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Clin. Otolaryngol. 2010, 35 , 474–478 Objectives: Our objectives were to assess whether a CT chest, when performed as part of initial staging investigations, is a robust method to identify lung metastases or synchronous primary lung cancers in patients with head and neck squamous cell and whether small nodules are likely to represent metastases in this group of patients. Design: Retrospective observational study performed between 1994 and 2005. Setting: Head and neck cancer department, Queen Elizabeth Hospital, Birmingham. Participants: All patients that were included had a new head and neck squamous cell carcinoma and underwent a CT chest as part of their staging investigation. Main outcome measures: The presence of lung masses on the initial screening CT of the chest as determined by the radiologist’s report. The development of lung metastases or primary bronchogenic carcinoma in any patient. Results: Two hundred and thirty-nine patients met the inclusion criteria. 38 (16%) patients had a CT chest report for a lung malignancy (either metastatic or primary bronchogenic), 33 of these 38 (87%) patients actually had a lung malignancy. 32 (13%) patients had a CT chest report for a small nodule, three of these 32 (9%) patients were later diagnosed with a lung malignancy, all at a different site to the nodule. 169 (71%) patients had normal CT chest reports, of these 3 (2%) patients were later diagnosed with a lung malignancy. Conclusions: The CT chest is a useful screening tool but is not infallible. Small nodules should be taken seriously and monitored, but should not alter the initial decision as to the management of the patient. 相似文献
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OBJECTIVE: To assess whether pretreatment and posttreatment quality of life (QOL) is associated with long-term survival in patients with head and neck cancer. DESIGN: Ten-year follow-up of an inception cohort. SETTING: Regional tertiary referral center. PATIENTS: The study included 200 consecutive patients with primary epithelial head and neck cancer. INTERVENTIONS: Quality of life and several recognized risk factors for death were assessed prospectively using the Auckland QOL questionnaire before treatment and 12 months after treatment; survival was determined at 10 years. MAIN OUTCOME MEASURES: Survival and odds of death (hazards ratio) were measured. RESULTS: At 10 years, 136 patients (68%) were deceased, 48 patients (24%) were alive, and the status of 16 patients (8%) was unknown. Median survival was 6 years (interquartile range, 4.4-7.7). Before treatment, patients with low QOL had no significantly increased odds of death (hazard ratio, 1.4; 95% confidence interval, 0.8-2.4). In contrast, after treatment, patients with low QOL at 1 year had significantly increased odds of death (2.5; 95% confidence interval, 1.4-4.3; P = .001) even after adjustment for covariates. CONCLUSIONS: Findings suggest potential survival benefits from improvements in QOL. However, the observed associations between survival benefit and QOL at 1 year may be confounded by comorbidity, which was not measured and deserves further investigation. 相似文献
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BACKGROUND: Various studies have demonstrated the prognostic significance of the pretherapeutic blood hemoglobin concentration for patients with head and neck cancer following surgery or primary definitive or adjuvant radio- or radiochemotherapy. It was the aim of this study to evaluate whether the prognosis of these patients might be improved when correcting decreased pretherapeutic hemoglobin values by administering erythropoietin. METHOD: In a prospective placebo-controlled double-blind study (Cochrane "evidence-based medicine" level Ib) the effect of erythropoietin was analyzed in patients with locally advanced head or neck tumours with low blood hemoglobin values (women: < 12 g/dL; men: < 13 dL) and a Karnofski value of > 60 following primary definite or adjuvant radiotherapy (up to 70 Gy). The time to local tumour progression and survival was evaluated. Kaplan-Maier estimates were applied and, the relative risk of well-known prognostic factors tested for with a Cox Proportional Hazards model. RESULTS: 157 patients of the Freiburg University ENT-clinic were recruited from 1997 to 2001. Study conduct was performed according to the GCP guidelines. A rapid increase of the