objects of study for a better

  4. Dose-volumetric parameters for predicting hypothyroidism after radiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    To investigate predictors affecting the development of hypothyroidism after radiotherapy for head and neck cancer, focusing on radiation dose-volumetric parameters, and to determine the appropriate radiation dose-volumetric threshold of radiation-induced hypothyroidism. A total of 114 patients with head and neck cancer whose radiotherapy fields included the thyroid gland were analysed. The purpose of the radiotherapy was either definitive (n=81) or post-operative (n=33). Thyroid function was monitored before starting radiotherapy and after completion of radiotherapy at 1 month, 6 months, 1 year and 2 years. A diagnosis of hypothyroidism was based on a thyroid stimulating hormone value greater than the maximum value of laboratory range, regardless of symptoms. In all patients, dose volumetric parameters were analysed. Median follow-up duration was 25 months (range; 6-38). Forty-six percent of the patients were diagnosed as hypothyroidism after a median time of 8 months (range; 1-24). There were no significant differences in the distribution of age, gender, surgery, radiotherapy technique and chemotherapy between the euthyroid group and the hypothyroid group. In univariate analysis, the mean dose and V35-V50 results were significantly associated with hypothyroidism. The V45 is the only variable that independently contributes to the prediction of hypothyroidism in multivariate analysis and V45 of 50% was a threshold value. If V45 was <50%, the cumulative incidence of hypothyroidism at 1 year was 22.8%, whereas the incidence was 56.1% if V45 was ≥50%. (P=0.034). The V45 may predict risk of developing hypothyroidism after radiotherapy for head and neck cancer, and a V45 of 50% can be a useful dose-volumetric threshold of radiation-induced hypothyroidism. (author)

  5. Deformable planning CT to cone-beam CT image registration in head-and-neck cancer

    International Nuclear Information System (INIS)

    Purpose: The purpose of this work was to implement and validate a deformable CT to cone-beam computed tomography (CBCT) image registration method in head-and-neck cancer to eventually facilitate automatic target delineation on CBCT. Methods: Twelve head-and-neck cancer patients underwent a planning CT and weekly CBCT during the 5-7 week treatment period. The 12 planning CT images (moving images) of these patients were registered to their weekly CBCT images (fixed images) via the symmetric force Demons algorithm and using a multiresolution scheme. Histogram matching was used to compensate for the intensity difference between the two types of images. Using nine known anatomic points as registration targets, the accuracy of the registration was evaluated using the target registration error (TRE). In addition, region-of-interest (ROI) contours drawn on the planning CT were morphed to the CBCT images and the volume overlap index (VOI) between registered contours and manually delineated contours was evaluated. Results: The mean TRE value of the nine target points was less than 3.0 mm, the slice thickness of the planning CT. Of the 369 target points evaluated for registration accuracy, the average TRE value was 2.6±0.6 mm. The mean TRE for bony tissue targets was 2.4±0.2 mm, while the mean TRE for soft tissue targets was 2.8±0.2 mm. The average VOI between the registered and manually delineated ROI contours was 76.2±4.6%, which is consistent with that reported in previous studies. Conclusions: The authors have implemented and validated a deformable image registration method to register planning CT images to weekly CBCT images in head-and-neck cancer cases. The accuracy of the TRE values suggests that they can be used as a promising tool for automatic target delineation on CBCT.

  6. Inhibition of Hsp27 Radiosensitizes Head-and-Neck Cancer by Modulating Deoxyribonucleic Acid Repair

    Energy Technology Data Exchange (ETDEWEB)

    Guttmann, David M.; Hart, Lori [Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Du, Kevin [Department of Radiation Oncology, New York University School of Medicine, New York, New York (United States); Seletsky, Andrew [Department of Biology, Drexel University, Philadelphia, Pennsylvania (United States); Koumenis, Constantinos, E-mail: koumenis@xrt.upenn.edu [Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    2013-09-01

