Indications for radical neck dissection following radiation therapy

The recent trend has been away from elective neck dissection in the management of patients with cancer of the head and neck. In addition, improved techniques of radiation therapy have demonstrated their capacity to eliminate and sterilize occult and even frank neck metastases. An unselected series of 409 radical neck dissections performed in 357 patients in a period of eight years has been critically reviewed to determine the incidence of microscopically negative nodes in patients who were previously radiated for cure and in whom a neck dissection had been performed as a part of the surgical procedure. Findings and results support our current position that a neck dissection in the presence of clinically negative nodes, particularly when they were never previously present, need not be included in the surgical procedure designed to salvage patients following radiation failure. Because of the documented increase of postoperative complications following such surgery, the decrease in morbidity and mortality seems to justify this policy.     

Desmoid tumors of the head and neck

Desmoid tumors of the head and neck, also known as aggressive fibromatoses, are rare. They are soft tissue neoplasms arising from musculoaponeurotic structures and characterized of locally aggressive infiltration and recurrences. Complete surgical excision of desmoid tumors is considered to be the only effective method of cure. It is likewise important to make a function-preserving surgery. In addition to the radicality this aspect should be a primary goal to minimize morbidity. MRI is the first choice in the preoperative evaluation of neck desmoids. We describe the successful treatment of desmoid tumors in two cases (M. sternocleidomastoideus, M. levator scapulae). Intraoperative neuromonitoring was very helpful for identification and protection of the motor nerves.     

Desmoid tumours of the head and neck: A case report

IntroductionDesmoid tumours of the head and neck, also known as fibromatosis, are rare, locally invasive benign tumours with high recurrence rate, causing considerable morbidity. Complete surgical excision of desmoid tumours is considered to be the only effective treatment.Case reportWe present a case of fibromatosis of the right posterolateral region of the neck in a 56-year-old woman who presented with right neck mass. The patient underwent complete excision of the tumour with no adjuvant therapy. No recurrence or neurological deficit was observed 2 years after surgery.ConclusionAlthough desmoid tumour is a benign neoplasm with no metastatic potential, treatment is challenging due to its aggressive, infiltrative behaviour with a tendency to recur.     

Desmoid tumor (aggressive fibromatosis) of the neck

Desmoid tumors are histologically benign fibrous neoplasms arising from the musculoaponeurotic structures throughout the body. There is similar biological behaviour between benign fibrous proliferations and fibrosarcoma. These neoplasms have the tendency to locally invade and erode adjacent muscular tissue and bone. Within the head and neck area they also tend to encase vital structures. We present a case of a 28-year-old white female with a five-month history of a painful mass in her left posterior cervical triangle who was treated by excisional biopsy of the lesion with preservation of the accessory nerve and post-operative radiation. The histopathologic characteristics of desmoid tumors and treatment of these lesions are also reviewed.     

Desmoid tumours of the head and neck in children: Review of management

Objective

Desmoid tumours of the head and neck in children are rare, local invasive and potentially fatal tumours. The purpose of this review is to discuss the management of these tumours in the light of a case series and a review of the literature.

Synovial sarcoma of the neck associated with previous head and neck radiation therapy.

Synovial sarcoma is a rare neoplasm that uncommonly arises in the neck. Fourteen years after facial and neck radiation therapy for acne, synovial sarcoma of the neck developed in a young man. Possible radiation-induced benign and malignant neoplasms that arise in the head and neck region, either of thyroid or extrathyroid origin, remain a continuing medical problem.     

Postoperative radiation therapy for squamous cell carcinoma of the head and neck

PURPOSE: To discuss the role of postoperative radiation therapy (RT) for patients with squamous cell carcinoma of the head and neck. RESULTS: Patients with adverse pathologic features have a high likelihood of local-regional recurrence and a decreased probability of survival after surgery alone. Postoperative RT reduces the risk of local-regional failure and probably improves survival. Patients who are at high risk for recurrence after surgery benefit from more aggressive dose-fractionation schedules that may include altered fractionation to decrease the overall time from surgery to the completion of RT. Adjuvant chemotherapy also appears to improve the probability of cure in high risk patients. CONCLUSION: Patients who have a high likelihood of local-regional recurrence after surgery have improved disease control and survival after postoperative RT.     

New radiation therapy techniques for the treatment of head and neck cancer

This article reviews the most recent technology used in the treatment of head and neck cancer. It discusses brachytherapy, new ways to mix radionuclides for enhanced radiobiologic effects, and different fractionation schemes that have grown in clinical importance. Intensity-modulated radiotherapy has become a mainstay in head and neck cancer treatment, and the authors discuss several popular and emerging approaches. Patient immobilization and imaging are also discussed.     

Recent advances in radiation therapy for head and neck cancer

The treatment of locally advanced or recurrent head and neck cancers has improved from single modality interventions of surgery and radiation therapy alone to include combined modality therapy with surgery, chemotherapy and radiation. Combined therapy has led to improved local control and disease-free survival. New developments in radiation oncology such as altered fractionation, three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, stereotactic radiosurgery, fractionated stereotactic radiotherapy, charged-particle radiotherapy, neutron-beam radiotherapy, and brachytherapy have helped to improve this outlook even further. These recent advances allow for a higher dose to be delivered to the tumor while minimizing the dose delivered to the surrounding normal tissue. This article provides an update of the new developments in radiotherapy in the management of head and neck cancers.     

