Photodynamic therapy in the treatment of multiple primary tumours in the head and neck,located to the oral cavity and oropharynx

Objectives: Multiple primary tumours are a common problem in the head and neck cancer patients. Curative surgery or radiotherapy of these tumours can be very mutilating or even impossible. This study aims at evaluating meta‐tetrahydroxy‐phenyl chlorin‐mediated photodynamic therapy for second or multiple primary tumours in the head and neck. Design: Retrospective study of all patients with second or multiple primary tumours treated by photodynamic therapy over a 10‐year period. Setting: All patients were treated in the Netherlands Cancer Institute, a tertiary referral centre for the head and neck cancer patients. Participants: A total of 27 patients with 42 the second or the multiple primary head and neck tumours were treated by photodynamic therapy (0.15 mg/kg meta‐tetrahydroxy‐phenyl chlorin). Main outcomes measures: Cure rates. Results: Twenty‐eight of 42 tumours were cured (67%). Cure rates for stage I or in situ disease were 85%versus 38% for stage II/III. Conclusions: Cure rates for photodynamic therapy of the multiple primary head and neck tumours were lower than previously described for first primaries, but were still very encouraging for this difficult patient population. The high cure rate obtained in stage I multiple primaries emphasises the importance of a meticulous follow‐up of patients treated for the head and neck cancer to detect new tumours at a curable stage.     

Photodynamic therapy in the treatment of squamous cell carcinoma of the head and neck

Photodynamic therapy is an experimental modality for tumor treatment based on the combined action of the tumor-localizing agent, ie, hematoporphyrin derivative, and red light. From 1985 through 1989, 26 patients were treated using hematoporphyrin-derived drugs and 630-nm light delivered by a tunable dye laser. All patients had biopsy-proved squamous cell carcinoma of the head and neck, and they had either failed the traditional treatment modalities or refused conventional therapies. Histological complete responses were achieved in 20 (77%) of 26 patients and partial responses in 5 (19%) of 26 patients for periods up to 48 months. Only minimal toxic reaction was noted in the group. As a guide to treatment planning for a patient group with large tumors, we used an optical dosimetry model based on tissue optics. The rate of complete responses to this treatment was 8 (73%) of 11. Our data indicate that photodynamic therapy is capable of inducing significant clinical and histological responses in the majority of those treated, and in some patients a prolonged response is produced. In certain select head and neck malignancies, photodynamic therapy has an important role as a treatment modality.     

