Vascular architecture and hypoxic profiles in human head and neck squamous cell carcinomas

Tumour oxygenation and vasculature are determinants for radiation treatment outcome and prognosis in patients with squamous cell carcinomas of the head and neck. In this study we visualized and quantified these factors which may provide a predictive tool for new treatments. Twenty-one patients with stage III-IV squamous cell carcinomas of the head and neck were intravenously injected with pimonidazole, a bioreductive hypoxic marker. Tumour biopsies were taken 2 h later. Frozen tissue sections were stained for vessels and hypoxia by fluorescent immunohistochemistry. Twenty-two sections of biopsies of different head and neck sites were scanned and analysed with a computerized image analysis system. The hypoxic fractions varied from 0.02 to 0.29 and were independent from T- and N-classification, localization and differentiation grade. No significant correlation between hypoxic fraction and vascular density was observed. As a first attempt to categorize tumours based on their hypoxic profile, three different hypoxia patterns are described. The first category comprised tumours with large hypoxic, but viable, areas at distances even greater than 200 micrometer from the vessels. The second category showed a typical band-like distribution of hypoxia at an intermediate distance (50-200 micrometer) from the vessels with necrosis at greater distances. The third category demonstrated hypoxia already within 50 micrometer from the vessels, suggestive for acute hypoxia. This method of multiparameter analysis proved to be clinically feasible. The information on architectural patterns and the differences that exist between tumours can improve our understanding of the tumour micro-environment and may in the future be of assistance with the selection of (oxygenation modifying) treatment strategies.     

Surveillance imaging following treatment of head and neck cancer

Post-treatment surveillance is an important component in the treatment of head and neck cancers, especially as the proportion of human papilloma virus-positive cancers increases. Early detection of recurrences or second malignancies can increase success and minimize the toxicity of salvage treatment. Unfortunately, there are no consensus guidelines on the frequency and modality of post-treatment imaging. Computed tomography, ultrasound, magnetic resonance imaging and positron emission tomography-computed tomography (PET-CT) all have unique advantages and disadvantages when used as surveillance imaging. There is evidence that PET-CT may be the most sensitive of these modalities, but further research is needed to show an improvement in patient outcomes. Institutions will benefit most from a surveillance plan that is consistent and tailored to the individualized needs of their patients. This review focuses on the available evidence for different imaging modalities and general guidelines for developing an institution-specific practice pattern.     

Magnetic resonance imaging of head and neck tumors

Magnetic resonance imaging has revolutionized the imaging of head and neck malignancies and is now rapidly replacing computed tomography as the study of choice in the majority of lesions in the head, neck, larynx, hypopharynx, oropharynx, paranasal sinuses, paranasopharynx, and skull base. CT scanning can be used in the same region; however, inflammation obtained in CT is not as clearly demonstrated and in some situations, such as malignancies of the tongue, the lesions may be missed entirely. There are still occasional difficult clinical problems when the two studies are complementary, but this situation will definitely be rare.     

Recent advances in head and neck surgical oncology

In recent years, the field of head and neck oncology has witnessed a remarkable transformation with unprecedented advances that have revolutionized the management of complex tumors in this region. As an intricate subspecialty within oncology, head and neck surgical procedures demand detailed knowledge of the complex anatomy meticulous precision in surgical technique, and expertise to preserve vital functions while ensuring optimal oncological outcomes. With the relentless pursuit of improved patient outcomes, the integration of innovative technologies has significantly enhanced the surgical armamentarium. Robotics, endoscopic platforms, and image-guided navigation have revolutionized the surgical approach, enabling precise tumor resection and sparing healthy tissues. Furthermore, the application of advanced imaging modalities and molecular biomarker profiling has opened new avenues for personalized treatment strategies. From targeted therapies and immunotherapies to adaptive radiation techniques, clinicians are now equipped with an array of tailored options, ushering in a new era of personalized care for patients with head and neck malignancies. This article delves into the unfolding narratives of clinical triumphs, exploring the transformative potential of emerging therapies and the collaborative efforts propelling head and neck surgical oncology toward a future of hope and healing.     

