头颈科学

肥胖与甲状腺乳头状癌患癌风险的病例对照研究 背景：美国的肥胖患病率与甲状腺乳头状癌发生率息息相关。肥胖是引发癌症的公认危险因素，但是肥胖症和甲状腺乳头状癌患癌风险之间的关系鲜有研究。我们从3组病例对照人群中采集个人资料研究了人体测量和甲状腺乳头状癌风险之间的关系。     

头颈癌病因学中的职业因素

本语言综述了各种职业性物理和化学因素与头颈癌的关系。肯定了某些职业因素对头颈癌的致病作用。     

蛋白质组学技术研究进展及其在头颈肿瘤中的应用现状

头颈鳞状细胞癌的全球发病率在最近十年明显上升。头颈肿瘤的病理类型超过90%为鳞状细胞癌,临床上大部分患者确诊时已是晚期,早期识别诊断头颈肿瘤能够极大程度改善患者的预后。随着蛋白质组学技术的不断发展,从传统的蛋白质组学到靶向定量蛋白质组学,再到空间蛋白质组学的出现,特异性的生物标志物有望被发现用于头颈肿瘤的早期诊断、指导治疗以及判断预后。     

头颈鳞状细胞癌中MicroRNAs及相关单核苷酸多态性研究

头颈鳞状细胞癌泛指发生于口颌面部、咽喉及上呼吸消化道等部位的鳞状细胞癌。MicroRNAs是一类具有独立功能结构,可以调控基因表达的非编码小RNA,MicroRNAs能够控制mRNA生成与降解并以此抑制相关蛋白的生成,其中就包括许多原癌基因和抑癌基因。单核苷酸多态性主要是指在基因组水平上由单个核苷酸变异所引起的DNA序列多态性,与MicroRNAs相关的单核苷酸多态性可以影响相关基因的表达。本文简要综述MicroRNAs及相关单核苷酸多态性的作用机制与头颈鳞状细胞癌的关系。     

头颈鳞状细胞癌诊断中的癌放射免疫法

适合于头颈癌诊断的可靠循环瘤标尚未获得。本文报告了应用循环鳞状细胞癌抗原评价头颈鳞癌患者预后的效果。作者采取了89名头预鳞癌患者治愈前、后间期的血样。应用放射免疫法测定鳞癌抗原水平。经测定,89名患者中,于治疗前有39名(44％)呈现鳞癌抗原高血清水平(>2.0mg/ml)。其中治疗后复发者的血清鳞癌抗原水平与临床过程之间有显著的相关关系。16名确定有复发癌或癌残存的患者中,15名(93.5％)显示了高鳞癌抗原水平。而21名已确定为治愈性癌的患者中,仅10名     

日本头颈外科考察纪实

应日本医师会的邀请于今年初作为第六届中国医师研修考察团成员到日本东京考察学习一个月。共参观访问了三个单位:国立癌中心病院的头颈外科、癌研病院的头颈外科及东京女子医科大学的内分泌外科。观看了手术、察看了病人和设备,与医师们进行了座谈、会诊,还观看了加强监护病室内的工作情况。所到之处受到日本同道们热情友好地欢迎与接待。谨将所见到和感受到的有关日本头颈外科现状做一简要介绍。一、头颈外科一般工作情况:国立癌中心和癌研病院的头颈外科主要收治适合手术治疗的头     

诱导化疗在局部中晚期头颈鳞状细胞癌治疗中的应用进展

局部中晚期头颈鳞状细胞癌患者目前主要采用手术、放疗与化疗相结合的综合治疗模式，但是5年生存率并无显著提高。诱导化疗自20世纪70年代被广泛应用到头颈鳞状细胞癌的治疗中，在保留器官功能及减少远处转移方面显示出明显优势，但在提高生存率方面仍存争议。本文简述了诱导化疗在头颈鳞状细胞癌治疗中的发展历程，比较了诱导化疗、手术和同步放化疗在头颈鳞状细胞癌治疗中的优势与劣势，总结了诱导化疗在肿瘤局部控制率和远处转移率方面的作用，提出了诱导化疗在头颈肿瘤治疗中面临的问题与未来展望。     