Scandinavian and Danish Societies for Head and Neck Oncology

The following are the abstracts of the 3rd meeting held in Copenhagen, 19–20 April 1991 Prognostic value of Epstein-Barr virus titres in nasopharyngeal carcinoma J. Bentzen, P. Ebbesen, H. Albeck, N. Keldsen & H. S. Hansen Clinical radiobiology of oropharyngeal carcinoma S. M. Bentzen Patients with advanced head and neck carcinoma treated before irradiation with cisplatin and 5-fluorouracil A. Berthelsen Cancer of the oropharynx: incidence reports for 1985 from Denmark, Finland, Norway and Sweden A. BIÖRKLUND, M. BOYSEN, H. S. HANSEN & H. PUHAKKA Evaluation of malignancy in oral carcinoma T. BUNDGAARD, F. B. SORENSEN, M. GAIHEDE, H. SØGAARD & J. OVERGAARD Epidermal growth factor receptor expression in normal oral mucosa, dysplasia and squamous cell carcinoma M. CHRISTENSEN, M. H. THERKILDSEN, H. ALBECK, P. BRETLAU Nimorazole as a hypoxic cell radiosensitizer in laryngeal and pharyngeal carcinoma. DAHANCA Protocol 5–85 The Danish Head and Neck Cancer Study Group Surgical complications after 50–60 Gy preoperative irradiation for carcinoma of the tongue R. GRÉNMAN, H. JOENSUU, J. SUONPÄÄ, K. AITASALO, H. PUHAKKA & E. NORDMAN Analysis of tumour growth in human squamous cell carcinoma of the head and neck region after iododeoxyuridine labelling in vivo H. GUSTAFSSON, C. BERGSTRÖM, K. NYLANDER, G. ROOS, R. STENLING & B. ZACKRISSON Importance of the time interval between preoperative radiotherapy and surgery in the treatment of oral cavity cancer O. HANSEN, J. SØRENSEN, S. SIEMSSEN & H. POULSEN Phase II trial of accelerated hyperfractionated radiotherapy in cancer of the larynx N. V. JENSEN, & L. BASTHOLT Carbacholine in the treatment of radiation induced xerostomia H. JOENSUU, P. BOSTRÖM, T. MAKKONEN & R. GRENMAN Squamous cell carcinoma of the oropharynx: therapeutic results in a series of 105 patients J. JOHANSEN & K. JØRGENSEN Radiotherapy of oropharyngeal squamous cell carcinoma L.V. JOHANSEN & J. OVERGAARD Surgical treatment of advanced oropharyngeal carcinoma J. KIRKEGAARD The status of the on-going Scandinavian study of induction chemotherapy in advanced squamous cell carcinoma of the head and neck F. Lewin Induction chemotherapy in advanced squamous cell carcinoma of the head and neck F. LEWIN, J. WENNERBERG & C. MERCKE Squamous cell carcinoma of the oropharynx: primary radiotherapy, treatment schedules and results B. LINDELØV, J. MONBERG & H. S. HANSEN The management in Scandinavia of small squamous cell carcinomas of the mobile tongue A. NATHANSON, H. HJARTARSON, A. B. JACOBSEN, J. KIRKEGAARD & J. PUKANDER Examination and rehabilitation of the oral cavity in treatment of orofacial tumours O. ODELBERG-JOHNSON, A. NILSSON & I. JÄRNESTEN Protein kinase activity in squamous cell carcinoma and normal mucosa of the oral cavity E. L. RYDELL, K. L. AXELSSON, S. HELLEM & J. OLOFSSON Evaluation of swallowing disorders of patients with head and neck cancer treated by surgery and/or radiotherapy. A rehabilitation programme N. SANDBERG, S.-Å. ALMQVIST, H. DOTEVALL, M. RUTH & P. SVENSSON A phase-III study of adjuvant 13-cis retinoic acid in squamous cell carcinomas of the mouth, pharynx and larynx P. WAHLBERG, J. WENNERBERG, A. ASK, G. FEX, L.E. RUTQVIST & F. LEVIN Heterogeneous DNA content in oral squamous carcinoma M. TYTOR, S. WINGREN & J. OLOFSSON Chemotherapy for recurrence of squamous cell head and neck cancer using infusion pumps J. WITTEN & A. Berthelsen     

Chemoprevention of head and neck cancer with retinoids: a negative result

OBJECTIVE: To determine whether isotretinoin (or 13-cis-retinoic acid) decreases the risk of second primary cancers in patients previously treated for cure of head and neck squamous cell carcinoma. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Two head and neck multidisciplinary cancer clinics in university teaching hospitals taking cases from 4 to 5 million people in Queensland, Australia, combined to enter appropriate patients into this trial. PATIENTS: One hundred fifty-one patients with their first head and neck squamous cell carcinoma treated with high expectation for cure and living close by. They were randomized into 3 arms to receive 3 years of treatment. INTERVENTIONS: Patients took isotretinoin at a high dose (1.0 mg/kg per day) or a moderate dose (0.5 mg/kg per day) or placebo. Group 1 took the high dose for 1 year and then the moderate dose for 2 years. Group 2 took the moderate dose for 3 years. Group 3 took placebo for 3 years. MAIN OUTCOME MEASURES: The diagnosis of a second primary malignancy of the head and neck, lung, or bladder was regarded as the end point signifying failure of therapy. Issues of drug adverse effect profile and impact on survival were measured. RESULTS: There was no significant difference in the occurrence of second primary disease (P = .90), the recurrence of primary disease (P = .70), or disease-free time (P = .80) between the treatment and nontreatment arms. Numbers were too small to find differences in survival. CONCLUSION: With evidence that retinoid treatment adversely affects survival of lung cancer and with this drug not significantly decreasing the incidence of second primary tumors of head and neck squamous cell carcinoma, the use of this drug in head and neck cancer patients for second cancer prophylaxis is not indicated.     