    Purpose: To present a novel method of tumor radiosensitization through Hsp27 knockdown using locked nucleic acid (LNA) and to investigate the role of Hsp27 in DNA double strand break (DSB) repair. Methods and Materials: Clonogenic survival assays, immunoblotting, the proximity ligation assay, and γH2AX foci analysis were conducted in SQ20B and FaDu human head-and-neck cancer cell lines treated with Hsp27 LNA and Hsp27 short hairpin RNA (shRNA). Additionally, nude mice with FaDu flank tumors were treated with fractionated radiation therapy after pretreatment with Hsp27 LNA and monitored for tumor growth. Results: Hsp27 LNA and Hsp27 shRNA radiosensitized head-and-neck cancer cell lines in an Hsp27-dependent manner. Ataxia-Telangectasia Mutated-mediated DNA repair signaling was impaired in irradiated cells with Hsp27 knockdown. ATM kinase inhibition abrogated the radiosensitizing effect of Hsp27. Furthermore, Hsp27 LNA and shRNA both attenuated DNA repair kinetics after radiation, and Hsp27 was found to colocalize with ATM in both untreated and irradiated cells. Last, combined radiation and Hsp27 LNA treatment in tumor xenografts in nude mice suppressed tumor growth compared with either treatment alone. Conclusions: These results support a radiosensitizing property of Hsp27 LNA in vitro and in vivo, implicate Hsp27 in double strand break repair, and suggest that Hsp27 LNA might eventually serve as an effective clinical agent in the radiotherapy of head-and-neck cancer.

  7. Prospective Study of Psychosocial Distress Among Patients Undergoing Radiotherapy for Head and Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: To determine the prevalence of psychosocial distress among patients undergoing radiotherapy (RT) for head and neck cancer and to examine the association between depression and anxiety and demographic and medical variables. Methods and Materials: A total of 40 patients (25 men and 15 women) with nonmetastatic head and neck cancer were enrolled in this prospective study and underwent RT administered with definitive (24 patients) or postoperative (16 patients) intent. Twenty patients (50%) received concurrent chemotherapy. All patients completed the Hospital Anxiety and Depression Scale and Beck Depression Inventory-II instrument before RT, on the last day of RT, and at the first follow-up visit. The effect of patient-, tumor-, and treatment-related factors on psychosocial distress was analyzed. Results: The prevalence of mild to severe pre-RT depression was 58% and 45% using the Hospital Anxiety and Depression Scale-D and Beck Depression Inventory-II scale, respectively. The prevalence of severe pre-RT anxiety was 7%. The depression levels, as determined by the Hospital Anxiety and Depression Scale and Beck Depression Inventory-II instrument increased significantly during RT and remained elevated at the first follow-up visit (p < 0.001 for both). The variables that were significantly associated with post-RT depression included a greater pre-RT depression level, employment status (working at enrollment), younger age (<55 years), single marital status, and living alone (p < 0.05, for all). Conclusion: The results of our study have shown that an alarming number of patients undergoing RT for head and neck cancer have symptoms suggestive of psychosocial distress even before beginning treatment. This proportion increases significantly during RT. Studies investigating the role of antidepressants and/or psychiatric counseling might be warranted in the future

  8. Inhibition of Hsp27 Radiosensitizes Head-and-Neck Cancer by Modulating Deoxyribonucleic Acid Repair

    International Nuclear Information System (INIS)

    Purpose: To present a novel method of tumor radiosensitization through Hsp27 knockdown using locked nucleic acid (LNA) and to investigate the role of Hsp27 in DNA double strand break (DSB) repair. Methods and Materials: Clonogenic survival assays, immunoblotting, the proximity ligation assay, and γH2AX foci analysis were conducted in SQ20B and FaDu human head-and-neck cancer cell lines treated with Hsp27 LNA and Hsp27 short hairpin RNA (shRNA). Additionally, nude mice with FaDu flank tumors were treated with fractionated radiation therapy after pretreatment with Hsp27 LNA and monitored for tumor growth. Results: Hsp27 LNA and Hsp27 shRNA radiosensitized head-and-neck cancer cell lines in an Hsp27-dependent manner. Ataxia-Telangectasia Mutated-mediated DNA repair signaling was impaired in irradiated cells with Hsp27 knockdown. ATM kinase inhibition abrogated the radiosensitizing effect of Hsp27. Furthermore, Hsp27 LNA and shRNA both attenuated DNA repair kinetics after radiation, and Hsp27 was found to colocalize with ATM in both untreated and irradiated cells. Last, combined radiation and Hsp27 LNA treatment in tumor xenografts in nude mice suppressed tumor growth compared with either treatment alone. Conclusions: These results support a radiosensitizing property of Hsp27 LNA in vitro and in vivo, implicate Hsp27 in double strand break repair, and suggest that Hsp27 LNA might eventually serve as an effective clinical agent in the radiotherapy of head-and-neck cancer

