Panendoscopy and synchronous second primary tumors in head and neck cancer patients

Endoscopy techniques are used to diagnose and to determine the extent and exact location of malignancies in the head and neck region, bronchial tree and esophagus. Panendoscopy is used to find the primary tumor in the case of metastatic disease from unknown primaries or to detect a simultaneous second primary tumor at the time of diagnosis of a malignancy in the upper aerodigestive tract (UADT). The value of panendoscopy has been debated lately because of the relatively small proportion of malignant findings and because of the lack of convincing data concerning its effect on survival rates. However, despite the relatively low proportion of positive findings, their significance is often crucial for the individual patient. The significant number of late metachronous, second primaries, especially in the lungs, also emphasizes the importance of follow-up endoscopies. This study consists of 203 consecutive patients with squamous cell cancer (SCC) of the upper aerodigestive tract who underwent panendoscopy in Turku University Central Hospital as part of the initial diagnostic workup from 1992–1999. Eight patients with synchronous second primaries were found to represent a prevalence of 3.9%, and in addition, 19 patients with metachronous tumors were diagnosed. In the case reports we illustrate the importance of some of these findings.     

Panendoscopy as a screening examination for simultaneous primary tumors in head and neck cancer: A prospective sequential study and review of the literature

A prospective panendoscopic evaluation comprising direct laryngoscopy, bronchoscopy, and esophagoscopy was conducted in 100 consecutively seen patients with untreated head and neck primary tumors. Of the patients, 16% (18% counting two third primary lesions found in the 16 patients) had synchronous primary malignant tumors of the aerodigestive tract. Eleven of the 16 patients had silent lesions found only by endoscopy, and 6 (6% of the total group) had lesions found only because the full panendoscopic protocol was followed. Those 6 tumors would not have been discovered as early by clinical examination or by symptom-only directed studies. The initial treatment plan in 7 patients was changed by the panenodscopic findings, This study verifies the high incidence of synchronous primary tumors in the head and neck areas that have been reported in retrospective studies, and suggests that an intensive, full panendoscopic work-up as a screening test in all patients with primary head and neck tumors can be conducted without increased morbidity and yields enough information to justify its cost.     

Panendoscopy and bronchial washings: role and efficacy in detection of simultaneous primary head and neck cancers

The phenomenon of multicentricity in head and neck squamous cell carcinoma affects survival rates. We evaluated the use of panendoscopy/triple endoscopy and, in particular, the place of bronchial washings in the initial staging assessment of head and neck tumours. In a prospective panendoscopic study, a second primary rate of 4.8 per cent was discovered. All four bronchial tumours--both index and simultaneous primary cases--were obvious on bronchoscopy and chest X-ray, despite 50 per cent of them being clinically silent. A self-limiting complication rate of 2.4 per cent was encountered. The issue of bronchial washings was debated and our sensitivity (50 per cent) and specificity (97 per cent) results assessed. We advocate the inclusion of bronchoscopy as part of a panendoscopic work-up of head and neck tumours. The rationale for this is discussed. Bronchial washings, although cheap and easy to process, did not change the management of any patient in the study group and contamination could complicate assessment. Overall, panendoscopy is a safe worthwhile procedure.     

Second primary tumors in head and neck cancer

IntroductionThe development of second primary tumors (SPT) in patients with head and neck squamous cell carcinoma (HNSCC) has become an increasingly important factor in clinical treatment decisions.PurposeTo define favourable clinical characteristics for overall survival, in patients with SP head and neck cancer.Material and methodRecords of 633 patients with SCC treated from 1984 to 2004 were reviewed to describe clinical characteristics of the SPT.ResultsThe overall incidence of SPT was 11%. The incidence of the index tumors was as follows: supraglottic cancer 21% and oral cancer 16%. The most common SPT occurred in head and neck area in 47%, lung in 32% and esophagus in 11%. Second primary was associated with a poor 5 years survival in patients with HN-SCC (23 versus 53% in control group).ConclusionBecause of the high rate of second primary tumors, protocols including chemoprophylaxis should be investigated. Prevention and early detection are indicated.     

