Exercise and sports therapy for patients with head and neck tumors]

Important aspects in the aftercare of patients with cancer of head and neck can be realized by physical training in a sports group. The aftermath of operative therapy, e.g. loss of motion, imbalances of muscular activity or respiratory movements, can be reduced. The main importance of physical training in a group is the patient's reintegration in a social environment. Evaluating the quality of life of the individual patient we found that this method of psychosocial aftercare can improve subjective quality of life. Therefore, this conception of rehabilitation should not be missing in the aftercare of patients with malignant cancer.     

光动力疗法在头颈部恶性肿瘤中的应用

光动力治疗是近些年不断兴起的肿瘤治疗手段,将光敏剂注射到体内后,光敏剂能特异性聚集在肿瘤组织中,再予以特定波长的光照射肿瘤部位,使光敏剂产生光动力学反应,使肿瘤细胞器损伤、肿瘤细胞凋亡及坏死、肿瘤微循环障碍、机体肿瘤免疫等作用机制杀死肿瘤细胞。近年来,作为光动力疗法的关键因素,新的光敏剂及光源不断被探索并应用于临床,关于光动力治疗恶性肿瘤的临床研究日益增多,尤其是头颈部恶性肿瘤。随着新型光敏剂如金丝桃素及相关光源投入使用以及将光动力技术与其他治疗手段相结合后,光动力治疗效果主要观察指标“生存时间”较既往有所延长,相关不良反应如日光性皮炎、药物过敏反应等有所减少,且其在保存重要器官功能完整和美容功能上令人满意。本文对近年来光动力治疗在头颈部恶性肿瘤的临床应用做一综述,重点阐述光动力治疗鼻咽癌、鼻窦癌、喉癌、口腔癌、面部皮肤恶性肿瘤等头颈部常见恶性肿瘤时所体现的疗效好、完整保存重要器官功能、美容及副作用小的优越性,以了解近些年光动力技术对头颈部恶性肿瘤疗效的发展,及表达需进一步研发性能更优的光敏剂和光源、寻找光动力疗法结合其他治疗手段的需求。     

Photodynamic therapy for head and neck cancer

Photodynamic therapy (PDT) is a recently developed treatment involving the use of a photosensitizer and low power light, usually from a laser, to selectively destroy tumor cells. At present, we perform PDT for head and neck cancer using argon or excimer dye lasers with hematoporphyrin derivative as a photosensitizer. This study attempted to assess the utility and safety of PDT and to investigate the long-term outcome. All 24 patients had squamous cell carcinoma: 15 with laryngeal, 5 with lingual or oral, and 4 with pharyngeal cancer and were treated by PDT. Data were obtained from records from February 1988 through April 1995. After PDT, 12 of 15 laryngeal cancer patients were classified as having a complete remission (CR), as were 2 of the 5 lingual or oral and one of the 4 pharyngeal cancer patients. The patients were followed for 8 to 153 months. The longest duration of CR in patients treated by PDT alone was 148 months. Photosensitivity was experienced by all patients, but required no treatment. Liver, kidneys, and bone marrow showed no abnormal values. There were no clinically relevant adverse reactions, and patients with severe complications due to other types of treatment and elderly patients were also treated safely with this therapy.     

MR-guided ablation of head and neck tumors

Interstitial laser-induced thermotherapy (LITT) is a minimally invasive technique for local tumor destruction within solid organs using optical fibers to deliver a high-energy laser to the target lesion. MR imaging is used both for placement of the laser in the tumor and for monitoring progress of thermocoagulation caused by the laser The success of LITT is dependent on the delivery of the optical fibers to the target area, real-time monitoring of the effects of the treatment, and subsequent evaluation of the extent of thermal damage. The key to achieving these objectives is the imaging methods used. The thermosensitivity of certain MR sequences is the key to real-time monitoring, allowing accurate estimation of the extent of thermal damage.     