  9. Economic and quality-of-life outcomes in head and neck cancer

    International Nuclear Information System (INIS)

    Head and neck cancer offers a special and unique challenge to physicians and patients. Treatment of cancers in this part of the body, especially surgical resection, can cause profound changes in quality-of-life. The patient's ability to work, earn a living, articulate speech, communicate, have social interaction, and live a normal life, can be affected in a major way. Therefore, physicians and patients must look beyond the obvious oncologic outcomes of locoregional control, distant metastasis free survival, and overall survival. These outcomes must be assessed along with detailed, quality-of-life and economic outcomes, in order to properly manage patients. It is also mandatory that patients have a clear understanding of all their treatment options, and the implications of these options on cancer control and quality-of-life. This panel will focus on the available methods to assess quality-of-life and economic outcomes in head and neck cancer management. It will also highlight areas where new oncologic strategies are utilized which emphasize organ and function preservation. This latter area is an important aspect of modern clinical research and practice. In particular, management of cancers of the tongue, larynx, and hypopharynx offer special opportunities. Resection of these organs can produce debilitating functional outcomes. New multidisciplinary approaches to treat patients while avoiding primary resection have been developed. The oncologic and quality-of-life/economic outcomes will be assessed for these organ preserving strategies

  10. Hematoporphyrin-mediated photodynamic therapy for treatment of head and neck cancer: clinical update 1996

    Science.gov (United States)

    Schweitzer, Vanessa G.

    1996-04-01

    From 1983 to 1996 Phase II and III clinical studies at Henry Ford Hospital demonstrated complete or partial responses in 55 of 56 patients treated with hematoporphyrin-derivative or PHOTOFRIN-mediated photodynamic therapy (HPD-PDT) for a variety of benign and malignant upper aerodigestive tract disease: (1) superficial 'condemned mucosa' or 'field cancerization' of the oral cavity and larynx (7 cases); (2) Stage III/IV head and neck cancer (25 cases); (3) mucocutaneous AIDS-associated Kaposi's sarcoma of the upper aerodigestive tract and non AIDS-related Kaposi's sarcoma of the lower extremity (15 cases); (4) recurrent laryngotracheal papillomatosis (3 cases); (5) severe dysplasia/adenocarcinoma or squamous cell carcinoma in situ in Barrett's esophagus (4 cases); (6) partial or completely obstructing terminal esophageal cancer (9 cases). At the time of this report, HPD-PDT produced complete responses in 24 patients (follow up 6 months to 9 years) with 'field cancerization' (CIS, T1N0M0) of the oral cavity and larynx (6 cases), adenocarcinoma in situ in Barrett's esophagus (3 cases), mucocutaneous Kaposi's sarcoma (12 cases), obstructing esophageal carcinoma (1 case), and stage IV squamous cell carcinoma of the nasopharynx (1 case), and radiation therapy or solar-induced basal cell/squamous cell carcinomas (2 cases). PDT treatment protocols, results, complications, and application as adjunct or primary oncologic therapy for head and neck cancer are reviewed in this article.

  11. Effect of irradiation upon the bacterial flora in patients with head and neck cancer

    International Nuclear Information System (INIS)

    Twenty-two consecutive patients with cancer of the head and neck, who were to receive a full tumoricidal dose of irradiation to a field that included the oral cavity and pharynx, were studied to determine the effect of the irradiation on their local bacterial flora. Aerobic cultures were taken prior to, at the completion of, and one month after the completion of their irradiation. The percentage of patients with potentially pathogenic organisms increased dramatically as the effect of the irradiation increased. This change in the local flora has obvious implications concerning the increased incidence of postoperative wound infections in patients who have received prior irradiation

  12. Oral mucositis in radiotherapy of head and neck cancer and the possibilities of therapeutic intervention

    International Nuclear Information System (INIS)

