Observation on platelet aggregative ability in patients with malignant tumors of head and neck by electron microscope]

OBJECTIVE: To investigate the relationship between the platelet aggregative ability and malignant tumors of head and neck. METHOD: Platelet aggregative ability was detected by electron microscopy (EM) in 37 patients with malignant tumors of head and neck(Group C), 10 patients with non-neoplastic diseases(Group A) and 10 patients with benign tumors of head and neck(Group B) as the control group, with the ratio of aggregative type platelets as the index. Twenty-five of 37 patients with malignant tumors except 8 cases of nasopharyngeal carcinoma were included in the follow-up study 4-6 months after operations. RESULTS: 1. The mean ratio of aggregative type platelets in patients from Group C was significantly higher that that of Group A or Group B patients (P < 0.05); 2. In Group C, the mean ratio of aggregative type platelets increased significantly with the development of clinical staging(P < 0.05); 3. In follow-up study, the mean ratio of aggregative type platelets of 17 patients without metastasis and recurrence was significantly lower than that before-operation, while the results of 8 patients with metastasis or recurrence was totally opposite. CONCLUSIONS: 1. The aggregative ability of platelets increased in patients with malignant tumors of head and neck; 2. The ratio of aggregative type platelets detected by EM has an important potential value in judging the development, therapeutic effects and prognosis of the malignant tumors of head and neck.     

鼻恶性肿瘤病人血小板聚集功能的测定

对６８例鼻恶性肿瘤病人进行血小板聚集试验，并以１００例正常人和１０例鼻良性肿瘤病人作对照，结果发现（１）恶性肿瘤中，治疗前组，复发组和远隔转移组血小板最大聚集率（ＭＡＲ）均数高于正常组，良性肿瘤组和治疗后组（Ｐ〈０．０５）；（２）治疗前组中ＭＡＲ均数随肿瘤分期而增加，表明恶性肿瘤可引起血小板集增强，并就恶性肿瘤病人血小板聚集增强的机制，血小板在肿瘤生长，转移中的作用等进行讨论，还展望了血小板抑制剂     

Protein tyrosine kinase activity in laryngeal squamous cell carcinoma

Summary Oncogenes play an important role in the process of malignant transformation. Since many of the protein tyrosine kinases (PTK) are products of oncogenes, the aim of this study was to demonstrate whether an increased PTK activity could be found in head and neck tumors. By using a non-radioactive dot-blot assay, PTK activity was measured in tumor and normal tissues of 38 patients with laryngeal cancer. The control group consisted of 19 healthy persons. PTK activity in tumor cells was significantly higher (P < 0.001) than in normal cells of the tumor patients and normal controls. Additionally, the PTK activity in the normal mucosa of the tumor patients was significantly higher than in the normal mucosa of the control group.Correspondence to: H. P. Verschuur     

Presentation,course, and outcome of head and neck skin cancer in african americans: A case-control study

Background: Several reports have shown that the presentation, course, and outcome of skin cancer is altered in African Americans. Subset data from these studies suggest that the course of head and neck skin cancer may be different from that occurring in other sites. However, very few studies have specifically investigated skin cancer involving the head and neck region in African-American patients. Methods: Retrospective case-control study including 215 patients with skin cancer (squamous cell carcinoma [SCC], basal cell carcinoma [BCC], malignant melanoma, and adnexal tumors) presenting to a tertiary care institution over a 9.5-year period. Cases were defined as African Americans with skin cancer, and the control group included white and Latin-American patients with skin cancer. Results: Skin cancer occurred in the head and neck region in 135 cases (62%). However, head and neck involvement was less common in African-American patients (44%) than the control group (76%; P < .001). The anatomic distribution of head and neck skin lesions was similar between the groups, with nasal and scalp skin most often involved. In the head and neck region, the ratio of BCC to SCC (4:1) was similar among all groups. In contrast, in non–sun-exposed regions, the ratio was 1:8.5 for African-American patients compared with 1:1 for the control group (P < .001). The overall distribution of malignant melanoma was not influenced by sun exposure in either groups. The study groups were similar in gender distribution, primary treatment modality, rates of positive margins, and development of second skin cancers. Although African Americans presented with more advanced lesions (P < .001), their disease-free interval was similar to the control group. Only the margin status was a significant predictor of disease-free survival by multivariate analysis, with a relative risk of 1.68 (95% CI: 1.58–18.24) Conclusions: Head and neck skin cancer is similar with regard to presentation and distribution in patients of all skin types. Moreover, in contrast to previous reports, the course of head and neck skin cancer may be less aggressive in African Americans, if appropriate treatment is provided. This report suggests that differences in skin cancer in African Americans reported in the literature reflect cancer occurring in non–sun-exposed regions.     