Reirradiation: exploring new territory in the therapy of recurrent head and neck cancer

Traditionally, systemic chemotherapy has been the main form of treatment for recurrent squamous carcinoma of the head and neck. Unfortunately, response rates are seldom higher than 20-30%, with median survival times of 6-8 months. This paper explores the emerging role of reirradiation in the setting of recurrent squamous cell carcinoma of the head and neck; it reviews the existing literature focusing on radiation alone in this setting, and more recent literature integrating systemic radiosensitizing cytotoxics with reirradiation. Data from recent series using fluorinated pyrimidines and hydroxyurea, as well as platinating agents and taxanes, suggest occasional longterm survival benefits that exceed the historic norm. These approaches, largely confined to single institutions or small consortiums to date, are being evaluated prospectively in the cooperative group setting.     

Retrospective review of laser therapy for palliation of colorectal tumours.

Patients with inoperable colorectal tumours will often require symptomatic relief due to the nature of extensive disease spread or existing co-morbidities. The use of laser treatment for palliation of tumours in the lower gastrointestinal tract has become an attractive treatment option for such patients. This paper presents the results of a retrospective review of 58 case notes in order to determine the effectiveness of laser therapy in palliating symptoms of colorectal tumours. In addition, the paper aims to identify which colorectal symptoms laser is best used to palliate. The study was conducted in a regional coloproctology unit at the Western General Hospital in Edinburgh. The main findings show that 52% (n=30) of patients had successful (complete/good) resolution of symptoms, 36% (n=21) had a poor response and 12% (n=7) had no resolution of symptoms from laser therapy. Of all documented symptoms, this study found that laser is most effective at palliating obstructive symptoms. It also has beneficial application in the palliation of bleeding and mucous discharge. It is less effective for the anal symptoms of tenesmus and pain and for stool related symptoms such as diarrhoea, constipation, frequency and incontinence.     

Endocrine complications after radiotherapy for tumors of the head and neck

One hundred sixty-six patients 6 to 80 years of age with nasopharyngeal cancer and paranasal sinus tumors who were free of the primary disease were studied from 1 to 26 years after radiotherapy. Studies in 65 of these patients were performed prospectively. Both the hypothalamus and the anterior pituitary gland were in the field of irradiation. The median radiation dose was estimated to be 5700 rad to the anterior pituitary gland and 5000 rad to the hypothalamus. We found evidence of endocrine deficiencies in 134 of the 166 patients observed. One hundred eleven patients showed evidence suggestive of hypothalamic lesions and 67 patients showed evidence of primary pituitary deficiency. Forty-eight of the 110 patients who received radiotherapy to the neck for treatment or prevention of lymph node metastasis showed evidence of primary hypothyroidism. The median dose to the thyroid area was 5000 rad. Adolescents younger than 15 years of age had a higher incidence of growth hormone deficiency soon after radiotherapy, but the older group showed adrenocortical and luteinizing hormone deficiency. These results indicate that endocrine deficiencies after radiotherapy for tumors of the head and neck are common. The highest incidence of complications occurred 1 to 5 years after radiotherapy, but long-term follow-up is indicated because complications may appear years after radiotherapy.     

143例头颈部肿瘤的影像综合分析

目的：分析头颈部肿瘤的病种分类、组成及其影像学特点。方法：回顾性分析经手术病理证实的143例头颈部占位病变患者的临床及影像学表现,并与手术结果相对照。结果：143例头颈部肿瘤中包含5类,以海绵状血管瘤最常见,每种肿瘤的临床和影像学检查各有特点。结论：结合多种影像学检查可以对各种肿瘤做出正确的诊断。     

Perineural tumor spread in malignant head and neck tumors

Perineural tumor spread (PNS) of head and neck malignancies is a course of disease in which tumor metastasizes along the endoneurium or perineurium. Perineural tumor spread is a potentially devastating complication of head and neck cancer and has a high impact on the therapeutical management and overall prognosis. Imaging plays an important role in the detection of this condition, especially in view of a large number of clinically asymptomatic patients with PNS. Magnetic resonance imaging is the modality of choice in the assessment of PNS because of its multiplanar capability and its superior soft-tissue contrast. Knowledge of normal cranial nerve anatomy and the imaging appearance of perineural tumor extension is imperative in the evaluation of PNS which represents a special challenge in head and neck radiology.     