    Oral mucositis represents the key limiting toxicity of radiotherapy and chemo-radiotherapy of head and neck cancer. In many cases,it disables to keep the full dose intensity of the treatment and thereby decreases its effectiveness. To the patient, it means suffering, associated with pain and inability of normal food intake. In spite of high incidence an clinical importance of this problem, at present time, there is no approved medication or treatment procedure which could effectively prevent the development of radiation induced mucositis. This paper provides an evidence based review of possible therapeutic interventions with the aim of decreasing the extent and severity of oral mucositis induced by radiotherapy.(author)

  13. Counseling Is Effective for Smoking Cessation in Head and Neck Cancer Patients

    DEFF Research Database (Denmark)

    Klemp, Ingrid; Steffenssen, Mia; Bakholdt, Vivi T.;

    2016-01-01

    PURPOSE: The purpose of this systematic review was to describe the efficacy of smoking cessation counseling and the resulting quit rate in patients with head and neck cancer. MATERIALS AND METHODS: A systematic literature search was conducted in the PubMed, Embase, and Cochrane databases. Predictor...... using National Health and Medical Research Council guidelines. Review Manager 5.3 was used to conduct the meta-analysis. RESULTS: Eight studies involving 1,239 patients were included (3 randomized controlled trials, 3 cohorts, and 2 case series). Smoking cessation was achieved considerably more often...

  14. Analysis of endodontic therapy in patients irradiated for head and neck cancer

    International Nuclear Information System (INIS)

    The outcome of endodontic therapy in 16 patients irradiated for head and neck cancer was studied. Thirty-five postradiation endodontically treated teeth (54 roots) were included in the study. The follow-up period ranged from 6 months to 54 months. At the time of last follow-up, 46 of 54 roots were being maintained. No osteoradionecroses were seen in association with teeth that had been endodontically treated. From this review, it is clear that endodontic therapy is a viable method of treating diseased teeth in patients irradiated for oral neoplasms

  15. Adaptive Radiotherapy for Head-and-Neck Cancer: Initial Clinical Outcomes From a Prospective Trial

    International Nuclear Information System (INIS)

    Purpose: To present pilot toxicity and survival outcomes for a prospective trial investigating adaptive radiotherapy (ART) for oropharyngeal squamous cell carcinoma. Methods and Materials: A total of 24 patients were enrolled in an institutional review board–approved clinical trial; data for 22 of these patients were analyzed. Daily CT-guided setup and deformable image registration permitted serial mapping of clinical target volumes and avoidance structures for ART planning. Primary site was base of tongue in 15 patients, tonsil in 6 patient, and glossopharyngeal sulcus in 1 patient. Twenty patients (91%) had American Joint Committee on Cancer (AJCC) Stage IV disease. T stage distribution was 2 T1, 12 T2, 3 T3, 5 T4. N stage distribution was 1 N0, 2 N1, 5 N2a, 12 N2b, and 2 N2c. Of the patients, 21 (95%) received systemic therapy. Results: With a 31-month median follow-up (range, 13–45 months), there has been no primary site failure and 1 nodal relapse, yielding 100% local and 95% regional disease control at 2 years. Baseline tumor size correlated with absolute volumetric treatment response (p = 0.018). Parotid volumetric change correlated with duration of feeding tube placement (p = 0.025). Acute toxicity was comparable to that observed with conventional intensity-modulated radiotherapy (IMRT). Chronic toxicity and functional outcomes beyond 1 year were tabulated. Conclusion: This is the first prospective evaluation of morbidity and survival outcomes in patients with locally advanced head-and-neck cancer treated with automated adaptive replanning. ART can provide dosimetric benefit with only one or two mid-treatment replanning events. Our preliminary clinical outcomes document functional recovery and preservation of disease control at 1-year follow-up and beyond.

