Radiation therapy of carcinoma of the tonsillar region

From 1960 through 1976, 353 consecutive patients with carcinoma of the tonsillar region were primarily treated with radiation therapy. The mean age of patients was 58 years with males predominating (78%). Patients were classified according to a TNM and stage classification. Most of the tumors were large, and the specific site of origin could not be determined in 33% of the patients. The predominant identifiable sites were the soft palate and uvula, 18%, the anterior tonsillar pillar, 18%, and the tonsillar fossa, 13%. Patients were treated with radiation to doses of 6700 rad given in 48 days and 33 fractions using Cobalt 60 radiation. We found a 91.7% control rate for patients with T1 disease and 76.9%, 49.5%, and 25% for T2, T3, and T4 patients, respectively. The overall local control rate was 62.3%. Surgery was used most often in recurrences for Stage III patients. Salvage surgery was carried out in 93 patients. Surgery was more successful in controlling the disease in patients in whom the primary was controlled by irradiation. Overall, the tumors in 43% of the patients who had surgery were subsequently controlled as a result of this treatment. Metastasis occurred rapidly, with 75 of the patients exhibiting metastases by 18 months. Complications were not related to dose but were slightly higher in patients who had surgery (5%). We conclude that radiation therapy is the preferred treatment for Stage I and II squamous cell carcinoma of the tonsillar region. No satisfactory results were obtained in Stage IV; other approaches should be tried.     

Clinical importance of serum interleukin-18 and nitric oxide activities in breast carcinoma patients

BACKGROUND: Interleukin-18 (IL-18) is a novel immunoregulatory cytokine that was known previously as interferon-gamma-inducing factor. IL-18 levels can be used as a serum indicator for monitoring the clinical course of patients with hematologic malignancies and gastric carcinoma. Nitric oxide (NO) is a pleiotropic molecule that participates in the multistep processing of carcinogenesis. METHODS: In the current study, we measured serum IL-18 and nitrate and nitrite levels in 38 metastatic and 26 nonmetastatic breast carcinoma patients and 16 healthy control subjects. Serum nitrate and nitrite levels were measured as an index of NO generation. RESULTS: The levels of serum IL-18 and nitrate and nitrite were increased significantly in breast carcinoma patients compared with control subjects (P < 0.001). Serum IL-18 levels were significantly higher in the metastatic patients compared with the nonmetastatic patients (P < 0.001). There was no difference in serum nitrate and nitrite levels between metastatic and nonmetastatic patients (P > 0.05). Patients with bone metastasis have higher serum IL-18 levels and lower serum nitrate and nitrite levels compared with patients with liver, lung, and local metastasis (P < 0.001). There was no correlation among serum IL-18, nitrate and nitrite, CA 15-3, and carcinoembryonic antigen levels (P > 0.05). CONCLUSIONS: These findings suggest that serum IL-18 and nitrate and nitrite levels may be useful markers in monitoring metastatic breast carcinoma patients. IL-18 and NO activities in breast carcinoma patients with bone metastasis may be more valuable in the follow-up of these patients.     

An evaluation of ovarian carcinoma-associated antigen defined by murine monoclonal antibody CF511 in sera from patients with ovarian carcinoma

Murine monoclonal antibody CF511, raised against human ovarian clear cell carcinoma, detects a glycoprotein (Mr 600 kDa) called CF511 antigen which is elevated in the serum of many patients with ovarian carcinoma. A competitive enzyme-linked immunosorbent assay was developed to detect CF511 antigen in human serum and used to detected CF511 antigen in subjects with ovarian carcinoma and other diseases. No raised levels (less than 18 unit (U) ml-1) of the antigen were found in the serum of 220 normal individuals or of patients with germ cell tumours (n = 6), granulosa theca cell tumour (n = 1), gastric carcinomas (n = 10) and colo-rectal carcinomas (n = 8). Raised serum levels of CF511 antigen were found in 6/46 patients (13.0%) with benign gynaecological tumours (including endometriosis or ovarian cyst), in 5/7 patients (71.4%) with breast carcinoma and 16/21 (76.2%) lung carcinoma patients. In patients with ovarian carcinoma, 42.3% (11/26) of stage I and II, and 96.0% (24/25) of stage III and IV had levels of greater than or equal to 18 U ml-1. In all patients with serial determination of CF511 antigen levels before and after the surgery, the levels of antigen correlated with the clinical course of disease. Determination of CF511 antigen levels may be useful for detection of ovarian carcinoma as well as lung and breast carcinomas and for monitoring progress of disease and response to therapy.     