Carbonic anhydrase-9 expression in head and neck cancer: a meta-analysis

The purpose of the study was to compare CA-9 positivity versus CA-9 negativity in head and neck malignancies and to correlate levels of CA-9 with tumor grade, size, and nodal status. Overall and disease-free survival were also compared for CA-9 positive and negative tumors. A literature search was performed using Medline, Embase, Ovid and Cochrane databases for studies between 1990 and 2009. Carbonic anhydrase IX, CA IX, CA-9, head and neck, and survival were used as search terms. Random-effect meta-analytical techniques were conducted for outcome measures of overall survival and disease-free survival. Sixteen studies matched the selection criteria, reporting on 1,470 patients. Eight hundred and forty two specimens were reported as being CA-9 positive or negative: 512 (60.81%) were CA-9 positive and 330 (39.19%) were CA-9 negative. Nine hundred and eighty specimens had levels of CA-9 expression recorded: 547 (55.82%) had high levels of CA-9 and 433 (44.18%) had low CA-9 levels. Survival was significantly reduced if the tumor was positive for CA-9 (P < 0.0001). Disease-free survival is significantly reduced in patients with CA-9 positive (P = 0.0008) head and neck malignant tumors. The presence of CA-9 in head and neck malignant tumors is associated with reduced overall survival and disease-free survival.     

Whole-body MRI for staging patients with head and neck squamous cell carcinoma

Conclusions. Whole-body MRI is feasible for the tumor staging of patients with malignant head and neck tumors and appears to be a quick, reliable and proven alternative in general and for patients with contraindications to CT. This examination minimizes the logistical effort required compared to multimodality strategies. Its economic impact remains to be determined. Objective. To assess the performance of whole-body MRI for staging patients with squamous cell carcinoma of the head and neck region. Material and methods. This was a randomized, prospective clinical study. For tumor staging, 21 patients (mean age 56.7 years; range 43–80 years) with advanced malignant head and neck tumors underwent whole-body MRI in addition to routinely performed imaging investigations, including sonography, chest X-ray, CT of the head, neck and thorax and endoscopy. All investigations were accomplished within a period of 10±3 days in a random order. A randomized, blinded, consensus assessment of all the whole-body MRI examinations was performed by two radiologists. The localization and extent of the primary tumor and metastases were documented for whole-body MRI and compared to the standard of reference (all other imaging modalities as well as histology). Point estimates of the diagnostic accuracy of whole-body MRI were calculated. Results. In accordance with the standard of reference, the overall TNM category was correctly determined with whole-body MRI in all 21 patients. However, four patients were classified as having carcinoma of unknown primary, as the primary tumor was not found with any imaging modality. Two patients had mediastinal, pulmonary and hepatic metastases.     

Tenotomy of the middle ear muscles causes a dramatic reduction in vertigo attacks and improves audiological function in definite Meniere's disease

Conclusions. Occupational therapy significantly improves shoulder range of motion in patients with accessory nerve palsy after radical neck dissection, but it has limited effects on the associated pain. Objective. To evaluate the outcome of occupational therapy rehabilitation for patients with accessory nerve palsy. Patients and methods. The occupational therapy group involved 35 shoulders of 29 patients with accessory nerve palsy after radical neck dissection; the control group included 10 shoulders of 9 patients who did not receive occupational therapy. All patients had a malignant tumor in the head or neck that necessitated radical neck dissection. We collected data pertaining to resting pain, motion pain, and the active and passive range of motion during shoulder flexion and abduction. Results. Occupational therapy did not adequately relieve resting or motion pain, but all patients achieved independence in activities of daily living and housekeeping activities. Although occupational therapy significantly improved shoulder elevation for all movements, shoulder elevation was significantly better for flexion than for active and passive abduction.     