Surgical complications following twice-a-day versus once-a-day radiation therapy

With increasing numbers of radiotherapists using twice-a-day (BID) rather than conventional once-a-day (QD) radiation therapy to treat carcinomas of the head and neck, we attempted to determine whether the increased tissue reaction seen with a BID program results in greater morbidity for subsequent surgery. Postoperative complications in 24 patients receiving prior BID irradiation were compared with 37 controls receiving QD treatments. The incidence of major surgical complications for BID and QD groups was equivalent (20.8% and 18.9%, respectively). The incidence of minor complications was almost three times greater for the BID group (37.5% vs. 13.5%). Patients receiving BID radiation therapy required twice as many intraoperative transfusions (2.13 vs. 1.11) and five additional days of postoperative hospitalization (23.7 vs. 18.2). These differences are statistically significant with p-values of less than 0.5 and less than 0.1, respectively. We consider this increase in surgical morbidity to be acceptable if BID radiation therapy leads to improved tumor control.     

Tenosynovial giant cell tumour of the neck

We report the case of a diffuse tenosynovial giant cell tumour to be found adjacent to the thyroid gland. These tumours, also known as extra-articular pigmented villonodular synovitis, are found more commonly in the fingers, wrist, knee thigh and foot, rarely in the head and neck. These tumours are prone to local recurrence, require a high clinical index of suspicion and if they have atypical features may be extremely difficult to obtain a histological diagnosis.     

Microvascular free tissue reconstruction following extirpation of head and neck tumour: experience towards an optimal outcome

Familiarity with four types of free tissues transfers allows appropriate reconstruction of most defects in the head and neck region functionally and aesthetically. These include jejunal graft, radial forearm, rectus abdominus myocutaneous and fibula osteocutaneous flaps. Free colonic and gastric patches were used occasionally. We report our experience of 215 free tissue transfers for reconstruction of defects in the head and neck region after tumour extirpation. The overall success rate was 94 per cent. The commonest cause of failure was related to arterial inflow (70 per cent). Three patients died in hospital, but their mortality was not related to the tissue transfers. Complications due to free tissue transfer at both the donor and recipient sites were few and manageable. The co-operation between the two surgical teams, together with the timely application of suitable salvage procedures, contribute to an optimal outcome.     

Effects of head and neck radiation therapy on vocal function.

OBJECTIVE: Radiotherapy (RT) is used to treat a variety of head and neck malignancies. The larynx may receive high radiation doses even in the absence of disease. The effects of RT on the nondiseased larynx are unknown. This study will evaluate subjective and objective parameters of vocal function in patients treated with RT for nonlaryngeal malignancies. DESIGN: Cross-sectional observational study. METHODS: Videostroboscopic, aerodynamic, and acoustic analyses were performed. Results were compared to age- and gender-matched controls. Self-assessment of voice quality was measured using the Voice Handicap Index. RESULTS: A majority of patients demonstrated increased supraglottal activity (i.e., ventricular fold constriction) during stroboscopic evaluation. Significant differences compared to normative data were found in many aerodynamic and acoustic parameters. A substantial proportion (27%) of patients reported significant voice handicap. Younger patients reported greater handicap, and voice quality was worse with time. CONCLUSIONS: Significant objective and subjective changes in vocal function occur in patients radiated for nonlaryngeal head and neck malignancies. Young patients may have the worst impact, and vocal dysfunction may increase with time. A prospective study of this patient population should include a baseline voice quality assessment.     

A case of laryngeal aspergillosis following radiation therapy.

Primary laryngeal aspergillosis is extremely rare. It is commonly seen as a part of a systemic infection involving the respiratory system in an immunocompromised host. Differential diagnosis is important, as the clinical symptoms are similar to those of malignant laryngeal disease. We describe a 73-year-old man with a history of hoarseness. He had a history of radiotherapy for laryngeal squamous cell carcinoma and had a history of diabetes. Direct laryngoscope and biopsy confirmed the diagnosis of aspergillus. We cauterized the lesion with a CO(2) laser. In the present case, irradiation seemed to have played a more important role in the onset of this disease rather than diabetes.     

头颈部韧带样瘤临床分析

目的 探讨少见的头颈部韧带样瘤的临床表现、诊断依据、治疗方法及预后,为临床医师正确认识该病,减少复发率提供帮助.方法 回顾性分析头颈部韧带样瘤4例,1例面颊部肿瘤位于右颞下窝及右咽旁间隙,1例左侧上齿槽肿瘤,侵犯同侧上颌窦及眶底,2例颈部肿瘤,分别位于右胸锁乳突肌中部后缘及右锁骨上窝,均采用手术切除.结果 术中见肿瘤实质性,呈浸润性生长,无包膜,可破坏周围骨质及肌肉.术后随访1～2年,1例颊部肿瘤及2例颈部肿瘤无复发,1例左上齿槽肿瘤于术后半年复发.结论 头颈部韧带样瘤为介于良性纤维母细胞瘤与纤维肉瘤间的交界性肿瘤,术前症状不典型,诊断主要依靠术后病理,彻底手术切除是降低复发的主要手段.