Laser light-induced cytotoxicity of cultivated squamous cell cancer cells of the head and neck following photosensitization

Photodynamic therapy, which involves the action of light-activated dyes on biological tissues, has been attempted to treat tumors. In order to achieve effective tumor cell destruction in head and neck cancer, the direct photodynamic effects on in vitro cultured squamous carcinoma cell lines were analyzed. Without light no tumor cell killing was observed after photosensitization up to 6 hrs with dihematoporphyrinester/-ether (DHE) concentrations of 5 micrograms/ml. With longer incubation times and higher light irradiation dosages, however, an increasing cytotoxicity could be observed. Optimal intervals for photosensitization were 48 hours. Squamous cell carcinoma lines of the head and neck from different locations did not differ in their photodynamic behaviour with respect to photodynamic treatment. With the results presented, it will be appropriate to complete in vivo studies to inspire photodynamic tumor cell destruction in the treatment of head and neck cancer as a new approach besides the classical therapeutic modalities.     

High-dose intra-arterial cisplatin therapy followed by radiation therapy for advanced squamous cell carcinoma of the head and neck.

OBJECTIVE: To assess the effectiveness of a protocol consisting of 4 cycles of high-dose intra-arterial cisplatin infusions followed by radiation therapy for improving chemotherapy response rates, organ preservation, and survival in patients with advanced-stage untreated and previously treated squamous cell carcinoma of the head and neck. DESIGN AND SETTING: A prospective study of sequentially enrolled patients treated in an academic medical center. The Kaplan-Meier method was used for survival analysis. PATIENTS: Fifty-eight nonpregnant adults, 18 years of age or older, with measurable untreated or recurrent advanced biopsy-proven squamous cell carcinoma of the head and neck. MAIN OUTCOME MEASURES: Response rate to targeted intra-arterial cisplatin infusions, organ preservation, and survival. RESULTS: Fifty-eight patients (44 men and 14 women) were followed up for at least 2 years (median duration of follow-up, 27 months). Twenty-nine (67%) of the 43 previously untreated patients had a complete response to intra-arterial cisplatin therapy. Of the untreated patients, 28 are alive and disease free after a median follow-up time of 30 months. Five of the patients with recurrent disease had a complete response to intra-arterial cisplatin therapy. There were 4 survivors after a median follow-up time of 17.5 months. Of note, there were no deaths or serious complications related to the treatment in either group. CONCLUSIONS: High-dose intra-arterial cisplatin therapy provides a high complete and partial response rate (91%). The combination of high-dose intra-arterial cisplatin and radiation therapy is effective in improving survival and organ preservation rates in patients with previously untreated, advanced squamous cell carcinoma of the head and neck. This treatment protocol is much less effective for recurrent disease.     

Photodynamic therapy and the treatment of neoplastic diseases of the larynx

Photodynamic therapy (PDT) is an innovative treatment involving the use of light-sensitive drugs to selectively identify and destroy diseased cells. Therefore, photodynamic therapy has the potential to treat and cure precancerous and early cancerous lesions (carcinoma in situ [CIS], T1 and T2) of the larynx while preserving normal tissue. Eleven patients with recurrent leukoplakia and carcinomas of the larynx were treated with PDT with follow-up to 27 months. One patient with a Tl verrucous carcinoma, 5 patients with T1 squamous cell carcinomas of the vocal cord failing radiotherapy, 1 patient with a T2 squamous cell carcinoma of the vocal cord failing radiotherapy, and 3 patients with CIS and severe atypia were treated with PDT and obtained a complete response and are disease free. One patient with a T3 carcinoma of the larynx was treated with PDT but died 4 weeks post-treatment of unrelated causes and could not be assessed. Photodynamic therapy is a promising therapy for treatment of precancerous and cancerous lesions of the larynx. This therapy may be particularly beneficial for the treatment of recurrent carcinomas of the larynx that have failed conventional radiotherapy, thereby preserving voice and eliminating the need for destructive laryngeal surgery.     