Postural Stability Using Different Neck Positions in Normal Subjects and Patients with Neck Trauma

Subjects with neck problems, such as whiplash injuries, often complain of disturbed equilibrium and, in some instances, provocation of the neck position can elicit such problems. The importance of neck proprioceptors for maintaining balance is gaining increased interest, moreover the function or malfunction of the otoliths may disturb equilibrium in certain head positions. The aim of the study was to create a reference material for postural control and its dependence on head position in healthy subjects and to compare this with a set of patients with known neck problems and associated vertiginous problems. A total of 32 healthy subjects (16 men, 16 women; age range 21-58 years) as well as 10 patients age range 27-62 years (mean 44 years) with neck problems and associated balance problems since a whiplash injury were tested for postural control using the EquiTest dynamic posturographic model. The normal subjects were initially split into four age groups in order to estimate the effects of age on performance. The postural stability was evaluated for dependence of support surface conditions (stable or sway-referenced), visual input (eyes open or closed) and head position (neutral, left rotated, right rotated, extended backwards or flexed forward) using analysis of variance (ANOVA) with Tukey's post hoc test in case of a significant factor effect. As expected, visual cues as well as stable support surface improve postural stability (p&lt;0.001). Postural stability is statistically different in the head extended backwards condition compared with the other four head positions (p&lt;0.001 in all cases) in both patients and controls. Eliminating this test condition from the analysis, only a slight (p&lt;0.05) difference between head forwards and head turned left remained. This pattern of results remained if the normal subjects were only split into two age groups instead of four. Finally, the patient group exhibited significantly lower postural performance than all the groups of normal subjects (p&lt;0.01), but none of the normal groups differed significantly from each other. It is concluded that the postural control system is significantly challenged in the head extended backwards condition in both normal subjects and patients with previous whiplash injury and persistent neck problems. The patient group differed statistically from all groups of normal subjects. This suggests that neck problems impair postural control, and that the head extended position is a more challenging task for the postural system to adapt to. Whether this is due to utricular malpositioning, central integrative functions or cervical proprioceptive afferents is not within the scope of this study to answer.     

Vocal changes following radiotherapy to the head and neck for non-laryngeal tumors

To investigate vocal changes in patients following the neck irradiation for non-laryngeal tumors sparing the glottic region. Fifteen patients were enrolled for the study. Phonatory effort and voice evaluation were reported. Perceptual evaluation and acoustic analysis were performed. Men/women ratio was 6/9. The mean age was 54 years with a range from 24 to 84. The most common primary site of tumor was the nasopharynx and tongue. The mean phonatory effort was significantly greater in the irradiated group versus controls (0.54 vs. 0.08 with a P value 0.01). Fifteen percent reported their voice as being poor and almost 85% as being fair. All the parameters of the GRABS perceptual evaluation were significantly worse in the irradiated group. There were no statistically significant differences between all the acoustic variables in both groups except for an decrease in the Habitual pitch in the irradiated patients. Radiation therapy to head and neck region can affect voice even if the radiation beams spare the vocal folds.     

Quantitative assay of telomerase activity in head and neck squamous cell carcinoma and other tissues