Radiation therapy for squamous cell carcinoma of the tonsillar region: a preferred alternative to surgery?

PURPOSE: There are no definitive randomized studies that compare radiotherapy (RT) with surgery for tonsillar cancer. The purpose of this study was to evaluate the results of RT alone and RT combined with a planned neck dissection for carcinoma of the tonsillar area and to compare these data with the results of treatment with primary surgery. PATIENTS AND METHODS: Four hundred patients were treated between October 1964 and December 1997 and observed for at least 2 years. One hundred forty-one patients underwent planned neck dissection, and 18 patients received induction (17 patients) or concomitant (one patient) chemotherapy. RESULTS: Five-year local control rates, by tumor stage, were as follows: T1, 83%; T2, 81%; T3, 74%; and T4, 60%. Multivariate analysis revealed that local control was significantly influenced by tumor stage (P =.0001), fractionation schedule (P =.0038), and external beam dose (P =.0227). Local control after RT for early-stage cancers was higher for tonsillar fossa/posterior pillar cancers than for those arising from the anterior tonsillar pillar. Five-year cause-specific survival rates, by disease stage, were as follows: I, 100%; II, 86%; III, 82%; IVa, 63%; and IVb, 22%. Multivariate analysis revealed that cause-specific survival was significantly influenced by overall stage (P =.0001), planned neck dissection (P =.0074), and histologic differentiation (P =.0307). The incidence of severe late complications after treatment was 5%. CONCLUSION: RT alone or combined with a planned neck dissection provides cure rates that are as good as those after surgery and is associated with a lower rate of severe complications.     

Chronic infection with hepatitis G virus in relation to hepatocellular carcinoma among non-Asians in Los Angeles County, California.

BACKGROUND: The recently identified hepatitis G virus (HGV) is a hepatotropic RNA virus belonging to the Flaviviridae family. The virus causes chronic viremia, and exposure to blood products is a recognized route of transmission in humans. To the authors' knowledge there is scant information regarding the hepatocarcinogenic potential of HGV. The current study examined the association between HGV infection and the risk of hepatocellular carcinoma. METHODS: A population-based, case-control study involving 144 non-Asian patients with hepatocellular carcinoma who were ages 18-74 years at diagnosis and 252 community controls of similar age, gender, and race was conducted in Los Angeles, California. Study subjects were assessed for serologic markers of infections with the hepatitis B virus (hepatitis B surface antigen, antibody to the hepatitis B core antigen, and antibody to the hepatitis B surface antigen), hepatitis C virus (HCV) (anti-HCV and HCV RNA), and HGV (HGV RNA). RESULTS: Twelve of the 144 hepatocellular carcinoma patients (8.3%) and 5 of the 252 control subjects (2.0%) were positive for serum HGV RNA. The presence of HGV RNA in the serum was associated with a statistically significant 5.4-fold risk of hepatocellular carcinoma (95% confidence limit, 1.8, 16.6). The excess risk for hepatocellular carcinoma among HGV-infected individuals was independent of the effects of hepatitis B and hepatitis C infections. CONCLUSIONS: Chronic infection with HGV may play a role in the development of hepatocellular carcinoma. If the observed statistical association is a causal one, then infection with HGV may account for approximately 8% of hepatocellular carcinoma cases occurring in non-Asians in Los Angeles, California.     

Ipsilateral irradiation for carcinomas of tonsillar region and soft palate based on computed tomographic simulation.