人乳头状瘤病毒与喉癌

喉癌是耳鼻咽喉头颈外科较常见的疾病，在头颈部肿瘤中占第二位。人乳头状瘤病毒（humanpapillomavirus，HPV）是一种重要的致瘤DNA病毒，它与宫颈癌、头颈肿瘤中的口咽癌等密切相关已得到大量研究证实，然而HPV与喉癌的关系仍不明确。本文就HPV与喉癌的关系研究进展做一综述。     

长链非编码RNA在头颈肿瘤中的异常表达

头颈肿瘤是全球最常见的恶性肿瘤之一，主要有喉癌、鼻咽癌、下咽癌和甲状腺癌等。长链非编码RNA（long noncoding RNAs，lncRNAs）已被报道参与广泛的生物学过程，特别是癌症发生和发展过程中的关键调控者。本文就在头颈肿瘤中异常表达的lncRNAs调控机制及研究进展做一综述。     

人乳头状瘤病毒与喉癌

喉癌是耳鼻咽喉头颈外科较常见的疾病,在头颈部肿瘤中占第二位.人乳头状瘤病毒(human papillomavirus,HPV)是一种重要的致瘤DNA病毒,它与宫颈癌、头颈肿瘤中的口咽癌等密切相关已得到大量研究证实,然而HPV与喉癌的关系仍不明确.本文就HPV与喉癌的关系研究进展做一综述.     

Impact of metastases on nodal immunoreactivity in head and neck cancer

It has been previously demonstrated by the authors that lymph nodes from patients with head and neck cancer are capable of regional immunoreactivity and that this immunoreactivity could be enhanced with certain nonspecific immunostimulants. However, it is unknown how metastases to the neck nodes would affect this immunoreactivity. The purpose of this study is to compare the immunoreactivity of matched node pairs (metastatic versus nonmetastatic) from head and neck cancer patients. The soft agar assay system was the methodology employed. The effect of nodal lymphocytes on tumor growth in soft agar was studied with and without nonspecific immunostimulation in both normal and metastatic nodes from the same location in the neck in 16 patients. The results demonstrate that lymph nodes from head and neck cancer patients are capable of an immune reaction to cancer, and that this immunoreactivity appears to be significantly increased in metastatic lymph nodes with and without the use of specific immunostimulants.     

Immunosuppressive retroviral-related factors in sera of patients with head and neck cancer

Summary The chemotactic responsiveness of mononuclear phagocytes has often been found defective in patients with various malignancies. We have previously reported a defective chemotactic responsiveness in patients with head and neck cancer. Low-molecular-weight factors (LMWFs) have been isolated from tumors and can be held responsible for the inhibitory effect on monocyte chemotactic responsiveness. It is an intriguing new finding that these LMWFs can be neutralized by antibodies reactive to P15E, a structural envelope protein of murine leukemia retroviruses. In this report we describe a relatively easy and rapid method for the detection of immunosuppressive P15E-like factors in the sera of patients with head and neck cancer. The test is based on the monocyte polarization assay. Although only nine head and neck cancer patients were included in this study, the findings indicate that the test might be of value for clinical application. An early detection of a recurrence after treatment might be possible by the finding of a reappearance of the P15E-like factors in patients' sera during follow-up.     

NED survival in head and neck cancer (post-mortem correlations)

A common feature of reporting head and neck squamous cancer statistics in recent years has been to consider patients dying with no evident disease (NED) as successfully treated. We present two patients who died with no clinically evident squamous cancer and who could therefore have been reported as cured but for autopsy findings which showed significant distant spread. These findings are supported by several reports of distant metastases in squamous head and neck cancer and it is suggested that rates of post-mortem examinations be included in survival figures in the future.     