  16. Adaptive Radiotherapy for Head-and-Neck Cancer: Initial Clinical Outcomes From a Prospective Trial

    Energy Technology Data Exchange (ETDEWEB)

    Schwartz, David L., E-mail: dschwartz3@nshs.edu [Department of Radiation Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, NY (United States); Feinstein Institute for Medical Research, Manhasset, NY (United States); Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Garden, Adam S.; Thomas, Jimmy [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Chen Yipei; Zhang Yongbin [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Lewin, Jan; Chambers, Mark S. [Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Dong, Lei [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

    2012-07-01

    Purpose: To present pilot toxicity and survival outcomes for a prospective trial investigating adaptive radiotherapy (ART) for oropharyngeal squamous cell carcinoma. Methods and Materials: A total of 24 patients were enrolled in an institutional review board-approved clinical trial; data for 22 of these patients were analyzed. Daily CT-guided setup and deformable image registration permitted serial mapping of clinical target volumes and avoidance structures for ART planning. Primary site was base of tongue in 15 patients, tonsil in 6 patient, and glossopharyngeal sulcus in 1 patient. Twenty patients (91%) had American Joint Committee on Cancer (AJCC) Stage IV disease. T stage distribution was 2 T1, 12 T2, 3 T3, 5 T4. N stage distribution was 1 N0, 2 N1, 5 N2a, 12 N2b, and 2 N2c. Of the patients, 21 (95%) received systemic therapy. Results: With a 31-month median follow-up (range, 13-45 months), there has been no primary site failure and 1 nodal relapse, yielding 100% local and 95% regional disease control at 2 years. Baseline tumor size correlated with absolute volumetric treatment response (p = 0.018). Parotid volumetric change correlated with duration of feeding tube placement (p = 0.025). Acute toxicity was comparable to that observed with conventional intensity-modulated radiotherapy (IMRT). Chronic toxicity and functional outcomes beyond 1 year were tabulated. Conclusion: This is the first prospective evaluation of morbidity and survival outcomes in patients with locally advanced head-and-neck cancer treated with automated adaptive replanning. ART can provide dosimetric benefit with only one or two mid-treatment replanning events. Our preliminary clinical outcomes document functional recovery and preservation of disease control at 1-year follow-up and beyond.

  17. Integrated therapeutic approaches in head and neck cancer: the importance of multidisciplinary team management.

    Science.gov (United States)

    Perri, Francesco; Muto, Paolo; Aversa, Corrado; Daponte, Antonio; Della Vittoria, Giuseppina; Pepe, Stefano; Caponigro, Francesco

    2013-07-01

    Multidisciplinary team (MDT) is of paramount importance in the approach to patients with head and neck cancer. Its aim is to provide the best diagnostic work-up, tumor staging, and treatment. Furthermore, the prognosis of patients who are managed by MDT is usually better. MDT has a great value in all presentation settings. The role of the pathologist in the team is of utmost importance, in particular with regards to information provided on Human Papilloma Virus (HPV) status, which has a well acknowledged independent prognostic value mainly in oropharyngeal carcinoma. In early stage disease, namely in T1-2 N0 M0 patients, the meetings within the MDT mainly involve surgeons and radiation therapists. Surgery represents the mainstay of treatment, while radiation therapy is a suitable alternative, in particular in patients with advanced age, poor performance status and comorbidities. In locally advanced disease, surgeons, medical oncologists and radiotherapists are the key people, since different approaches have been carried out. In operable patients, adjuvant chemoradiation is indicated when resection margins are involved or close, or in presence of extracapsular nodal spread. Concurrent chemoradiotherapy, preceded or not by induction chemotherapy, is the favourite approach in this setting when surgery is strictly not indicated. In recurrent/metastatic disease chemotherapy and best supportive care are the main options, although local treatments, such as reirradiation and salvage surgery, are also worth considering. The standard chemotherapy treatment has finally evolved after about 30 years, and strong efforts are being pursued to further improve the outcome, mainly with the addition of new drugs. PMID:23194421

  18. Amifostine modulates radio-induced apoptosis of peripheral blood lymphocytes in head and neck cancer patients

    International Nuclear Information System (INIS)