PURPOSE: To reduce xerostomia in selected patients with carcinomas of the tonsillar region and soft palate. METHODS AND MATERIALS: We evaluated the treatment results of 32 patients with tonsillar region and soft palate carcinoma treated by radical radiotherapy between May 1989 and December 1996. They have a unilateral tumor that did not cross midline and have no contralateral neck lymphnode metastasis and treated with an ipsilateral technique (an anterior oblique and a posterior oblique field). All patients were planned with computed tomographic (CT) simulation and given 65 Gy in 26 fractions in 6.5 weeks with or without 5-15 Gy boost irradiation. The median follow-up was 44 months (4-86 months). RESULTS: Five-year overall, cause-specific survival, local control, and regional control rate was 64, 79, 74 and 81%. No failure at the contralateral neck occurred. Moderate or severe symptomatic xerostomia was seen in 3 (9%) patients and ostero-radionecrosis requiring surgery occurred in one (3.3%) of 32 patients. CONCLUSION: It is suggested that the ipsilateral technique is indicated in patients who had an unilateral tonsillar region or soft palate carcinoma that did not cross midline and have no contralateral neck lymphnode metastasis.     

鼻咽癌围放疗期EB病毒IgA抗体水平的变化

目的:探讨鼻咽癌围放疗期EB病毒免疫球蛋白A（IgA）抗体水平变化的价值。方法:选自我院于2014年4月至2017年3月期间收治的鼻咽癌患者61例;另选自我院于2014年4月至2017年3月行EBV血清学检测的50例健康者作为对照组。空腹采集外周静脉血,分离血清,采用ELISA法测定衣壳抗原IgA（VCA-IgA）和早期抗原IgA（EA-IgA）水平。比较两组VCA-IgA和EA-IgA抗体水平,鼻咽癌患者放疗前后VCA-IgA和EA-IgA抗体水平和阳性率,及VCA-IgA和EA-IgA联合诊断灵敏度和特异度。结果:观察组VCA-IgA和EA-IgA抗体水平高于对照组,且有统计学差异（P<0.05）;鼻咽癌患者放疗后VCA-IgA和EA-IgA抗体水平低于放疗前,且有统计学差异（P<0.05）;鼻咽癌患者放疗后VCA-IgA和EA-IgA阳性率低于放疗前,且有统计学差异（P<0.05）;鼻咽癌患者VCA-IgA和EA-IgA联合诊断灵敏度和特异度高于VCA-IgA和EA-IgA单项诊断。结论:VCA-IgA和EA-IgA用于鼻咽癌患者治疗效果评估具有重要价值,且联合诊断灵敏度和特异度较高,具有重要研究意义。     

The measurement of SCC antigen in squamous cell carcinoma of the lung

Serum squamous cell carcinoma (SCC) antigen levels were measured in 55 patients with lung cancer, 43 with benign diseases and 50 normal subjects. At the same time, carcinoembryonic antigen (CEA) was measured for comparison. The mean SCC antigen levels were 1.47 + 0.50 ng/ml in 50 normal subjects. The percentage of positive case for SCC antigen (higher than 2.6 ng/ml) was 27.8% in lung cancer as a whole, 17.6% in adenocarcinoma, 47.6% in squamous cell carcinoma, 6.7% in small cell carcinoma and none in large cell carcinoma. Fifty percent of the Stage II patients were positive for SCC antigen, and the assay might be a possibility for early diagnosis. Our study suggests that SCC antigen assay may be a useful test for the identification and evaluation of lung cancer patients.     

The levels of caspase-cleaved cytokeratin 18 are elevated in serum from patients with lung cancer and helpful to predict the survival

Caspase-cleaved cytokeratin 18 fragments (M30 antigen) can be detected in the circulation of patients with carcinoma and are believed to reflect cell death of tumors of epithelial origin. M30 antigens cleaved at Asp396 are detected using an epitope-specific antibody (M30 antibody). We here measured the levels of such fragments in patients with lung cancer (n=60), patients with benign lung disease (n=22) and healthy control subjects (n=32). A statistically significant difference was observed between these groups (p<0.001; Kruskal-Wallis). Basal M30 antigen levels were evaluated with regard to their predictive power of survival. The best cut-off value for M30 antigen level for the prediction of death was 43.8 U/L. Patients with basal M30 antigen levels higher than 43.8 U/L had significantly shorter median survival than those with lower basal M30 antigen levels (p=0.013; hazard ratio: 3.9) (95% CI=1.3-11.4). To determine whether cytotoxic therapy increases serum M30 antigen in lung cancer patients, we monitored the levels of M30 antigen in 18 lung cancer patients before chemotherapy and after 24 and 48 h. An approximately four-fold increase in M30 antigen levels was observed at 48 h (p<0.001). These results suggest as a first time that serum M30 antigen might be used as a novel biomarker for prediction of survival as well as for monitoring the efficiency of chemotherapy in lung cancer patients.     