Adjuvant treatment of locally-advanced head and neck tumours

Every year about 40,000 new patients are diagnosed as having squamous cell carcinoma of the head and neck (HNSCC) and nearly 60% of this population present with locally-advanced, but non-metastatic, disease. For many years, radiation therapy (RT) alone has been the standard non-surgical treatment for locally-advanced disease. Nevertheless, even the most effective RT regimens (the once-daily, hyper-fractionation or accelerated fractionation) show an improvement in local control rates of 50%–70% and disease-free survival rates of 30%–40%. These modest results have stimulated the search for novel strategies combining RT and chemotherapy. Several chemotherapeutic agents have been tested in combination with RT and cisplatin appears the most powerful agent in the treatment of locally-advanced head and neck tumours; as has been demonstrated in a large meta-analysis and, recently, in two multicentred randomized trials. Based on these results, concurrent chemo-radiotherapy may be considered the standard adjuvant treatment for locally-advanced head and neck tumours.     

Docetaxel and irinotecan in recurrent or metastatic head and neck cancer

BACKGROUND:

Docetaxel and irinotecan have single‐agent antitumor activity in squamous cell carcinoma of the head and neck (SCCHN). The authors sought to evaluate their combination in the treatment of patients with recurrent or metastatic SCCHN.

METHODS:

Eligibility criteria included recurrent or metastatic SCCHN with measurable disease, good performance status, and adequate laboratory parameters. Patients received docetaxel 35 mg/m² and irinotecan 60 mg/m², intravenously, on Days 1 and 8, every 21 days, until disease progression. The authors assessed UGT1A1 genotype, vascular endothelial growth factor (VEGF) in serum, and cyclooxygenase‐2 and VEGF in baseline tumor tissue.

RESULTS:

Fifty‐two patients were analyzable: 20 chemotherapy naive (Group A) and 32 previously treated with 1 chemotherapy regimen (Group B); 73% of patients had distant metastasis, and 60% were paclitaxel‐exposed. In Group A, 3 (15%) patients achieved a partial response; in Group B, 1 (3%) patient achieved a partial response. Median progression‐free survival (PFS) and overall survival were 3.3 and 8.2 months in Group A and 1.9 and 5.0 months in Group B, respectively. Common serious toxicities were diarrhea, fatigue, and anorexia. Patients with high serum VEGF had a median PFS of 2.8 months versus 1.7 months for patients with low VEGF (P = .085).

CONCLUSIONS:

Docetaxel and irinotecan had acceptable toxicities, but efficacy results in unselected patients with recurrent or metastatic SCCHN did not suggest an advantage over docetaxel alone or platinum‐based regimens. Cancer 2009. © 2009 American Cancer Society.     

Parenteral hyperalimentation in surgical patients with head and neck cancer: A randomized study

Sixty-nine patients were entered in a randomized study to determine the usefulness and practicality of parenteral hyperalimentation (TPN) in preparing and supporting patients with head and neck cancer undergoing radical resections. The patients were stratified by nutritional status and prognosis and randomization were done within each strata to TPN or control. Minimum full TPN was given at 35 calories/kgm/day for at least 14 days postoperatively. Eight patients received preoperative TPN also. Control patients received customary enteral alimentation by feeding tubes. Under the conditions of this particular study, the administration schedules, and type of solutions used, we were unable to demonstrate any superiority of TPN over conventional enteral nutrition in terms of immune parameters, wound healing, complications, and survival.     

Rehabilitation problems of head and neck cancer patients.

Head and neck cancer and its treatment result in varying degrees of disability affecting various organ systems. Ideal treatment of such patients requires a unit capable of managing problems in the areas of: Reconstructive surgery, maxillofacial prosthodontia, dentistry, deglutition disorders, and psychological, social, and vocational rehabilitation. Provision of such facilities in an integrated manner will give the patient the optimal chance for rehabilitation from the complex disabilities occurring in head and neck cancer.     