Sentinel lymph node biopsy in head and neck cancer

Sentinel lymph node biopsy (SLNB) offers a minimally invasive technique to examine the proximal lymph node basin for micrometastases in clinically N0 necks in patients head and neck cancer.This technique has been validated in the management of breast cancer and cutaneous malignant melanoma (CMM) and is under active investigation in the management of multiple other solid tumors.SLNB is used routinely in the management of head and neck melanoma and is investigational for other cancers of the head and neck. SLNB provides prognostic information for patients with CMM and identifies those patients that may benefit from additional treatment. This article examines the history, rationale,science, and current status of SLNB in head and neck with emphasis on melanoma.     

Head and neck squamous cell carcinoma in the young patient

PURPOSE OF THE REVIEW: Squamous cell carcinoma of the upper aerodigestive tract most commonly develops in the sixth or seventh decade of life, usually in patients who have significant risk factors from smoking or alcohol use. A subgroup of patients less than 45 years old, however, develops squamous cell carcinoma of the head and neck in whom the role of tobacco or alcohol use is less clear in the etiology of their cancer. Furthermore, there has been considerable debate regarding the tumor biology in this group of patients and its effects on prognosis and overall survival. This paper reviews the current literature and controversies on the etiology and management of squamous cell carcinoma of the head and neck in young patients. RECENT FINDINGS: Young patients with head and neck squamous cell carcinoma do not have a poorer prognosis or disease-specific survival. SUMMARY: Young patients with squamous cell carcinoma of the head and neck have a similar prognosis to older patients. There is a trend, however, towards a higher regional recurrence in young patients with head and neck squamous cell carcinoma, suggesting that prophylactic neck treatment should be considered. Further research is needed to determine whether a subgroup of patients (young nonsmoking women with tongue cancer) have a worse prognosis and warrant more aggressive treatment.     

High incidence of laryngopharyngeal reflux in patients with head and neck cancer

OBJECTIVES: Laryngopharyngeal reflux may play a role in the etiology of squamous cell cancer of the head and neck and contribute to complications in head and neck cancer patients after surgery or during radiotherapy. STUDY DESIGN: Prospective study. METHODS: To investigate the incidence of laryngopharyngeal and gastroesophageal reflux in patients with head and neck cancer, ambulatory 24-hour double-probe pH monitoring was performed in 24 untreated patients with laryngeal or pharyngeal squamous cell carcinoma. In addition, 10 patients who had been irradiated in the head and neck area were analyzed for reflux to study the effect of radiotherapy on reflux. RESULTS: Only 4 of the 24 head and neck cancer patients (17%) had neither pathological laryngopharyngeal nor gastroesophageal reflux. Esophageal acid exposure was abnormal in five patients and acid exposure at the level of the upper esophageal sphincter was abnormal in four patients. Eleven patients had pathological reflux in both areas. Irradiated patients did not differ from the untreated patients considering the incidence of pathological laryngopharyngeal or gastroesophageal reflux. CONCLUSIONS: The data obtained in this study indicate that reflux is a common event in head and neck cancer patients.     

Head and neck cancer surgery in the elderly

BACKGROUND: The literature on management of advanced head and neck cancer in the elderly is limited. Diagnostic and treatment decisions may be implicated by advanced age itself. METHOD: Treatment outcomes of head and neck cancer in elderly patients were reviewed in the literature. The results should serve as a basis for an individualized treatment strategy. RESULTS: A comparison of data shows that chronologic age alone should not be a contraindication to adequate oncologic surgery. An aggressive approach to head and neck cancer management with curative intention can be also considered in high aged patients with advanced cancer. Surgical therapy of head and neck cancer can be as effective in elderly patients as in younger patients without a significant increase in mortality and complications. CONCLUSIONS: Head and neck cancer patients of all age groups should have a treatment of equal quality regardless of whether the expected outcome is cure or palliation.     