Panendoscopy in screening for synchronous primary malignancies

The entire upper aerodigestive tract must be evaluated at the time of initial tumor evaluation in patients with squamous cell carcinoma of the head and neck. The necessity of panendoscopy (laryngoscopy, bronchoscopy, esophagoscopy) in this evaluation has not been demonstrated convincingly. Between January 1, 1984 and December 31, 1985, 208 patients with previously untreated squamous cell carcinoma of the head and neck were analyzed prospectively. These patients underwent head and neck examination, chest radiograph, barium esophagram, and panendoscopy. Fifteen (7.2%) had synchronous malignancies of the upper aerodigestive tract. In four patients (1.9%) the synchronous primary tumor was found only by endoscopy. Three patients (1.4%) had cancers of the hypopharynx. One patient (0.5%) had a bronchial cancer detected only on bronchoscopy. No tumors were detected by esophagoscopy that were not also seen on barium esophagram. We conclude that endoscopic examination of the hypopharynx is very helpful in screening for additional tumors in head and neck cancer patients, but routine esophagoscopy cannot be supported. Screening bronchoscopy cannot be strongly supported due to its very low yield.     

Genome-wide screening for radiation response factors in head and neck cancer

INTRODUCTION: Radiation therapy is an integral part of the treatment of head and neck cancer. Factors predicting radiation response are ill defined. The aim of this study was to identify genetic aberrations associated with radiation response in cell lines derived from head and neck squamous cell carcinomas (HNSCC) using comparative genomic hybridization (CGH) for genome-wide screening. METHODS: Five cell lines derived from HNSCC were subjected to a single course of radiation (400 cGy) in parallel with a similarly handled, untreated control. Cellular response to radiation was determined on posttreatment days 1, 2, 3, 4, and 5 using a cell viability assay (MTT assay). Radiation response was defined as 35% or greater decrease in cell survival relative to control. Tumor doubling time was determined by cell counts performed at day 0 and 1 for each cell line. All experiments were done in quadruplicate. CGH analysis was performed by differentially labeling DNA from tumor and normal tissue with fluorescent agents. The labeled DNAs were simultaneously hybridized to normal metaphase chromosomes. Image analysis for fluorescence intensity along the entire length of each metaphase chromosome allowed generation of a color ratio, which was used to detect copy number changes. RESULTS: Radioresistance was identified in two of five cell lines. The tumor doubling time was not a predictor of radiation response. CGH identified a complex pattern of aberrations, with gain of 3q common to all cell lines. The number of genetic aberration was higher in radiation-sensitive cell lines than in radiation-resistant ones. No recurrent aberrations were unique to the radiation-resistant cell lines. Recurrent gains at 7p and 17q and losses at 5q, 7q, and 18q were unique to the radiation-sensitive cell lines. CONCLUSIONS: The number of aberrations identified by CGH analysis may be a predictor of radiation response. A large study of primary tumors is warranted to confirm this association and identify specific genetic aberrations associated with radiation response.     

Audiological findings in pacients treated with radiotherapy for head and neck tumors

Radiotherapy has been widely used given its increase in the successful outcomes and cure of some cancers.AimTo evaluate the functionality of the auditory system in patients who underwent radiotherapy treatment for head and neck tumors.Materials and MethodsFrom May 2007 to May 2008, otorhinolaryngological and audiological evaluation (Pure Tone Audiometry (air and bone conduction), Speech Audiometry, Tympanometry, Acoustic Reflex testing and Distortion Product Otoacoustic Emissions) were performed in 19 patients diagnosed with head and neck neoplasia and treated with radiotherapy. Prospective case series study.Results10.5% left ears and 26.3% right ears had bilateral hearing loss soon after radiotherapy according to ASHA criteria.ConclusionsRadiotherapy treatment for head and neck cancer has ototoxic effects. Early programs of auditory rehabilitation should be offered to these patients.     

Twenty-five years experience with laser surgery for head and neck tumors

During the last 25 years, the treatment of tumors arising in the upper aerodigestive tract has changed fundamentally. Whereas surgery in the 1970s aimed at radical block resection and defect repair from outside, the establishment of transoral laser microsurgery marked a new era of organ- and function-preserving therapy. An international symposium, held on 10 and 11 June 2005 in Göttingen, was dedicated to a critical review and assessment of the current role of laser surgery for the treatment of head and neck cancer. Experts from five continents presented their experiences and scientific results and had an intensive exchange with participants from different countries. The topics of the symposium were focused on the surgical principles of laser resection, the oncological and functional results in comparison with traditional therapy, the difficulties and limits of laser surgery in distinct anatomical regions and on the role of radiotherapy. This report summarizes the most important results and statements and gives an overview of actual developments. The names and addresses of the participants mentioned in this report are appended below.     

