Immunoglobulin allotypes in head and neck cancer patients with multiple primary cancers

Immunoglobulin allotypes G1m, G2m, G3m, A2m and Km were determined in patients with a single head and neck cancer and in head and neck cancer patients with multiple primary tumours. Frequencies were compared with those of healthy controls. In all 39 patients with multiple primary tumours studied, Km(1) was absent vs. 82% and 75% absence in healthy controls and patients with a single head and neck cancer, respectively. This difference is highly significant. We conclude that head and neck cancer patients lacking the Km(1) are susceptible to the development of new cancers, and therefore should be screened thoroughly for more tumours.     

Results of bleomycin therapy in recurrent head and neck tumors (author's transl)]

40 patients with previously treated recurrent head and neck carcinomas have been treated with Bleomycin. The total dose of drug administered ranged from 360-600 mg. In three patients, treatment had to be interrupted because of severe side effects of the drug. Temporary complete disappearance of tumor occurred in three patients, whereas incomplete tumor regression briefly occurred in one third of those patients treated. Survival time for all patients averaged three months. A possible immunosuppressive effect of Bleomycin is also discussed, as based on clinical observations noted in one of the patients treated.     

(Chemo-) prevention of second tumors in patients with head and neck neoplasms

This review discusses the possible role of chemoprevention in the improvement of survival rates and the prevention of secondary primary tumours in patients with head and neck cancer. Chemoprevention is a new treatment that is especially promising for high risk groups. The fear that the advantages of this treatment will be outweighed by the disadvantages of side-effects and toxicity has not been confirmed by current studies. Randomized studies are needed to show whether chemoprevention can reduce the frequency of second primary tumours.     

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 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.     

同期双侧颈清扫在头颈部恶性肿瘤治疗中的应用

目的:探讨头颈部恶性肿瘤行原发灶切除加同期双侧颈清扫的安全性、适应证及手术难点.方法:回顾分析1998-01-2007-12间134例行肿瘤原发灶切除加双侧颈清扫术头颈部恶性肿瘤患者的临床资料,同期双侧颈清扫术方式分为:一侧根治性颈清扫加一侧功能性颈清扫(29例),一侧根治性颈清扫加一侧侧颈清扫(34例),双侧功能性颈清扫(14例),一侧功能性颈清扫例加一侧侧颈清扫(48例), 双侧颈侧清扫6例.结果:134例患者无一例手术死亡,并发症为创口出血3例,乳糜漏4例,咽瘘8例,咽瘘伴颈部清扫区感染1例,消化道应激性溃疡5例,其中1例抢救无效死亡,脑梗塞1例.结论:头颈部恶性肿瘤行同期双侧颈清扫是安全的,但要选择适当的清扫方式,以降低颈部淋巴结转移,减轻患者痛苦.     

Diagnostic sensitivity of 18fluorodeoxyglucose positron emission tomography for detecting synchronous multiple primary cancers in head and neck cancer patients

We assessed the sensitivity of positron emission tomography (PET) for detecting synchronous multiple primary cancers, particularly synchronous esophageal cancers in head and neck cancer patients. We retrospectively reviewed 230 head and neck cancer patients. All the patients routinely underwent the following examinations: urinalysis, occult blood, tumor marker detection [squamous cell carcinoma (SCC), cytokeratin fragment (CYFRA), and carcinoembryonic antigen (CEA)], esophagogastroduodenoscopy, colonoscopy (when CEA was high or occult blood was positive), abdominal ultrasonography, plain chest computed tomography (CT), and PET. Bronchoscopy was performed when CT revealed lung shadow of central region. Synchronous multiple primary cancers were detected in 42 (18.2%) patients. The diagnostic sensitivity of PET for synchronous primary cancers was as follows: esophagus, 7.6% (1/13); stomach, 25.0% (2/8); lung, 66.7% (4/6); head and neck, 75.0% (3/4); colon, 0% (0/1); kidney, 0% (0/1); and subcutaneous, 100% (1/1). The sensitivity of PET for detecting synchronous esophageal cancers is low because these are early-stage cancers (almost stage 0–I). Therefore, it is necessary to perform esophagogastroduodenoscopy for detecting synchronous esophageal cancers. PET is an important additional tool for detecting synchronous multiple primary cancers because the diagnostic sensitivity of PET in synchronous head and neck cancer and lung cancer is high. But PET has the limitation of sensitivity for synchronous multiple primary cancers because the diagnostic sensitivity of PET in synchronous esophageal cancer is very low.     