blood hemoglobin value happened during the first five weeks of treatment under epoetin beta. Placebo patients experienced only minor changes of the hemoglobin value. Following adjuvant radiotherapy local tumour control probability at two years was 68 % +/- 7 % and 72 +/- 7 % for placebo and epoetin beta patients, respectively (p = 0.64). Patients who had undergone primary definite radiation experienced a local control probability of 36 % +/- 11 % in the placebo arm after two years, compared to epoetin beta with 23 % +/- 11 % (p = 0.05). CONCLUSION: Epoetin beta resulted in prompt and stable correction of blood hemoglobin values in anemic patients with advanced head or neck tumours, but tumour control and survival was impaired particularly in patients with a high tumour burden. 相似文献
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Rivoirard Romain Moncharmont Coralie Assouline Avi Auberdiac Pierre Mery Benoite Falk Alexander Tuan Annède Pierre Trone Jane-Chloé Guy Jean-Baptiste Vial Nicolas Fournel Pierre Merrouche Yacine Chargari Cyrus Magné Nicolas 《European archives of oto-rhino-laryngology》2015,272(3):719-725
European Archives of Oto-Rhino-Laryngology - In the field of radiotherapy, there is very little scientific data on the management of nonagenarians, especially in patients aged 90 years or... 相似文献
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A major complication of irradiation therapy for head and neck cancer is salivary gland dysfunction and xerostomia. The purpose of this clinical investigation was to evaluate the effects of a commercially available oral moisturizer (Optimoist) on salivary flow rate, symptoms of xerostomia, oral pH, oral microflora, and swallowing in postirradiation head and neck cancer patients (XRT) and patients with Sj?gren's syndrome (SS). Subjects who were post-XRT and subjects with SS (n = 24; mean age = 54.1) discontinued their use of any salivary substitute or moisturizer for 2 weeks prior to entering the study. Baseline whole unstimulated saliva was collected for 5 minutes using a standard sialometric technique. Candida albicans and Lactobacillus cultures were performed using kits from Orion Diagnostica, Inc., and a pH analysis was performed on the salivary sample using a Markson (model 00663) pH meter. Swallowing was assessed by clinical measures by videofluoroscopic techniques. Several subjective assessments were performed to evaluate symptoms of xerostomia. Subjects were instructed in the use of a daily diary and to use only the provided article ad libitum for a period of 2 weeks. After the 2-week period, the results indicated significant subjective and objective improvements in signs and symptoms of xerostomia. Whole unstimulated salivary flow rate improved from (mean +/- SEM) 0.1150 +/- 0.02 to 0.2373 +/- 0.09 mL/min. Salivary pH did not change. Global subjective improvement in xerostomia improved in 58% of the subjects. Candida colonization decreased in 43% of the subjects. There was no change in Lactobacilli colonization. Swallowing objectively improved in 75% of subjects. These results indicate significant improvement in both signs of hyposalivation and symptoms of xerostomia with the use of Optimoist in postirradiation head and neck cancer patients and patients with SS. 相似文献
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Mrinal Supriya Vignesh Narasimhan Michael A. Henderson Andrew Sizeland 《American journal of otolaryngology》2014
Background
Neck dissection is recommended for patients with head and neck cutaneous melanoma and nodal metastasis. However, there appears to be no clear evidence to guide the extent of nodal resection.Methods
Loco-regional recurrence (LR), overall survival (OS) and progression free survival (PFS) was retrospectively compared between patients who had Comprehensive neck dissection (CND) and Selective neck dissection (SND).Results
There was no difference in LR, OS and PFS between CND (n = 18) and SND groups (n = 79). Extra capsular extension (ECE), frontal disease and increasing number of involved nodes resulted in worse OS and PFS but had no impact on LR.Conclusion
Patients with disease limited to one node without ECE can be effectively treated by SND alone. In patients who have these unfavourable pathological features more extensive nodal resection does not improve outcome if they receive radiotherapy. Extent of neck dissection or adjuvant radiotherapy has no impact on overall survival. 相似文献8.