头颈外科神经外科联合手术治疗颅底沟通肿瘤

目的 介绍头颈外科与神经外科合作处理颅底沟通肿瘤的经验和优势.方法 回顾性分析2005年7月至2008年7月头颈外科和神经外科联合制定手术方案并共同实施手术54例(良性21例,恶性33例)颅底沟通肿瘤的临床资料,其中前颅底19例,侧颅底12例,中央颅底17例,后颅底(颈静脉孔区)6例.结果 本组颅底沟通肿瘤均一期手术切除.良性肿瘤全切除20例,近全切除1例;恶性肿瘤肉眼全切除25例,6例鼻窦、鼻咽、腮腺恶性肿瘤及2例脊索瘤近全切除.无手术死亡病例,恶性肿瘤并发症13例,其中术后出血2例.随访8～43个月,良性与恶性肿瘤中位随访时间分别为19.1及21.0个月,恶性患者失访3例.21例良性肿瘤复发1例.33例恶性肿瘤中复发12例,死亡9例(其中1例死于心脏病),Kaplan-Meier法统计3年生存率与无瘤生存率分别为53.0%及52.7%.结论 头颈外科和神经外科合作有利于提高颅底沟通肿瘤的手术切除率从而提高治疗效果.     

Multiple primary malignancies in head and neck cancer

Multiple primary (MP) malignancies were found in 9.7% of 1961 patients with primary head and neck cancer diagnosed at The Johns Hopkins Hospital, Baltimore, during the years 1975 to 1985. The index tumors were divided into six main groups. Out of the 190 MP malignancies, 46.9% were synchronous and 53.1% were metachronous. Seventy-four percent of MP lesions were noted during the first year after diagnosis of the index primary tumor. Patients with an index tumor in the upper aerodigestive tract had a significantly increased risk of developing a second cancer in the head and neck area. This risk was 5.94 for the oral cavity, 6.98 for the pharynx, 3.57 for the larynx, and 7.02 for the esophagus. Patients with an index tumor in the salivary gland or the thyroid gland had, respectively, a 3.59 and a 7.38 higher risk than the general population of developing a second tumor. Efforts aimed at improving the survival of patients with head and neck cancer must incorporate strategies for the prevention, early detection, and treatment of MP neoplasms.     

Deep neck infection as the main initial presentation of primary head and neck cancer

OBJECTIVES: Primary head and neck cancer and deep neck infection are not uncommon, but deep neck infection as the initial presentation of primary head and neck cancer is rare and these patients risk potential misdiagnosis. MATERIALS AND METHODS: The records of 301 patients with deep neck infection and 3,337 patients with primary head and neck cancers from 1990 to 2002 were retrospectively reviewed. Patients with primary head and neck cancers who had deep neck infection as their initial presentation were enrolled. RESULTS: Seven patients were identified (six men and one woman). The median age was 64 years. All patients presented with painful, erythematous neck swelling and all image studies showed abscess formation. Four abscesses received needle aspiration and three received surgical drainage, which yielded malignant cells in four specimens. The primary origins of malignancies were the nasopharynx (two patients), oropharynx (two patients), hypopharynx (one patient), parotid gland (one patient) and maxillary sinus (one patient). All patients had stage IV disease. Only three patients could receive curative therapy and only one patient was disease-free after three years. CONCLUSION: We suggest that detailed history-taking, complete examination of the ENT field and pathological study of the infected tissue must be performed for patients with deep neck infection to enable early detection and prompt treatment of any underlying malignancy.     

Elective treatment of the neck for second primary tumors of the head and neck

The aim of this study was to define the role of elective neck dissection in patients with a second N0 head and neck squamous cell carcinoma (HNSCC). We carried out a retrospective study in 74 patients with a second N0 HNSCC treated with an elective neck dissection. Thirteen patients (17.6 %) had occult neck node metastases. The risk of occult neck nodes was low for patients with a second glottic tumor (0 %), and for patients with non-glottic T1–T2 tumors who had received previous radiotherapy in the neck (5.3 %). Patients with non-glottic locally advanced tumors (T3–T4) and non-glottic T1–T2 tumors who had not received previous radiotherapy in the neck had a risk of occult neck nodes of 28.1 and 33.3 %, respectively. Elective neck dissection could be omitted in patients with glottic tumors and in patients with an early tumor (T1–T2) who had received previous radiotherapy in the neck.     