93例扁桃体鳞癌的治疗分析

目的 探讨扁桃体鳞癌治疗方式。方法 本院自1987年到1996年共收治扁桃体鳞癌93例，回顾性分析其临床资料。结果 扁桃体鳞癌预后与病理分级、临床分期、治疗方法等诸多因素相关。本院采用根治手术 术后放疗的综合疗法治疗中晚期扁桃体鳞癌22例，5年生存率达68．18％。结论 治疗除早期病例可考虑行单纯手术或单纯放疗外，中晚期病例应采取以手术为主的综合治疗。     

扁桃体癌不同治疗方法的疗效对比分析

目的：分析与探讨扁桃体癌不同的治疗方案与疗效的关系。方法：１９８７年１０月￣１９９５年１２月间收治了９５例扁桃体癌,均经病理证实。８例采用联合根治术加化疗,９例为联合根治术前术后放疗,６２例单纯根治性放疗,１６例用根治性放疗加化疗。结果：本组１年、３年和５年生存率分别为８６．３２％,６２．９３％和５６．２６％。８例手术加化疗的患仅１例存活５年,四种治疗情况对其５年生存率和局部控制率的影响具有显     

Evaluation of bismuth subgallate and adrenaline paste as haemostat in tonsillectomy bleeding

Haemorrhage is a frequent and often feared complication of tonsillectomy. This has prompted the use of a variety of topical haemostatics such as bismuth subgallate to achieve haemostasis and reduce the risk of postoperative haemorrhage. In this study effect of bismuth subgallate and adrenaline paste was investigated. A total of twenty five subjects undergoing tonsillectomy were randomly recruited. The distinctive feature of study was that each patient constituted a matched pair, with left tonsillar fossa acting as control and right tonsillar fossa as trial side. Bismuth subgallate adrenaline paste was made by mixing 13 gm of Bismuth subgallate powder with 10 ml of normal saline and 0.35 ml of 1: 1000 adrenaline. The application of twin reagent paste resulted in reduced blood loss in trial fosse (60.8 ± 19.3 ml) as compared to control fossa (91.2 ± 20.27) (p < 0.0001). Similarly the average number of ligatures applied to control bleeding was also less in trial fosse. Only one patient reported reactionary haemorrhage while there was no report of secondary haemorrhage from amongst tonsillar fosse on trial side. However, two patients presented with secondary haemorrhage from control side fosse.     

The benefits and pitfalls of ipsilateral radiotherapy in carcinoma of the tonsillar region

PURPOSE: Ipsilateral techniques designed to restrict treatment to the primary tumor and neck on the same side have been used in selected cases of cases of carcinoma of the tonsillar region at our institution for many years. The primary purpose of this study is to evaluate the risk of failure in the opposite neck in cases selected for unilateral radiotherapy over a 21-year period. METHODS AND MATERIALS: Ipsilateral radiotherapy techniques were used in 228 of 642 patients with carcinoma of the tonsillar region from 1970 to 1991. Local control, regional lymph-node control (including contralateral failure), and survival were calculated for different degrees of tumor extent treated with these techniques. RESULTS: Mean follow-up was 7 years. Cases tended to be T1 and T2, with N0 disease. The 3-year actuarial local control rate was 77% and cause-specific survival was 76%. Opposite neck failure was seen in 8 patients (crude rate of 3.5%). In the earlier period of the study, primary coverage was problematic in a proportion of cases and resulted in higher rates of local failure. CONCLUSION: Appropriately selected cases of carcinoma of the tonsil show minimal risk of failure in the opposite neck with ipsilateral techniques. Patients should undergo computed tomography planning to ensure adequate target coverage.     