OBJECTIVES: To confirm the applicability and use of a new technique to detect and quantify telomerase activity of specimens from head and neck malignant neoplasms and to explore whether the levels of telomerase activity can be a useful marker for cancer risk assessment in head and neck malignant neoplasms. DESIGN: Ninety-six specimens from 39 patients with head and neck malignant neoplasms were obtained. The specimens included 39 from patients with primary tumors (25 with head and neck squamous cell carcinoma and 14 with others), 10 from patients with neck metastases, 10 from patients with dysplasias, and 37 from patients with normal tissue. HeLa cell lines were used as positive control samples. MAIN OUTCOME MEASURE: The levels of telomerase activity were determined using a liquid scintillation counter. RESULTS: The new method has a high rate of outcome reproducibility. The intrabatch and extrabatch variations were 15.6% and 16.4%, respectively. The linear relationship was good between the telomerase activity and the value within 700 radioactive cpm (rcpm) to approximately 7000 rcpm. The levels of telomerase activity determined by radioactive count were more than 1000 rcpm in 42 of the 49 malignant specimens and much more than that in the normal tissues, with the exception of 3 specimens. The levels of telomerase activity in normal tissues were less than 1000 rcpm in every sample and less than that in the malignant neoplasm samples, with the exception of 1 specimen (P < .000). Higher levels of telomerase activity in 2 of 10 tissues from patients who had dysplasias were detected (2 specimens from patients who had severe dysplasia). The differences in the levels of telomerase activity between the head and neck squamous cell carcinomas and the other tumors were not statistically significant (P > .05). CONCLUSIONS: Detection of telomerase activity in head and neck malignant neoplasms can be a useful marker for the assessment of cancer. Telomerase reactivation may play an important role in tumorigenesis in head and neck squamous cell carcinoma. The quantification of telomerase activity may have clinical diagnostic value for head and neck malignant neoplasms.     

Neck dissection for non-squamous malignancy

Of 1030 patients who underwent neck dissection (radical, modified or selective) in a 27-year period 103 had malignant neck nodes from a primary site in the head and neck with a histological diagnosis other than squamous carcinoma. There were 71 men and 32 women in this group with a mean age of 55 years. 28 patients had neck dissection as part of their initial treatment and 75 for later nodal recurrence. Five-year survival was 52% (40-63%). Survival was site dependent, best for thyroid tumours and worst for tumours of the major salivary glands (χ2/1 = 6.52, P < 0.05). Histology significantly affected survival, best for papillary tumours and worst for melanoma and undifferentiated tumours (χ2/1 = 3.85, P < 0.05). Survival was worse with advanced N stage but varied little with node level. The number of nodes invaded had a highly significant effect on survival (χ2/1= 23.94, P < 0.001), but extracapsular rupture had no effect. Advanced T stage at the time of surgery had a significant adverse effect on survival using univariate analysis, but this effect disappeared using multivariate analysis. In the 75 patients who had neck dissections for nodal recurrence the presence of a simultaneous recurrence at the primary site had no significant effect on survival. These patients had a better 5-year survival than patients having neck dissection for squamous disease, but the usual predictors of survival in squamous carcinoma do not always apply to non-squamous malignancy. Keywords head and neck cancer non-squamous neck dissection survival     

The use of cyanoacrylates for wound closure in head and neck surgery

The purpose of this study was to compare the mean duration and complication rates of cyanoacrylate application in head and neck incision closures to those performed with conventional sutures. Eighty patients who underwent head and neck surgical operations (20 thyroidectomies, 13 submandibular gland resections, 9 parotidectomies, 6 neck dissections in conjunction with other surgical procedures, 1 lateral rhinotomy, 1 thyroglossal cyst resection and 30 open neck biopsies) were included in the study. The incisions were closed either with interrupted suture technique (32 patients) or cyanoacrylate (48 patients). The duration of skin closure time was compared between the two groups with nonparametric Mann–Whitney U test and a P value <0.05 was considered as statistically significant. The patients were followed up for complications at 2 weeks, 1 and 3 months after surgery. The two treatment groups were similar with respect to age, gender, and wound lengths (P = 0.27, 0.22 and 0.99, respectively). The mean wound length was 7.21 + 3.15 cm in the cyanoacrylate group and 7.22 + 2.99 cm in the suture group within a range of 5–15 cm. The mean closure time was 33.69 + 9.77 s in the cyanoacrylate group and 504.38 + 169.27 s in the suture group (P < 0.001). The patients in the cyanoacrylate group were satisfied with their scar appearances. No complication was observed in both the groups. Cyanoacrylates provide an easy and convenient application resulting in a faster wound closure as compared to the interrupted suture technique.     

EBV and not HPV sensitizes tobacco-associated head and neck cancer cell line FaDu to radiotherapy

Conclusion EBV radiosensitized the p53 mutant tobacco associated head and neck cell line, FaDu.