Percutaneous endoscopic gastrostomy as a standard procedure in head and neck surgery

Adequate nutritional support is essential in patients with head and neck cancer, especially if extended oropharyngeal surgery is indicated. Enteral nutrition is an effective and safe alternative to parenteral nutrition, but the use of nasogastric tubes has several disadvantages in these patients. We describe our experience with percutaneous endoscopic gastrostomy as a standard procedure prior to surgical resection in patients with head and neck cancer.     

Neoadjuvant therapy for organ preservation in head and neck cancer

OBJECTIVES/HYPOTHESIS: We designed two sequential trials of induction chemotherapy followed by definitive radiation in patients with potentially resectable head and neck cancer to determine whether organ preservation is feasible without apparent compromise of survival Study Design Both trials were Phase II studies. METHODS: Two clinical trials were conducted sequentially at the University of Michigan. Fifty-two patients enrolled in the first study and were treated with a planned three cycles of carboplatin and 5-fluorouracil. Patients who achieved at least 50% reduction in the size of the primary tumor received definitive radiation therapy, to a dose of 6600 to 7380 cGy. Patients with minimal response or progression had immediate salvage surgery. Thirty-seven patients enrolled in the second trial, in which the chemotherapy consisted of carboplatin, 5-fluororuracil, and leukovorin. Responders were treated with accelerated radiation therapy, to a total dose of 7120 cGy delivered in 41 fractions over 5.5 weeks. RESULTS: Toxicity and response were similar in both trials; therefore, the results are reported first separately and then combined for all 89 patients. Tumor sites included: oropharynx, 55 patients; hypopharynx, 34 patients. Eighty-three percent of patients tolerated all three cycles of chemotherapy and toxicity was mild. Response to chemotherapy was: 48% complete response at the primary tumor site, and 34% partial response at the primary tumor site. Initial organ preservation at individual tumor sites was: oropharynx, 58%; hypopharynx, 59%. Median survival was 28 months, and survival at 3 and 5 years was 40% and 24%, respectively. CONCLUSIONS: These two regimens were well tolerated, and survival did not appear to be compromised by organ preservation treatment compared with historical controls. This approach warrants further investigation, particularly in those patients for whom surgery could be functionally debilitating.     

Treatment results for simultaneous primary squamous cell carcinomas of the head and neck

Forty patients with simultaneous multiple primaries of the head and neck were treated with curative intent between June 1964 and April 1983. The primary sites were treated with radiation therapy alone or in combination with surgery. Surgery was used to salvage local failures of radiation treatment. Neck disease was treated with radiation therapy alone or with neck dissection added after completion of radiation therapy to the primary lesions. Minimum follow-up was 2 years with a range of 2 to 20 years. For the 32 patients whose primary tumors were treated with radiation alone, the 2-year local control rates for the 53 individual tumors evaluated were as follows: T1, 18/21; T2, 16/23; and T3-T4, 1/9. In the T3-T4 group, there was only one successful surgical salvage. Local control rates for disease at all primary sites in each patient according to highest T-stage were as follows: T1, 4/5; T2, 9/15; and T3-T4, 1/9. Eight patients whose primary tumors were treated with radiation and surgery are discussed. The absolute disease-free survival rate at 2 years for 40 patients was 42%. Complications of treatment are described.     

原发性头颈部非霍奇金淋巴瘤62例临床分析

目的 :探讨原发性头颈部非霍奇金淋巴瘤 (NHL)的临床特征。方法 :分析 6 2例头颈部NHL的临床资料。结果 :腭扁桃体 (2 5 .8% )、颈淋巴结 (19.4 % )、鼻腔及鼻窦 (12 .9% )为NHL的好发部位 ;临床分期ⅠE期和ⅡE期分别为 38.7%、2 4 .2 %。病理分型高度恶性为 75 .8%。CR率 75 .8% ,PR率 14 .5 % ,有效率 90 .3% ;部分患者无瘤长期生存。结论 :头颈部NHL一般恶性度高 ,多发于结外组织且易发生淋巴结转移 ,准确的取材活检结合免疫组化有利于早期确诊 ,治疗上应采用化疗、放疗或结合手术的综合治疗方案。     

Life-satisfaction in patients with head and neck cancer

Life-satisfaction is a measure of a patient's perception of the difference between his reality and his needs, or wants. This study reports the results of a longitudinal survey of patients’self-reported life-satisfaction following treatment for head and neck cancer. Life-satisfaction scores improved with time, and were related to pain, speech difficulty, and dysphagia. Lack of adequate family support was also important, although an uncommon problem. Treatment modality did not emerge as a significant determinant of life-satisfaction; speech difficulties were more likely to be due to articulation problems than voicing difficulty.