Serum levels and biochemical characteristics of human ovarian carcinoma-associated antigen defined by murine monoclonal antibody, CF511

The murine monoclonal antibody (Mab) against human common epithelial ovarian carcinoma, CF511, was generated by immunising mice with human fetal tissue extract from early first trimester, followed by booster injection of an ovarian cancer cell line. Mab CF511 recognised the 600 kDa sialylated glycoprotein as different from previously known tumour associated-marker antigens. Distribution of the Mab CF511-recognised antigen (CF511 antigen) in various tissues and sera was investigated. In immunohistochemical analysis, Mab CF511 reacted strongly with tumour cells of ovarian serous, clear cell, endometrioid and undifferentiated carcinoma and partially with those of mucinous carcinoma. Mab CF511 also reacted with breast carcinoma as well as lung carcinoma. In normal tissues, Mab CF511 cross-reacted with only five tissues, namely lung, breast, thyroid gland, fallopian tube and uterus. Serum levels of CF511 antigen were tested by ELISA inhibition using Mab CF511. This assay showed the circulating CF511 antigen levels to be elevated in 25 of 36 sera from patients with various clinical stages of common epithelial ovarian carcinoma compared to three of 47 and three of 111 sera from patients with other benign gynaecological diseases, including ovarian cysts, uterine fibroids with or without endometriosis and normal healthy subjects, respectively. For the relation between antigen levels and clinical stages of common epithelial ovarian carcinoma, greater than 34.0% ELISA inhibition was detected in 100% of patients with advanced stages (FIGO III and IV) compared with in 35.3% with early stages (FIGO I and II) patients. While patients with breast carcinoma (100%) and lung carcinoma (100%) also had elevated circulating CF511 antigen levels, patients with hepatoma, colorectal carcinoma and gastric carcinoma had no detectable elevation of antigen. Although the test showed a high degree of specificity, the detection of an elevated CF511 antigen level would not be so helpful in distinguishing patients with ovarian carcinoma from those with either breast carcinoma or lung carcinoma. These data suggest that CF511 antigen is a useful new ovarian tumour marker for diagnosis and management of the disease.     

Evaluation of leukocyte adherence inhibition (LAI) test in primary and secondary hepatic malignancies

Leukocyte adherence inhibition (LAI) has been demonstrated to be a simple, rapid, and reliable technique in the diagnosis of various malignancies including hepatocellular carcinoma. The LAI test was carried out employing modified tube LAI technique in patients with primary hepatocellular carcinoma (HCC) and secondary carcinomas of liver. Positive LAI response to HCC antigen was obtained in all six (100%) cases of hepatocellular carcinoma tested. None of the control cases, which included 8 healthy subjects and 16 cases of benign liver diseases, gave positive LAI response. Two out of 19 cases of secondary carcinoma gave a positive LAI reaction to HCC antigen. In secondary carcinomas, 19 out of 21 cases (90.48%) gave positive LAI reaction to secondary adenocarcinoma antigen. There were two false positives in controls (1 each of cirrhosis and amebic liver abscess), and 1 out of 8 cases of HCC also gave positive response to secondary carcinoma antigen. Thus, LAI test was found to be useful in the diagnosis of hepatic malignancies.     

Further studies on the detection of early lung and breast carcinoma by T antigen

We measured the cellular and humoral autoimmune response to carcinoma (CA)-associated T antigen in patients with the earliest clinical stages of lung (T1N0M0) and breast (Tis) CA. We used desialylated MN glycoprotein from healthy human erythrocytes in a single measurement of 1) delayed-type skin hypersensitivity response (DTHR-T) and 2) humoral anti-T response with a solid-phase immunoassay (SPIA-T). DTHR-T detected 19/20 lung CA and 10/12 ductal and 7/10 lobular breast CA patients. Sixteen of 18 stage T1N0M0 lung CA patients had a positive SPIA-T as did 7/8 patients with Tis breast CA. Two of 35 patients with benign lung and 11/144 with benign breast disease had a positive DTHR-T. None of 160 persons with either other non-CA diseases or healthy had a positive DTHR-T. Three of 68 such control subjects had a positive SPIA-T. The difference between CA patients and control populations is statistically highly significant.     