T. Kurzweg N. M?ckelmann S. Laban R. Knecht 《European archives of oto-rhino-laryngology》2012,269(10):2157-2167
The majority of patients with a squamous cell carcinoma of the head and neck present with locally advanced tumors. The first-line treatment of locally advanced tumor stages consists of a combined modality management. Despite these aggressive protocols, many patients develop locoregional recurrences or metastasis and place particularly high demands on the interdisciplinary treatment team. Treatment with a curative intent must be differentiated from a palliative one. In addition to prior treatment, resectability, age and performance status, patient wishes must be taken into consideration in treatment planning, especially considering that most therapies offer little to no overall survival benefit. Salvage surgery, chemo- and target therapies, and reirradiation are head and neck surgeon’s and radiooncologist’s weapons in the fight against these strong opponents. This review focuses on publications and meeting news from last year and reviews the current status of the clinical application of each treatment modality in recurrent or metastatic head and neck cancer. 相似文献
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Gleich LL Wang J Gluckman JL Fenoglio-Preiser CM 《ORL; journal for oto-rhino-laryngology and its related specialties》2003,65(4):193-198
OBJECTIVE: A reliable genetic marker to predict outcome for head and neck cancer is needed. In colon cancer, microsatellite instability (MSI) predicts response to therapy and improved prognosis. Colon cancer patients with MSI have a 60% improvement in survival as compared to patients without MSI. To assess whether MSI is a predictor of improved prognosis in head and neck cancer we used our tumor registry to find 8 patients treated between 1995 and 1998 with head and neck squamous cell carcinoma and either a history of colon cancer or a parent who had colon cancer. As a control, 15 T(2) or T(3) oral cavity cancers were used. METHODS: The tumor specimens were obtained and laser capture microdissected for analysis using the following microsatellite markers: BAT25, BAT26, BAT40, D1S2883, D2S123, D3S1611, D5S346, D7S501 and D8S25. RESULTS: All 8 patients with head and neck cancer and a colon cancer history exhibited MSI or loss of heterozygosity (LOH) at 1 or more of the markers tested. Three patients had 2 abnormal markers, 1 patient had 3 abnormal markers and 1 had 7 abnormal markers. Only 1 of the patients with a colon cancer history, all of whom had MSI, developed recurrent head and neck cancer. Of the 15 control patients, 5 had MSI or LOH and 1 had MSI or LOH at 2 markers. Three of the 5 patients with MSI or LOH had a recurrence; hence MSI and LOH at these markers were uncommon, and there was no relation between MSI and outcome in patients without a history of colon cancer. CONCLUSIONS: These results support a possible alternative mode of carcinogenesis in patients with head and neck cancer and a history of colon cancer and, most significantly, that these cancers are a subgroup of head and neck cancer that may have a better prognosis. 相似文献
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Cost and morbidity of MRSA in head and neck cancer patients: what are the consequences? 总被引:4,自引:0,他引:4
Methicillin resistant Staphylococcus aureus (MRSA) has become a prevalent nosocomial pathogen worldwide. The objectives of this study were to assess the morbidity and cost associated with the treatment of head and neck cancer patients who become colonized or infected with MRSA following major surgical procedures. We present a retrospective review of patients who underwent major surgery for head and neck cancer over a one year period and who then became MRSA positive in the post-operative period. MRSA affected 25/55 (45 per cent) patients who underwent major head and neck procedures during the period studied. The mean time of diagnosis was 13 days post-surgery. Morbidity included cellulitis, osteomyelitis and MRSA pneumonia. Thirteen of the patients who became MRSA positive (52 per cent of the MRSA group) required further surgery including plate removal, new flap formation and wound debridement as a result of the infection. Average in-hospital stay was almost three times more prolonged for patients who became MRSA positive compared to those who did not have MRSA. The costs of the first hospital stay were over three times more in the MRSA-positive group of patients. Antibiotic costs were increased by pound 2470 per patient because of MRSA. The extra stay in hospital, together with extra days in intensive care, extra medical and nursing care and additional costly antibiotic treatment, led to major cost implications and loss of health service resources in the unit. MRSA infection is a serious cause of morbidity in any surgical group of patients and this study focuses on the consequences for treatment of head and neck cancer patients in particular. 相似文献
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Koichiro Yamada Keigo Honda Hisanobu Tamaki Shinzo Tanaka Shogo Shinohara Shinji Takebayashi Ichiro Tateya Morimasa Kitamura Masanobu Mizuta Toshiki Maetani Tsuyoshi Kojima Yoshiharu Kitani Ryo Asato Kazuyuki Ichimaru Yohei Kumabe Koji Ushiro Koichi Omori 《Auris, nasus, larynx》2018,45(5):1066-1072
Objective
Clinical studies demonstrating the prognostic factors in submandibular gland carcinoma are limited because the tumor is relatively rare. The aim of this study was to identify clinical outcomes and prognostic factors in submandibular gland carcinoma.Methods
The study included 65 patients with submandibular gland carcinoma who underwent initial surgical treatment at the Kyoto University and its affiliated hospitals.Results
The 3-year overall survival (OS), disease specific survival, locoregional control (LRC), and no distant metastasis (NDM) rates were 74.2%, 74.2%, 90.0%, and 64.8%, respectively. In the current follow-up study, 16 patients died of the disease, 5 patients were alive with recurrence, 43 patients were alive without disease, and 1 patient died of unrelated disease without recurrence. All patients who died of the disease had developed distant metastasis. Based on univariate analysis, tumor grade (high grade) and lymph node metastases (≥N2) were significant prognostic factors for OS and LRC. It also revealed tumor grade (high grade), T classification (≥T3), and lymph node metastases (≥N2) were significant for distant metastasis. Multivariate analysis showed the following significant prognostic factors: lymph node metastases (≥N2) for OS, LRC, and NDM, and high tumor grade for NDM.Conclusion
Our study suggested death of submandibular gland carcinoma occurred mainly due to distant metastasis. The significant predictors of distant metastasis were lymph node metastases (≥N2) and tumor grade (high grade). 相似文献14.