Treatment of the Clinically Negative Neck in Oral Squamous Cell Carcinoma

Objective: To define the most effect treatment plan of patients with oral cavity squamous cell carcinoma with clinically negative (N0) neck staging. Study Design: Retrospective review of 54 patients with N0 neck staging who underwent resection of an oral cavity primary tumor with or without elective neck dissection between January 1982 and December 1992 and with a minimum follow-up of 3 years. Methods: The records of 54 patients with previously untreated oral cavity squamous cell carcinoma and N0 neck staging were retrospectively reviewed to determine the impact of elective neck dissection on patient outcomes including regional recurrence and overall survival. Results: All patients underwent surgical resection of their oral cavity tumors, with 33 patients undergoing “watchful waiting” observation for the development of neck disease while 21 patients had elective neck dissections. The most controversial group of patients were those with intermediate-sized (T2 and T3) primary tumors. Eighteen of these patients underwent elective neck dissection, with two patients developing recurrent neck disease and an ultimate prognosis of 72%. Twelve patients had observation of their necks, with five of these patients subsequently requiring neck dissection. An additional seven patients did not undergo neck dissection, and this group had four survivors free of disease. The prognosis was 42% in patients not having elective neck dissections. Conclusions: Tl tumors do well with neck treatment other than careful observation. The data suggest that patients with T2 and T3 oral squamous cell carcinoma should undergo surgical resection of their primary tumor site and elective neck dissection. Patients with T4 oral cavity lesions should routinely undergo neck dissection.     

Is routine follow-up useful after combined-modality therapy for advanced head and neck cancer?

OBJECTIVE: To evaluate the usefulness of routine follow-up in a selected group of patients with head and neck cancer. DESIGN: Retrospective cohort study with follow-up of 5 years for all patients. PATIENTS: Three hundred two patients with advanced (stage II or IV) squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx were treated with curative intent with surgery and postoperative radiation therapy between January 1, 1970, and December 31, 1990. MAIN OUTCOME MEASURE: Survival after recurrence of the index tumor or the development of a second head and neck primary tumor. RESULTS: Overall actuarial 5-year survival was 56%. Relapse occurred in 119 patients, and salvage therapy was attempted in 49 patients. Only 2 patients survived to 5 years after relapse. CONCLUSION: In patients with advanced head and neck squamous cell carcinoma, routine follow-up is more important for evaluation of treatment results and emotional support than of benefit in improving patient survival.     

Occult nodal metastasis in head and neck carcinoma patients treated with chemoradiotherapy

Background and aimNeck lymph node metastasis plays an important role in the prognosis of patients with squamous cell carcinoma of the head and neck. The aim of this study was to evaluate the occult nodal metastasis in patients with head and neck squamous cell carcinoma (HNSCC) treated with chemo radiotherapy.MethodsIn this 5-year prospective study, patients with recurrent head and neck squamous cell carcinomas (HN-SCC) after primary treatment with chemoradiotherapy or radiotherapy that candidate for surgery were enrolled. In total, 50 patients with squamous cell carcinomas of the head and neck with N0 neck were included in the study. Age, initial location of recurrent tumor, T staging in primary and recurrent tumors, neck condition (N0 or N+), and pathology report for neck metastasis, number of affected lymph nodes and duration of tumor recurrence were examined.ResultsOut of 50 patients with mean age of 57.04 ± 14.4 years, 13 were female (26%) and 37 (74%) were male. In terms of primary tumor size, 52% (26 patients) were in T2 stage. The primary and recurrent tumor was located in the oral cavity in 33 patients (66%). Nine 0f 50 patients (18%) had occult metastases.ConclusionIt seems that END surgery is necessary for treatment the occult lymph node neck metastasis of recurrent head and neck cancers with N0 neck. Therefore, it is possible that END surgery has reduced cervical recurrence in these patients.     