Quantitative and qualitative characterization of human cancer-associated serum glycoprotein antigens expressing fucosyl or sialyl-fucosyl type 2 chain polylactosamine

The quantity of tumor-associated antigens carrying type 2 chain polylactosamines with four types of fucosyl determinants, LeX (X-hapten), poly-LeX, sialyl LeX, and LeY (Y-hapten), present in sera of patients with various malignant and non-malignant disorders, as well as the qualitative chemical properties of the carrier molecules in sera, have been investigated using four monoclonal antibodies, each of which defines one of these determinants. The following findings are of particular importance: the serum levels of LeX defined by antibody FH2 and poly-LeX defined by ACFH18 in patients with cancer were occasionally high (incidence about 10%); however, the majority of patients did not show elevated levels; the serum level of the antigen, defined by monoclonal antibody FH6 (termed sialyl LeX-i since this determinant is carried by i antigen), was significantly high in patients with cancers originating from organs from which adenocarcinomas often develop. For example, among various types of lung cancer, only adenocarcinoma but not squamous cell carcinoma, small cell carcinoma, or large cell carcinoma showed a high level of sialyl LeX-i antigen in sera. The incidence of high antigen levels in sera of patients with adenocarcinomas of lung was as high as 76% of the observed cases; the serum level of Ley (Y-hapten) was frequently high in patients with hepatoma (incidence, 34%); sialyl LeX-i antigen was separated on gel filtration as a glycoprotein with an average molecular weight greater than 10(6). It was characterized by its susceptibility to basehydrolysis, Pronase digestion, and sialidase and endo-beta-galactosidase treatment and is assumed to be a high molecular weight mucin-type glycoprotein; sialyl LeX-i antigen expressed in sera of patients with cancer was soluble in perchloric acid, while the same antigen in sera of patients with noncancerous diseases and normal subjects was mostly insoluble in perchloric acid. LeX, a poly-LeX, and essentially all LeY antigens in sera of patients with cancer were perchloric acid-insoluble.     

Presence of EBNA in nasopharyngeal carcinoma and control patient tissues related to EBV serology.

A search was made for Epstein-BARR virus (EBV) associated nuclear antigen (EBNA) in touch preparations of fresh biopsy material from 26 carcinomas of the nasopharynx, 39 other tumours of the head and neck, the nasopharyngeal mucosa of 32 patients in whom nasopharyngeal neoplasm had been excluded, and the mucosa from enlarged but non-neoplastic tonsils removed from 12 patients. EBNA-positive cells were uniformly detected in the preparations from the undifferentiated and poorly differentiated squamous-cell carcinomas of the nasopharynx, provided they contained tumour-cell aggregates. Such cells were not detected in the preparations from the single case of well-differentiated papillary adenocarcinoma in the nasopharyngeal carcinoma group. There were no moderately or well-differentiated squamous-cell carcinomas among the nasopharyngeal carcinoma group. Among other tumours of the head and neck, only three undifferentiated carcinomas of the nasal fossa were found to contain EBNA-positive cells. None of the nasopharyngeal or tonsillar mucosal preparations contained such cells. These findings confirm the unique regular association of EBNA with nasopharyngeal carcinoma of undifferentiated and poorly differentiated squamous-cell types (NPC). The EBV-related serological findings support the value of tests for IgG and IgA antibodies to VCA and EA(D) in the exclusion of NPC in patients with suspicious symptoms and the differentiation between NPC and other tumours of the head and neck. Examination of biopsy specimens for the presence of EBNA-positive cells or EBV-DNA is essential, however, for confirmation of the diagnosis.     

扁桃体癌近距离插植后装放射治疗疗效分析

目的:分析常规外照射 插植近距离后装放射治疗扁桃体癌的疗效。方法:回顾分析我科1992年1月至2005年12月收治的经病检证实的扁桃体癌39例,采用常规外照射 插植近距离后装放射治疗组(观察组)23例,采用常规外照射治疗组(对照组)16例,比较两组局部控制率和生存率。结果:观察组3、5年局控率分别为86.9%和86.6%,对照组为75.0%和62.5%;观察组3、5年生存率分别为73.9%和52.2%,对照组为68.8%和37.5%。5年生存率分别为:观察组Ⅰ Ⅱ期为77.7%,对照组71.4%。观察组Ⅲ Ⅳ期为35.7%,对照组为22.2%,均无显著性差异(P>0.05)。结论:扁桃体癌患者行外照射 插植近距离后装放射治疗对提高疗效有一定增益,值得进一步深入研究。