Audit of referrals for head and neck cancer – the effect of the 2‐week,fast track referral system

Audit of referrals for head and neck cancer – the effect of the 2‐week, fast track referral system The NHS Cancer Plan sets out targets for the diagnosis and treatment of cancer. Ideally, there should be a maximum of a 2‐week wait from a referral for suspected cancer to an outpatient appointment. A fast track referral system has been established nationally, with general practitioners given guidelines as to appropriate referrals. In the South Essex region, we audited all such referrals using this system for a 12‐month period and also all new patients diagnosed with head and neck cancer during the same period. We found that 71% of patients diagnosed with cancer were not referred using the fast track system and that only 15% of patients who were referred by the fast track system were subsequently found to have cancer. For patients with cancer who were referred using standard letters, the time from referral to initial consultation was generally much longer than the recommended period of 2 weeks. We conclude that improvements in utilizing the fast track system need to be made if it is to bring about an improvement in early diagnosis of head and neck cancer. As things stand, it may actually be detrimental for most cancer patients.     

Treatment of patients with spinal metastases from head and neck neoplasms

BACKGROUND: Spinal metastases are uncommon in patients with advanced head and neck cancer. Treatment strategies in this patient group have not been defined. Although it has been established that neurologic dysfunction in patients with spinal metastases and cord compression constitutes an oncologic emergency, the role of surgical treatment remains controversial. OBJECTIVE: To clarify the treatment options in patients with head and neck cancer who develop spinal metastases. METHODS: The clinical course of patients seen at our institution with head and neck neoplasms and spinal metastases from January 1992 to January 2000 was reviewed. RESULTS: Eleven patients were identified. Nine developed spinal metastases more than 3 months after the diagnosis of advanced head and neck cancer. The other 2 presented with synchronous spinal involvement and skull base neoplasms. Patients without neurologic symptoms were offered intravenous steroids and palliative radiation. Patients with neurologic symptoms were treated with either intravenous steroids and radiation or surgical decompression and spinal fusion. In 1 patient, no improvement occurred within the first 2 days of radiotherapy, and the patient underwent surgical decompression. Patients with an unstable spine underwent surgical decompression and spinal fusion. Patients with a life expectancy of more than 6 months and neurologic symptoms were offered surgical therapy. In the 9 patients with advanced cancer, the average survival time was 3 months. Two of these patients have survived longer than 6 months. CONCLUSIONS: We propose that surgical decompression is a viable, justifiable option for selected patients with advanced head and neck cancer and spinal cord compression. Furthermore, we recommend surgical decompression as a first option in patients with an unstable bony spine and/or in whom survival is expected to be longer than 6 months. Finally, we propose a patient management algorithm in these cases.     

Decreased hearing after combined modality therapy for head and neck cancer

PURPOSE: Combined platinum-based chemoradiation therapy is frequently being used as therapy for head and neck cancer at multiple sites. These therapies are individually ototoxic, but little has been reported on their combined toxicity. MATERIALS AND METHODS: A retrospective investigation of 37 patients known to have undergone therapy with both agents, in combination, for head and neck malignancy was performed. Sixty percent of the patients had complaints of hearing loss subjectively. Reliable pretreatment and posttreatment audiograms were obtained on 15 of these patients. Audiograms were analyzed for sensorineural changes at 0.5, 1, 2, 4, and 8 kHz. RESULTS: By paired t test analysis, there were significant changes in the patients with pretreatment and posttreatment audiograms at all frequencies. More than 50% of the patients had a change of 10 dB or greater in their pure-tone average. More than 85% of the patients experienced changes in their hearing at 4 and 8 kHz. CONCLUSIONS: We conclude that patients undergoing combined modality therapy for head and neck cancer experience hearing loss. We recommend that hearing assessment, including pretreatment and posttreatment audiometry, be performed in all patients undergoing combined platinum-based chemotherapy and radiation for the treatment of head and neck cancer.