PET/CT imaging in recurrent head and neck cancer

PET/CT offers advantages over PET alone, which is limited by poor anatomic localization and CT alone, which provides morphologic data only. Retrospective fusion of separately acquired PET and CT images allows for potential fusion misregistration in the mobile head and neck between imaging sessions. Indications for PET/CT include recurrent neoplasm, tumor surveillance, and staging. This article will focus on recurrent head and neck neoplasm including, head and neck cancer, thyroid cancer, recurrent skull base tumor. PET/CT may change management in facilitating earlier detection of recurrence than is possible with conventional CT or MR imaging, in guiding biopsy, and in detecting second primary sites and distant metastases. Limitations of PET/CT include physiologic uptake, metabolically active tissue, and muscle contraction during uptake phase. PET/CT, however, is better equipped than is PET alone to mitigate these limitations by precisely localizing FDG uptake to anatomic structures. In addition, small lesions (< 1 cm) may be below scanner resolution and, therefore, a lower SUV (that is < or = 3), may suggest neoplasm. Recent treatment may result in false negative findings, especially when PET is performed within 4 months of radiation therapy. Finally, tumors of low metabolic activity (e.g., salivary gland tumors) may be prone to false negative results. In the future, PET/CT imaging will become more useful in staging head and neck cancer with improved scanner resolution. Development of specific tumor markers may allow for tumor-specific ligands that will increase sensitivity to head and neck neoplasia. Treatment targeting for radiation therapy is an application that is likely to become widely used.     

Prolactinoma and other head and neck tumors after scalp irradiation

Tumors of the thyroid and parathyroid glands may develop together or separately in patients who previously have been exposed to head and neck irradiation. Whether cranial irradiation confers an increased risk for pituitary adenoma remains unknown. We report the case of a 52-year-old woman who was treated during childhood for tinea capitis with scalp irradiation and later in life developed a prolactin-secreting tumor, a parathyroid adenoma, a benign thyroid lesion, and a basal cell carcinoma of the skin. She was treated successfully with bromocriptine and surgical removal of the parathyroid adenoma. Molecular analysis of the parathyroid tissue failed to demonstrate any abnormality of the multiple endocrine neoplasia Type 1 gene. This case report is the first to describe a prolactin-secreting tumor that developed in association with other endocrine neoplasia after head and neck irradiation. Our case suggests that multiple endocrine neoplasia may develop in a sporadic pattern after scalp irradiation.     

Cytology of head and neck tumors, liver, and pancreas

The use of fine needle aspiration biopsy helps in reducing the number of thyroidectomies. Cytologic differentiation between cellular adenomas and well-differentiated follicular carcinomas is difficult, however; hence, both groups of lesions should be excised. Cytologic diagnosis of the common salivary gland tumors (ie, pleomorphic adenomas and Warthin's tumors) is accurate, but much experience is required for the cytodiagnosis of other tumor types. The majority of liver malignancies is metastatic in origin and poses no diagnostic problems. Pathologists also should be familiar with the cytology of hepatocellular carcinoma as the population of Asian immigrants in North America is increasing. Most of the pancreatic tumors are ductal adenocarcinomas, which can be diagnosed cytologically. Occasionally, atypical ductal epithelium in chronic pancreatitis may mimic malignancy. Cytodiagnosis of nonduct-cell neoplasms of the pancreas requires experience.     

头颈部炎性肌纤维母细胞瘤CT和MRI表现

目的 探讨头颈部炎性肌纤维母细胞瘤(IMT)的CT和MRI表现。方法 回顾性分析12例经手术病理证实的头颈部IMT患者的临床及影像学资料,9例接受CT平扫,其中7例接受增强CT扫描;4例接受MR平扫及增强扫描。结果 12例IMT均为单发,发生于上颌骨、颌面部软组织、上颌窦及颈部软组织各2例,下颌骨、眼眶、颧骨及腮腺各1例,肿瘤体积1.0 cm×1.0 cm×1.0 cm~5.0 cm×3.8 cm×4.8 cm。CT平扫7例密度均匀,2例密度不均匀,CT值30~85 HU,增强扫描6例轻至中度强化,1例明显强化;6例可见骨质被吸收破坏,呈压迫性或膨胀性溶骨改变,周围无硬化边和骨膜反应。MRI示软组织肿块,边界不清,T1WI呈等略低信号,T2WI呈等略高信号;增强后3例明显均匀强化,1例不均匀强化。结论 CT和MRI可清晰显示IMT部位、大小及周围改变,但无特异性,确诊需依赖病理检查。