Treatment of primary mucosal head and neck squamous cell carcinoma using photodynamic therapy: results after 25 treated cases

The use of photodynamic therapy for the treatment of malignant and non-malignant conditions is increasing. This paper demonstrates the efficacy of a second-generation photosensitizer, Foscan, in the primary treatment of a wide range of mucosal head and neck squamous cell carcinomas. Tumours ranged in stage from T(1) to T(3). A complete response to primary treatment was seen in 19/21 patients (90 per cent). In laryngeal cancer recurrent after radical radiotherapy, one out of four patients treated obtained a complete response (25 per cent). Six patients (24 per cent) required surgery after photodynamic therapy, for local recurrence or dysplasia. Mean follow up was for 27.3 months (standard deviation 20.6 months).     

Negative-pressure wound therapy for the treatment of pharyngocutaneous fistula

IntroductionPharyngocutaneous fistula is a well-known complication of head and neck cancer surgery. The purpose of this study was to determine the value of negative-pressure wound therapy (NPWT) for the treatment of these fistulas. NPWT is used in many fields of medicine, but its use in otorhinolaryngology has been rarely reported. NPWT is a cost-effective means to accelerate wound healing.Patients and methodsA single-centre retrospective study was conducted on 7 patients with pharyngocutaneous fistula following surgery for squamous cell carcinoma between January 2011 and April 2013. These fistulas were treated by negative-pressure wound therapy (NPWT).ResultsThis series comprised seven male patients with a mean age of 65 years and 9 months. The mean duration of treatment was 23 days (range: 11 to 42 days). Two patients had a history of radiotherapy for pharyngolaryngeal cancer. Negative-pressure wound therapy achieved cure of the fistula in all patients with satisfactory acceptability. Mean follow-up was 10 months (range: 6 months to 2 years).ConclusionNegative-pressure wound therapy represents a valuable treatment option in certain settings for the management of pharyngocutaneous fistula following head and neck cancer surgery.     

Radiologic percutaneous gastrostomy: Results in 56 patients with head and neck cancer

Objective: The establishment of a direct enteral feeding route is critical in the overall treatment of many patients with head and neck cancer. Use of radiologic percutaneous gastrostomy (RPG), the newest technique for gaining enteral access, has not been studied in such patients extensively. This study evaluated the indications, technique, success rate, and complications associated with RPG in patients with head and neck cancer. Study Design: Retrospective. Methods: A comprehensive chart review was undertaken of 56 patients with head and neck cancer treated at a tertiary care institution who had undergone successful or attempted RPG at some point during their treatment course. Results: Most study patients had advanced oropharyngeal squamous cell carcinoma. The most frequent indications for RPG were dysphagia/aspiration following tumor resection (n = 26) and dysphagia following completion of single- or combined-modality therapy (n = 22). The success rate of attempted RPGs was 98.2%. The overall complication rate for RPG was 12.7% (10.9% minor and 1.8% major). Conclusions: RPG is a valuable tool for establishing enteral nutrition in patients with head and neck cancer. Advantages of RPG include high success rate despite obstructing lesions, low complication rate, time efficiency and scheduling ease compared with intraoperative percutaneous gastrostomy (PEG) by a second team, no reported tumor seeding of the tube site, and the fact that postoperative RPG allows for more accurate selection of patients who require a gastrostomy tube.     

Differential Effects of Retinoic Acid and N-(4-hydroxyphenyl)retinamide on Head and Neck Squamous Cell Carcinoma Cells

Both retinoic acid (RA) and the synthetic retinoid N-(4-hydroxyphenyl)retinamide (4HPR) have shown efficacy in head and neck cancer chemoprevention trials. To compare their activity and mechanism of action, the 1483 oral head and neck squamous cell carcinoma (HNSCC) cell line was grown in organotypic culture, an in vitro system that allows cellular stratification and simulates carcinoma in situ, and was exposed to 10 μmol/L of either RA or 4HPR. Extensive apoptosis, as evidenced by in situ deoxyribonucleic acid end-labeling, occurred in 4HPR-treated cultures after 9 days, with >80% cell loss (P<.001). In contrast, the growth of cultures treated with RA was inhibited by only 32%, with no evidence of apoptosis. Because 4HPR has low systemic toxicity and is a potent inducer of apoptosis in HNSCC cells, its role in chemoprevention of head and neck cancers, including cancers that are resistant to RA-induction therapy, warrants further investigation.     