Objectives In the head and neck, HPV is a major risk factor associated with tonsil and base of tongue cancers, while a majority of undifferentiated nasopharyngeal cancers are positive for EBV. Clinically, head and neck tumors positive for HPV or EBV are more radiosensitive than tumors associated with tobacco and alcohol. This study aimed to evaluate whether viral infections can sensitize tobacco-associated head and neck squamous cell carcinoma cell line that harbors multiple mutations, especially TP53, to radiotherapy. Method Four FaDu cell lines (vector control – FaDu-DN; FaDu expressing HPV16 E6/E7 – FaDu-HPV; FaDu infected with EBV – FaDu-EBV; and FaDu-HPV infected with EBV – FaDu-HE) were evaluated for their radiation sensitivity using clonogenic assay. Cell cycle, protein expression, apoptosis, and cellular senescence were analyzed.

Results FaDu-EBV and FaDu-HE exhibited significantly increased radiosensitivity in comparison with the control cell line. Radiation-induced cell cycle arrest was altered in all cell lines expressing viral genes. The observed distribution of cells at G1 and S phases was associated with a significant increase in expression of p21 protein along with decreased levels of pAKT/AKT and pERK/ERK ratio (p?p?相似文献   

Serum immunoglobulin E levels in patients with head and neck cancer

Serum immunoglobulin E levels were estimated in 50 patients with head and neck cancer and in 25 controls. Mean serum IgE value was significantly higher in patients with various sites of cancer in the head and neck region other than carcinoma of the tonsil. The levels increased with advancement in the stage of cancer. There was, however, no difference in mean serum IgE value with respect to the character of the lesion, to the histopathological type of growth or to radiotherapy. In patients with carcinoma of the tonsil, the mean serum IgE concentration was significantly lowered.     

Cellular DNA amounts of squamous cell carcinomas of the head and neck region in relation to prognosis

Cytophotometric measurements of Feulgen DNA content were made in individual tumor cells from 45 patients with squamous cell carcinomas of the head and neck region. Eleven carcinomas were found to have a predominantly diploid distribution of DNA values, while the remaining 34 carcinomas were non-diploid. In 11 of the tumors — not entirely identical with the diploid tumors — 50% or less of the malignant cells had DNA values exceeding the modal diploid value (DNAG1 + 2 S.D.), whereas 34 had higher DNA values. The non-diploid carcinomas and those where >50% of the cells had DNA values >DNAG1 + 2 S.D. showed more advanced clinical stage, due to the presence of regional metastases. They were also associated with a poorer prognosis than the diploid carcinomas or those with ≤50% of the cells with DNA values >DNAG1 + 2 S.D. Cellular DNA amounts seemed to be of greater prognostic value than type of ploidy. The study indicates that DNA analysis may contribute important information on the biological behavior and prognosis of squamous cell carcinomas of the head and neck region.     

Definitive re-irradiation using intensity-modulated radiation therapy in cancers of the head and neck,focusing on rare tumors

Purpose: To analyze the outcomes following re-irradiation for local recurrence of rare head and neck tumors.

Material and methods: We retrospectively analyzed 11 patients who had received intensity-modulated radiation therapy (IMRT) for recurrent tumors in the head and neck except for laryngopharynx.

Results: Primary tumor sites included the maxillary sinus, nasal cavity, and external ear canal in six, three, and two patients, respectively. The median follow-up times were 13 (range, 3–54) months. The median survival time was 17 months with 1- and 2-year survival rates of 63.64 and 39.77%, respectively. Among 11 patients, five experienced local failure in the follow-up period. The 1- and 2-year local control rates were 58 and 47%, respectively. Patients who had received a radiation dose of ≥3?Gy per fraction showed significantly better local control than those receiving less (p?=?.0419). One patient experienced Grade 3 facial pain as acute toxicity. Late toxicities included radiographic findings of partial central nervous system necrosis in three patients and Grade 3 osteonecrosis and Grade 3 facial nerve disorder in one patient.

Conclusions: Re-irradiation of rare head and neck tumors using IMRT for loco-regional recurrence may be an acceptable treatment option.     