Current management of mucosal melanoma of the head and neck

While mucosal-based melanomas of the head and neck region are uncommon lesions, when they do arise they usually follow an inexorably aggressive course. Experience with these tumors is, necessarily, limited; as such, well-worked out treatment protocols for the treatment of such lesions are in short supply. It appears as though mucosal melanomas (MuMs) develop more frequently in the nasal cavity and paranasal sinus region, and less often in the oral cavity. It seems that the incidence of nodal metastasis is significantly lower for sinonasal MuMs than it is for MuMs of the oral cavity; this observation may influence decisions about performing neck dissection as a function of location of the primary MuM. At present, surgical excision remains the mainstay of treatment; however, anatomical complexities within the region can hamper attempts at complete excision. Radiotherapy has not traditionally been relied on for routine treatment of MuM, although some recent reports have challenged this view. Chemotherapy is, at present, employed principally in the treatment of disseminated disease and for palliation. As a diagnostic matter, MuM belongs to the class of tumors that, on light microscopy, may with some regularity be confused with other malignancies (including sarcomas, plasmacytomas, and carcinomas); as a consequence, this is a diagnosis which is often best confirmed by way of ancillary testing via immunohistochemical studies. A better grasp of the best means of treating MuM will likely come only when large referral centers are able to pool their experiences with these uncommon yet virulent malignancies.     

Local control in advanced head and neck cancer by combined modalities of treatment

From July 1979 to January 1983, 20 patients with locally advanced head and neck cancer were treated with a combination of chemotherapy and irradiation with or without surgery. A majority of the patients were in the age range of 45 to 54 years. Eighty-five percent of the patients were male. Seventy-five percent of the patients had oral cavity lesions, the tongue being the most common site. Eighty percent of the patients had T₄ lesion and 35% had N₃ disease in the neck. A majority of the patients had combination chemotherapy, including bleomycin, methotrexate, and cis-platinum (BMP). All patients received irradiation with megavoltage equipment and 55% of patients received a dose of 5,000 to 6,000 rads in 5–6 weeks time. The tumor was converted to be resectable in ten patients. Nine patients (45%) had the neck and primary tumor completely controlled, while six patients (30%) had partial control. Six of the ten patients who had resection had the tumor controlled at the primary site and neck. The median duration of follow-up is 12 months (range, 4–32 months). The median survival of the whole group of patients is 12.5 months. A brief review of the current literature is also done in this paper.     

A review of the predictive role of functional imaging in patients with mucosal primary head and neck cancer treated with radiation therapy

Advanced radiotherapy techniques, such as intensity‐modulated radiotherapy, have been reported to reduce toxicities by improving the dose conformity in mucosal primary head and neck cancer (MPHNC). However, to further optimize the therapeutic ratio, details on individual patient and disease characteristics may be necessary to tailor treatments. This is likely to include identifying poor responders for treatment intensification and good responders for de‐escalation strategies. Non‐invasive, repeatable imaging biomarkers are attractive modalities in both pre‐treatment and intra‐treatment response prediction with a view to individualized treatment options. This review has assessed the current literature on the prognostic/predictive role of widely available functional imaging (FI) studies such as fMRI(functional magnetic resonance imaging), functional computed tomography (fCT) and positron‐emission‐tomography(PET). A literature search was carried out using Medline, Embase and PubMed. Studies were included if imaging was undertaken pre and/or during radiotherapy (with or without the addition of chemotherapy and/or surgery). A total of 99 relevant studies were identified: 14 fMRI, 10 fCT, 59 FDG‐PET and 16 non‐FDG‐PET studies. These articles were reviewed to identify imaging parameters demonstrating a correlation with patient outcome or a factor considered to impact on patient outcome and thus likely to be of potential predictive value in MPHNC and associated future radiotherapy treatment directions. Several studies have demonstrated that both pre‐treatment and mid‐treatment FDG‐PET is predictive of outcomes. However, further studies are required to confirm the role of other imaging studies including fMRI and PET using other tracers. There is large heterogeneity within and between published studies, including tumour sites, treatment options, outcome endpoints and parameters assessed. We propose a minimum set of factors that should be reported and make recommendations for studies evaluating the predictive utility in MPHNC.     