Effect of Hyperbaric Oxygenation on Existing Oral Mucosal Carcinoma

Hyperbaric oxygen therapy (HBO) is used to treat some complications of head and neck carcinoma treatment. Several patients treated with HBO have had rapid growth of a clinically cured squamous cell carcinoma. Prior studies have produced conflicting evidence about the effect of HBO on tumor growth. This study was undertaken to determine the effects of HBO on established squamous cell carcinoma. Forty Golden Syrian hamster cheek-pouch carcinomas were induced with the established chemical carcinogen 9,10-dimethyl-1,2-benzanthracene. Twenty hamsters underwent 30 HBO dives for 60 minutes each to 2.81 atm, while 20 served as controls. At necropsy, animals receiving HBO therapy had significantly smaller tumors (P<.05) and showed a trend toward fewer cervical metastases (P<.06). HBO therapy with coexistent carcinoma inhibited the established tumor's growth.     

Phase 2 bioadjuvant study of interferon alfa-2a, isotretinoin, and vitamin E in locally advanced squamous cell carcinoma of the head and neck: long-term follow-up

OBJECTIVE: To evaluate the long-term effects of the combination of isotretinoin, interferon alfa-2a, and vitamin E in locally advanced squamous cell carcinoma of the head and neck. DESIGN: Phase 2 prospective study. SETTING: Tertiary care academic medical centers. PATIENTS: Forty-five patients entered this study. All patients had stage III or IV squamous cell carcinoma of the head and neck and had been treated with surgical resection, radiation, or both. All patients were then treated with bioadjuvant chemopreventive treatment for 12 months. We previously reported a 24-month median follow-up of this phase 2 trial of the combination of isotretinoin, interferon alfa-2a, and vitamin E as bioadjuvant therapy after definitive local therapy. In that study, all 45 patients completed treatment, but 1 patient was excluded from analysis of recurrence and development of second primary tumors.Main Outcome Measure Longer-term (49.4-month median) follow-up. RESULTS: Among the 45 patients treated under the protocol, only 7 patients (16%) had died. Nine (20%) of 45 patients experienced progressive disease. Only 1 second primary tumor (acute promyelocytic leukemia) occurred during follow-up, and no aerodigestive second primary tumors occurred among the 45 patients. The 5-year progression-free survival and overall survival percentages were 80% (95% confidence interval, 65.1%-89.1%) and 81.3% (95% confidence interval, 63.7%-90.9%), respectively. These results are significantly better than the historical 5-year overall survival for advanced squamous cell carcinoma of the head and neck (approximately 40%). CONCLUSION: The bioadjuvant combination is highly effective in preventing recurrence and second primary tumors, and its role as standard therapy in advanced squamous cell carcinoma of the head and neck is being investigated in a randomized phase 3 study.     

Simultaneously presenting head and neck and lung cancer: a diagnostic and treatment dilemma.