Pain therapy in patients with incurable tumors of the head and neck

The treatment of pain in patients with terminal cancer of the head and neck is discussed. The treatment must be tailored to the individual patient and should use oral agents if possible. The basic medication consists of peripherally acting analgesics; if the results are inadequate, these must be combined with centrally acting agents. Neuroleptics are important adjuvant analgesics, which have proved to be particularly valuable for more severe pain in head and neck cancer. This treatment can be carried out either in hospital or in domiciliary practice.     

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.     

Experiences in the treatment of patients with multiple head and neck paragangliomas

Purpose

To analyze treatment results in the multidisciplinary management of patients with multiple head and neck paragangliomas (HNPs).

Methods

Retrospective analysis including all patients with multiple HNPs (VP, vagal paraganglioma; JTP, jugulotympanic paraganglioma; CBT, carotid body tumor) treated between 2000 and 2013 at a tertiary referral center.

Results

Ten patients (three men, seven women) had 25 HNPs (two VPs, eight JTPs, and 15 CBTs). The age range at diagnosis was 31–71 years (mean 40.9 years, median 37 years). Nine tumors (four CBTs, three JTPs, two VPs) were treated only with stereotactic radiotherapy (SRT; 50.4–56 Gy, mean 55.3 Gy) or in one case intensity-modulated radiotherapy (60 Gy). Nine tumors were treated with surgery alone (eight CBTs, one JTP) and three JTPs with subtotal surgery combined with adjuvant SRT. A “wait and scan” strategy was used in three cases (two CBTs, one JTP). The mean follow-up period was 4.3 years (range 0.1–13 years, median 4 years). The rate of tumor control with surgery and/or SRT was 100% (21/21). One patient with a wait-and-scan strategy for CBT had slow asymptomatic progression during a 13-year follow-up.

Conclusions

The treatment results in this series of patients with multiple HNPs show that a very high rate of long-term tumor control with low morbidity can be achieved using tailored and individualized approaches. All of the different treatment strategies available should be discussed with the patient. In particular, the treatment should involve a multidisciplinary team of experts in the fields of nuclear medicine, genetics, pathology, radiology, radio-oncology, and surgery.     

Multiple primary carcinomas in patients with head and neck malignancies

BACKGROUND: Multiple primary tumors can lead to diagnostic and therapeutical problems. In this study we surveyed frequency, localisation, diagnostic, chronologic and therapeutic aspects of multiple primary carcinomas in patients with head and neck tumors. PATIENTS AND METHODS: The data of 843 patients from the tumor registry of the ENT-clinic Aachen were retrospectively studied. RESULTS: Larynx (41.87%) and oropharynx (12.57%) were the main localisation of the first primary neoplasma. In 65 patients (7.71%) multiple primary tumors were observed. 24.6% of these tumors occurred synchronously. Preferential localisation of a second tumor were lung (20%), oral cavity (15.3%) and larynx (13.8%). 28.57% of the metachronous tumors were observed after more than five years. In 46.15% clinical complaints led to the suspicion of a second tumor. Panendoscopy was the most reliable diagnostic procedure. The survival rate and time was significantly reduced in patients with synchronous tumors. 3-year survival rate was 15% compared to 81% in patients with metachronous tumor appearance (p < 0.0001). CONCLUSION: Patients with head and neck tumors have a high incidence of multiple primary malignomas varying from the region of the first presentation of a malignant tumor. Concepts comprising surgery provide the highest survival rates. Because of the high incidence of metachronous carcinomas after five years found in this study, the authors regard a prolonged follow-up period as necessary.     

Paraneoplastic syndromes in patients with primary head and neck cancer

Paraneoplastic syndromes represent the clinical manifestations of the indirect and remote effects produced by tumor metabolites or other products. The clinical spectrum of the various paraneoplastic syndromes related to primary malignancies of the head and neck region is presented. A review of the literature on paraneoplastic syndromes in patients with primary head and neck cancer was carried out. Paraneoplastic syndromes related to primary malignancies of the head and neck region can be categorized as: endocrine, cutaneous or dermatologic, hematologic, neurologic, osteoarticular or rheumatologic, ocular syndromes. Sometimes, paraneoplastic syndromes can be more serious than the consequences of the primary tumor itself and can precede, follow or be concurrent to the diagnosis of a malignancy; moreover, they can dominate the clinical picture and thus lead to errors with respect to the origin and type of the primary tumor. Physicians who deal with cancer-associated syndromes should be able to differentiate the paraneoplastic syndromes from the benign disorders that mimic them. Patients with a suspected paraneoplastic disorder should undergo a complete panel of laboratory studies, in addition to imaging studies and endoscopy. Identification of paraneoplastic syndromes allow the clinician to make an early diagnosis and to provide adequate treatment of tumors, with a favorable oncologic outcome and improved life expectancy for the patient. These syndromes can follow the clinical course of the tumor and thus be useful for monitoring its evolution.     