MRI直方图在头颈部肿瘤诊断中应用的研究进展

肿瘤的精准评估是肿瘤影像学研究的关键点。随着高分辨率磁共振成像(magnetic resonance imaging,MRI)和信号处理方法的不断进步,利用磁共振功能成像结合影像组学方法在肿瘤诊断中受到广泛关注。MRI直方图分析是从标准影像数据中通过高通量算法提取定量参数特征来分析肿瘤整体的异质性,进一步开发诊断、预测与预后模型,为临床医生诊疗过程提供参考依据。本文就近年来MRI直方图在头颈部肿瘤异质性诊断及治疗效果评估、预测方面进行综述,并强调了不同磁共振成像技术直方图在头颈部肿瘤诊断中的研究进展。     

头颈部肿瘤颈部放疗对甲状腺功能影响的研究进展

头颈部肿瘤颈部放疗后,会引起甲状腺功能减退（hypothyroidism,HT）,5年发生率于20%～60%之间。本文综述了放疗剂量-体积参数、年龄、放射技术、性别等因素与放射治疗引起的甲状腺功能减退（radiation-induced hypothyroidism,RIHT）的关系,以及产生的机制。甲状腺的剂量-体积阈值相关研究很多,但结论不一,不能明确定义。但共识是较高的甲状腺剂量和较小的甲状腺体积会增加RIHT的发生率,年龄、放射技术、性别会对RIHT的发生有影响。需大量前瞻性大样本进一步研究来开发更多的正常组织并发症概率 （normal tissue complication probability,NTCP）模型及探讨下丘脑-垂体轴和RIHT之间的关系。     

Ultrasonographic changes in malignant neck nodes during radiotherapy in head and neck squamous carcinoma

Limited information is available about the sonomorphological changes in metastatic neck nodes during radiotherapy. The aim of this study was to evaluate the pattern of sonomorphological changes in metastatic neck nodes with radiotherapy. The study population consisted of 16 consecutive patients planned for radical radiotherapy to the head and neck. All patients were subjected to four ultrasound examinations: before therapy, at 46 Gy, at the conclusion of radiation and at first follow up. A total of 59 ultrasound examinations were performed on 16 patients. The difference between the mean number of nodes detected per patient before (10.6) and after (7.8) radiation was significant (P = 0.05). Sixteen nodes were categorized as malignant at first sonography, half of which reverted back to normal by the end of radiation. Changes in the sonomorphology of malignant cervical lymph nodes occur with radiotherapy with more that half demonstrating reversion to normal pattern. Future studies correlating this with histopathology should be considered.     

Soft-tissue sarcomas of the head and neck in children

Thirty-two children aged three months to 17 years (median six years) were diagnosed with soft-tissue sarcoma of the head and neck and treated at the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania from 1971 to 1981. Thirty-one received chemotherapy and all received radiation therapy (RT). Twenty-five patients had pre-treatment computed tomography (CT) scans, which were used for staging and treatment planning. Doses of radiation therapy ranged from 3000 to 7300 rad to the primary tumor (median 5000 rad). The overall five-year survival of the entire group of 32 patients was 75%. Ten of the 32 patients had invasive cranial parameningeal disease as demonstrated by bony erosion at the skull base, seen on CT in eight and plain radiographs in two patients. Eight of these 10 patients have developed recurrent sarcoma: four in the meninges, two locally, one regionally and one distantly. Five of these 10 children with invasive cranial parameningeal sarcoma received 3000 rad of prophylactic cranial irradiation, begun within the first 12 days of chemotherapy, and none developed meningeal disease. In contrast, only one of the 22 patients without invasive cranial parameningeal disease has relapsed (local recurrence). The data suggest that soft-tissue sarcomas of the head and neck in children without invasion into the base of the skull (invasive cranial parameningeal disease) are usually cured. CT scans are essential for staging. Patients with invasion of the base of the skull may be protected from meningeal relapse by early cranial irradiation, although they still are at high risk for relapse in other sites.     

Cost analysis of microsurgical reconstruction in the head and neck

In a cost-conscious environment, pressure exists to justify the use of expensive techniques such as reconstructive microsurgery in head and neck patients. Therefore, the costs and effectiveness of 39 consecutive free tissue transfers in patients with head and neck defects due to neoplasia (77%), trauma (13%), or congenital causes (10%) were assessed by reviewing clinical and billing records. The technical success rate was 95% with a 29% rate of complications. Most patients returned to preoperative levels of social activities, and none admitted dissatisfaction with their results. Average cost was $27,000 per case with 16 days of hospitalization. Average cost for aerodigestive tract tumors was $37,400 with 21 days of hospitalization. Costs were directly related to the etiology of the defect and incidence of complications. Applying cost-effectiveness principles we believe that these costs are justified by the high level of patient satisfaction and enhanced quality of life.