OBJECTIVES/HYPOTHESIS: Synchronous tumors are defined as malignancies presenting within 6 months of the index tumors. A significant subset of patients present at initial evaluation with malignant tumors of both the head and neck (head and neck squamous cell carcinoma) and the lung, which are termed simultaneous primaries. The management and treatment outcomes in this cohort of patients have not been clearly defined and are the subject of the present review. STUDY DESIGN: Retrospective chart review of previously untreated patients. METHODS: From January 1974 to December 1997, a total of 2964 patients were treated for mucosal squamous cell carcinoma of the head and neck. Forty-two patients fulfilled the criteria for synchronous head and neck and lung malignancy. Of these, 27 patients had simultaneous tumors of the head and neck and the lung. This cohort of patients (n = 27) was stratified into three treatment groups. Patients in group A (n = 10) had resectable head and neck and lung primaries treated with curative intent. Group B (n = 8) was composed of patients who could have been treated with curative intent but declined and were given only palliative therapy. Patients in group C (n = 9) were candidates for only palliative treatment. RESULTS: The estimated 5-year disease-specific survival in group A was 47%, whereas patients in group B had a 5-year disease-specific survival of only 13% (P =.05). There were no survivors beyond 1 year in group C. The presence of mediastinal adenopathy in patients in group A portended poor clinical outcome. There was an estimated 5-year disease-specific survival of 51% in patients with no preoperative evidence of mediastinal adenopathy (n = 7), whereas 67% of patients with radiological evidence of mediastinal adenopathy died (two of three patients). CONCLUSION: The presence of simultaneous head and neck squamous cell carcinoma and pulmonary malignancies should not be a deterrent to aggressive surgical therapy because a potentially satisfactory outcome can be expected in these patients.     

Three-dimensional xenograft model of dysplastic human laryngeal mucosa

Objective: Development of new therapeutic interventions in head and neck squamous cell carcinoma (HNSCC) will be facilitated by a model system that incorporates the ease of manipulation found in current tissue culture systems while retaining the three dimensional architecture that defines these malignancies. Study Design: Original scientific investigation. Methods: We describe a modification of a normal respiratory mucosa model system which recreates premalignant mucosal histology. Grossly normal appearing human mucosa is harvested from laryngectomy specimens, the mucosal epithelium selectively removed by protease treatment and placed in conventional tissue culture. After 7 days, the cells are seeded into denuded rat tracheas, which are in turn implanted in flank pockets of athymic nu/nu mice. The tracheas are incubated for three weeks, removed and the mucosa examined histologically. Results: As originally described, normal pseudostratified squamous epithelium can be re-established in this system. ¹⁰ Using human dysplastic mucosa as a starting material, mucosal histologies of respiratory dysplasia, squamous metaplasia, squamous dysplasia and squamous carcinoma in situ can be established. Conclusion: This system will provide a paradigm for future therapeutic interventions to modify the progression of squamous metaplasia to dysplasia, carcinoma in situ and invasive squamous cell carcinoma. Key Words: Head and neck squamous cell carcinoma, xenograft model, dysplasia.     

Control of neck nodes in squamous cell carcinoma of the head and neck by radiotherapy: prognostic factors

313 patients with cervical metastases from a squamous carcinoma of the head and neck treated with radiotherapy, were studied by means of a multivariant analysis in order to determine the prognostic factors for cure. These were: lymph node response to irradiation (P= 0.0000), size of node (P= 0.0000), radiotherapy dose (P= 0.0037), condition of the primary (controlled vs non-controlled) (P= 0.0015), recurrent cervical metastases post-surgery (P= 0.0286).     

Surgical wound complications after intensive chemoradiotherapy for advanced squamous cell carcinoma of the head and neck

OBJECTIVE: To define the rate of complications from surgery following intensive chemoradiotherapy in patients with advanced squamous cell carcinoma of the head and neck. DESIGN: The medical records of 131 consecutive patients treated with a combination of chemotherapy and radiation therapy for head and neck squamous cell carcinoma from 1995 through 2002 were reviewed. Thirty-eight patients underwent 50 surgical procedures. Thirty-seven neck dissections were performed either for persistent disease, initial neck stage N2 or greater, recurrent disease, or electively as part of salvage surgery for the primary site. Thirteen salvage operations were performed for persistent or recurrent disease at the primary site. SETTING: Academic tertiary care referral center. PATIENTS: A total of 131 consecutive patients treated with a combination of chemotherapy and radiation therapy for head and neck squamous cell carcinoma (mean age at diagnosis, 53 years). MAIN OUTCOME MEASURE; Rate of complications from surgery. RESULTS: Wound complications occurred in 4 (11%) of 38 patients and 5 (10%) of 50 procedures. Major wound complications occurred in 3 (8%) of 38 patients. Minor wound complications occurred in 2 patients (5%). CONCLUSION: Surgery can be safely performed after intensive chemoradiotherapy.