Mutagen sensitivity of patients with laryngeal and oropharyngeal carcinoma

BACKGROUND: Carcinogenesis in the larynx and oropharynx is often associated with excessive exposure to tobacco smoke and alcohol. However, attention is increasingly being focused on genetically determined mutagen sensitivities and on the mutagenic impact of xenobiotics. The purpose of this study was to evaluate the genotoxicity of phthalates (plasticizers widely used in synthetic materials), as well as nitrosamines and polycyclic aromatic carbohydrates, on laryngeal and oropharyngeal epithelia and peripheral lymphocytes of patients with laryngeal and oropharyngeal carcinomas. METHODS: The comet assay was used to detect induced DNA strand breaks. Macroscopically healthy supraglottic and oropharyngeal epithelia of patients with laryngeal and oropharyngeal tumors, respectively, and lymphocytes were investigated with dibutyl phthalate (DBP), diisobutylphthalate (DiBP). N'nitrosodiethylamine (NDELA), and benzo[a]pyrene (BaP). The Olive Tail Moment (OTM) was used to quantify genotoxicity. RESULTS: For the first time, the genotoxicity of DBP and DiBP was demonstrated in laryngeal and oropharyngeal epithelia, as well as in peripheral lymphocytes, of patients suffering from laryngeal and oropharyngeal carcinomas. OTM levels for NDELA were higher than for phthalates; levels for BaP were lower. Testing of lymphocytes and mucosa showed no significant differences among the various substances. CONCLUSIONS: Phthalates show a genotoxic impact on epithelia of tumor patients. OTM levels were higher than in nasal and oropharyngeal mucosa of healthy donors in results reported earlier. Thus, specific susceptibilities to these xenobiotics need to be discussed. No such effect was demonstrated for NDELA and BaP. In tumor patients, no significant differences could be shown in mutagenic sensitivities in mucosal cells and lymphocytes.     

GSTM1 gene polymorphism in patients with head and neck tumors

BACKGROUND: Glutathione S-Transferase mu (GSTM) is a phase II detoxification enzyme, which rapidly detoxifies carcinogens found in tobacco smoke. The prevalence of this polymorphism is about 50% in the caucasian population. The lack of GSTM1 has been linked with an increased susceptibility of smoking related cancers. A homozygote deletion of the GSTM-gene results in a missing gene product. The objective of this study was to investigate the frequency of the GSTM1 null genotype in squamous cell carcinoma of head and neck, especially the larynx and hypopharynx and to analyse the occurrence with respect to certain anatomical sites of cancer. MATERIAL AND METHODS: The GSTM1 genotypes of 83 patients with head and neck cancers and 60 healthy controls were determined by polymerase chain reaction (PCR) using blood leukocyte DNA. The presence or absence of the PCR-product after electrophoretic separation in an 2.0% agarose gel revealed the positive or negative genotype. RESULTS: The absence of the GSTM1 gene (null genotype) was found in 64% of all head and neck cancer patients and in 48% of the healthy controls (p < 0.05). Separating for cancer site, the null genotype was found in 44% of patients with hypopharyngeal cancer and in 78% of patients with laryngeal cancer (p < 0.05). The protein concentration of GSTM-enzyme correlated with the genotype. CONCLUSIONS: The results suggest that GSTM1 deficiency predisposes to head and neck cancer, especially to cancer of the larynx, which is particularly exposed to tobacco smoke carcinogens.     

Defective monocyte chemotaxis in patients with epidermoid tumors of the head and neck

Summary Monocyte chemotactic activity was assayed by a modified Boyden-Chamber method using the chemoattractant casein and was found to be impaired in 13 patients with epidermoid tumors of the head and neck. Using 7 healthy subjects as controls, the depression in both monocyte chemotactic activity and monocyte random migration in the patients with tumors was found to be statistically significant by the leading front technique (P < 0.05).     

Defective monocyte chemotaxis in patients with epidermoid tumors of the head and neck

The function of the immune surveillance system has been studied extensively in patients with neoplastic disease. Defective monocyte chemotaxis has been demonstrated in a variety of neoplastic conditions. We have assayed chemotaxis in monocytic and polymorphonuclear leukocytes taken from patients with epidermoid tumors of the head and neck. Multiwell chemotaxis chambers and the chemoattractant, formyl-methionyl-leucyl-phenylalanine, were used. Polymorphonuclear leukocytes responded normally, but monocytes from all tumor patients studied displayed marked reductions in random migration (86% inhibition) and in chemotaxis (77% inhibition) toward formylpeptide.