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PURPOSE: Concurrent radiation and chemotherapy is being evaluated as an alternative treatment to surgery for patients with advanced squamous cell carcinoma of the head and neck, because organ preservation maybe possible without compromising survival. However, the response to concurrent chemoradiation treatment varies from patient to patient, and there is currently no available molecular predictor of response for this particular treatment modality. There is some evidence to indicate that glutathione S-transferase-pi (GST-pi), which is one of the drug detoxifying enzymes, may decrease the effectiveness of platinum-based chemotherapy in the treatment of a variety of tumor types. This study was performed to investigate whether GST-pi expression was correlated with response to concurrent chemotherapy and radiotherapy in patients with advanced squamous cell carcinoma of the head and neck. MATERIALS AND METHODS: Diagnostic biopsy specimens of 36 patients who underwent concurrent chemoradiotherapy for the treatment of advanced squamous cell carcinoma of the head and neck were examined for GST-pi expression by using immunohistochemistry with polyclonal antihuman GST-pi antibodies. GST-pi expression scores were compared among responders and nonresponders. RESULTS: Although the staining rate with antiGST-pi was slightly lower in the responder group in comparison with the nonresponders (82% vs 100%), the difference was not statistically significant. CONCLUSION: GST-pi expression is unlikely to be a valuable predictor of response to concurrent chemotherapy and radiation treatment in patients with advanced squamous cell carcinoma of the head and neck. 相似文献
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Keigo Honda Shinzo Tanaka Shogo Shinohara Ryo Asato Hisanobu Tamaki Toshiki Maetani Ichiro Tateya Morimasa Kitamura Shinji Takebayashi Kazuyuki Ichimaru Yoshiharu Kitani Yohei Kumabe Tsuyoshi Kojima Koji Ushiro Masanobu Mizuta Koichiro Yamada Koichi Omori 《American journal of otolaryngology》2018,39(1):65-70
Background
Parotid gland carcinoma is a rare malignancy, comprising only 1–4% of head and neck carcinomas; therefore, it is difficult for a single institution to perform meaningful analysis on its clinical characteristics. The aim of this study was to update the clinical knowledge of this rare disease by a multi-center approach.Methods
The study was conducted by the Kyoto University Hospital and Affiliated Facilities Head and Neck Clinical Oncology Group (Kyoto-HNOG). A total of 195 patients with parotid gland carcinoma who had been surgically treated with curative intent between 2006 and 2015 were retrospectively reviewed. Clinical results including overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), local control rate (LCR), regional control rate (RCR), and distant metastasis-free survival (DMFS) were estimated. Univariate and multivariate analyses were performed to identify prognostic factors.Results
The median patient age was 63 years old (range 9–93 years), and the median observation period was 39 months. The OS, DFS, DSS, LCR, RCR, and DMFS at 3 years were 85%, 74%, 89%, 92%, 88%, and 87%, respectively. Univariate analysis showed age over 74, T4, N +, preoperative facial palsy, high grade histology, perineural invasion, and vascular invasion were associated with poor OS. N + and high grade histology were independent factors in multivariate analysis. In subgroup analysis, postoperative radiotherapy was associated with better OS in high risk patients.Conclusion
Nodal metastases and high grade histology are important negative prognostic factors for OS. Postoperative radiotherapy is recommended in patients with advanced high grade carcinoma. 相似文献17.
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