    Head and neck cancer is treated mainly with surgery and radiotherapy. Xerostomia and mucositis are common adverse effects of radiation therapy. One of the strategies aimed at decreasing radiation toxicity is the use of radioprotective agents, such as amifostine. We previously reported that radio induced apoptosis of peripheral blood lymphocytes was statistically associated with normal tissue toxicity in the form of severe xerostomia. The aim of the present study was to explore the effects of amifostine on the radiation-induced apoptosis of peripheral blood lymphocytes from patients suffering head and neck cancer. Eighteen consecutive patients with squamous cell carcinoma of the head and neck were included in the study. Peripheral blood lymphocytes were isolated before and after the treatment with amifostine. Then, cells were irradiated at 0, 1, 2 and 8 Gy during 24 hours. Apoptosis was measured by flow cytometry using annexin V/propidium iodide. As expected, radio-induced apoptosis values fitted to a semi logarithmic equation as follows: RIA=βln(Gy)+α. The administration of amifostine prior to radiation therapy modulates radio-induced apoptosis of peripheral blood lymphocytes: 13.68 vs. 13.37 (P=0.027), 19.11 vs. 17.64 (P=0.001) and 30.70 vs. 28.84 (P=0.001), before and after the administration of the drug for 1, 2 and 8 Gy respectively. α and β decreased significantly after the administration of the drug: 13.58 vs. 12.99 (P=0.009) and 8.21 vs. 7.53 (P=0.017), respectively. Our results provide new information about the biological actions of amifostine in vivo. (author)

  19. Impact of dysphagia on quality of life after treatment of head-and-neck cancer

    International Nuclear Information System (INIS)

    Purpose: To evaluate the quality of life (QOL) associated with dysphagia after head-and-neck cancer treatment. Methods and materials: Of a total population of 104, a retrospective analysis of 73 patients who complained of dysphagia after primary radiotherapy (RT), chemoradiotherapy, and postoperative RT for head-and-neck malignancies were evaluated. All patients underwent a modified barium swallow examination to assess the severity of dysphagia, graded on a scale of 1-7. QOL was evaluated by the University of Washington (UW) and Hospital Anxiety and Depression questionnaires. The QOL scores obtained were compared with those from the 31 patients who were free of dysphagia after treatment. The QOL scores were also graded according to the dysphagia severity. Results: The UW and Hospital Anxiety and Depression scores were reduced and elevated, respectively, in the dysphagia group compared with the no dysphagia group (p = 0.0005). The UW scores were also substantially lower among patients with moderate-to-severe (Grade 4-7) compared with no or mild (Grade 2-3) dysphagia (p = 0.0005). The corresponding Hospital Anxiety (p = 0.005) and Depression (p = 0.0001) scores were also greater for the moderate-to-severe group. The UW QOL subscale scores showed a statistically significant decrease for swallowing (p = 0.00005), speech (p = 0.0005), recreation/entertainment (p = 0.0005), disfigurement (p = 0.0006), activity (p = 0.005), eating (p = 0.002), shoulder disability (p = 0.006), and pain (p = 0.004). Conclusion: Dysphagia is a significant morbidity of head-and-neck cancer treatment, and the severity of dysphagia correlated with a compromised QOL, anxiety, and depression. Patients with moderate-to-severe dysphagia require a team approach involving nutritional support, physical therapy, speech rehabilitation, pain management, and psychological counseling

  20. Tumor radiosensitivity (SF2) is a prognostic factor for local control in head and neck cancers

    International Nuclear Information System (INIS)

    Purpose: To evaluate prospectively the prognostic value of SF2 for local control and survival in patients undergoing radiation therapy for head and neck cancers. Methods and materials: Following informed consent tumor specimens were obtained from 156 patients with primary carcinomas of the head and neck region. The specimens were assessed for the ability to grow in vitro (colony forming efficiency, CFE) and inherent radiosensitivity measured as the surviving fraction at 2 Gy (SF2) using a soft-agar clonogenic assay. Patients were treated mainly with neoadjuvant chemotherapy plus radiation therapy usually as a combination of accelerated external beam and interstitial radiotherapy. The probabilities of local control and survival were analyzed by univariate, bivariate and Cox multivariate analyses. Results: Successful growth was achieved in 110/156 specimens and SF2 values were obtained from 99/156. Eighty four out of these patients underwent radical treatment. The median SF2 value for the 84 tumors was 0.40. At a mean follow-up time of 25 months (range 7-65) the median SF2 value of tumors from 14 patients who developed local recurrence was 0.53, which was significantly higher than the median of 0.38 for tumors from 70 patients without local recurrence (p = 0.015). Tumor SF2 was a significant prognostic factor for local control (p = 0.036), but not for overall survival (p 0.20). Tumor SF2 was an independent prognostic factor for local control within bivariate and Cox multivariate analyses. Conclusions: This study has shown that tumor radiosensitivity measured as SF2 is a significant prognostic factor for local control in head and neck cancers