The role of positron emission tomography with 18F-fluorodeoxyglucose in nodal staging of clinical and radiological N0 head and neck cancers

The objective of the study was to evaluate the impact of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) imaging on nodal staging for head and neck cancers. This was a retrospectively analyzed single institution study. The study population consisted of 36 patients with head and neck cancers who were evaluated with PET/CT and went on to neck dissection. All of them had clinically and radiographically negative neck (N₀) and each patient underwent PET/CT imaging before undergoing selective neck dissection for N₀ disease. Tissues were submitted for histopathologic examination and were oriented for the pathologist to permit correlation between the histopathologic findings and the imaging results. The sizes of the lymph nodes and the maximum standardized uptake values (SUV_max) measured from PET/CT images were compared with the histopathologic findings. All primary tumors were visualized with PET/CT. On histopathological examination, 19 patients had positive and 17 patients had negative lymph nodes. Receiver operating characteristic analyses were used to predict the optimal corrected SUV_max cutoffs; the optimal value was 2.95 for respective outcomes of lymph node involvement. This cutoff value yielded 84.2 % sensitivity and 76.5 % specificity for nodal-level staging. PET/CT proved to be accurate in 27 (75 %) patients and inaccurate in 9 (25 %) patients. PET/CT was a valuable tool to assess nodal stage of head and neck cancers, and should be considered before surgical treatment.     

Osteosarcoma of the Head and Neck: Meta-analysis of Nonrandomized Studies

To assess the role of adjuvant therapy in the treatment of osteogenic sarcoma of the head and neck, treatment and survival information from 173 patients with osteosarcoma of the head and neck was entered into a database. A meta-analysis of the data was attempted with primary emphasis on the effect of adjuvant therapy on disease outcome. The overall 5-year survival was 37%. Patients with mandibular and maxillary tumors had similar survival rates; both groups fared significantly better than patients with extragnathic tumors (P<0.001). Treatment with surgery alone was associated with significantly longer survival rates (P<0.03) than surgery with adjuvant therapy. In the majority of patients reported, information about surgical margins was not available. For this reason, the differences may not adequately represent the effect of adjuvant therapy. While there have been encouraging results with adjuvant treatment protocols for long bone osteosarcoma, the ultimate role of radiation and chemotherapy in the management of osteosarcoma of the head and neck remains unproven. Nevertheless, we recommend that adjuvant therapy be considered due to the poor prognosis in osteosarcoma of the head and neck.     

Increased risk of salivary gland tumors after low-dose irradiation

Objective: To assess the risk of neoplastic development among persons exposed to scalp irradiation. Study Design: Historical cohort study initially; prospective follow-up subsequently. Method: Two control groups—population and siblings—matched for age, sex, ethnic origin, and year of immigration. Follow-up from time of irradiation (1950s) until the end of 1991. Linkage with nationwide cancer registry. Results: A 4.5–fold incidence of cancer (P < .01) and a 2.6–fold increase of benign tumors were noted. The mean length of latency period until tumor development was 11 years for malignant tumors and 21.5 years for benign. A clear dose response effect for both cancer and benign tumors was demonstrated. Conclusions: The study confirms the role of radiation in salivary gland carcinogenesis. It indicates a need for better awareness, a comprehensive examination, and long-term follow-up of patients who have been subjected to head and neck radiation.     

Survey of immunosuppressive acidic protein and other immunological parameters in head and neck cancer patients.

Serum levels of immunosuppressive acidic protein (IAP) and other immunological parameters were examined in 95 head and neck cancer patients and 27 control patients. The mean values of IAP in patients in the advanced stage were significantly higher than in early stage patients. Statistically significant increases in the mean concentration of IAP were also observed in patients with a recurrence, as compared to findings in those in the advanced stages. The mean values of blastogenesis response to PHA and NK cell activity in the cancer patients were lower than in disease free individuals, but with no statistical differences. In the endstage patients, the IAP concentration was considerably elevated and the blastogenesis response showed a statistically significant decrease. Thus, the monitoring of serum IAP, in combination with other immunological parameters, aids in planning and assessing clinical staging in head and neck cancer patients.