Thyroid dysfunction after radiation therapy in head and neck cancer patients

INTRODUCTION: The reported incidence of hypothyroidism following surgery and/or radiation therapy for head and neck cancer varies widely. Most patients undergo thyroid lobectomy during laryngectomy. Standard radiation treatment portals often include the thyroid gland. The insidious development of hypothyroidism may be misdiagnosed. This study examines the incidence of thyroid dysfunction in the setting of head and neck cancer therapy. MATERIALS AND METHODS: Thyroid function tests were performed on 100 consecutive patients treated in the head and neck tumor clinic. Statistical inferences on proportions were made using chi-square analysis. RESULTS: Therapy included surgery only (10 patients), radiation therapy only (28 patients), and combined therapy (62 patients). These patients experienced thyroid dysfunction in 0%, 29%, and 45% of individuals respectively. These differences were statistically significant (P < .05). The highest rate of dysfunction (69%) was associated with patients undergoing laryngectomy and radiation therapy. When laryngectomy was not performed, thyroid dysfunction occurred in 28%. CONCLUSION: The likelihood of thyroid dysfunction after radiation therapy is high particularly when combined with surgery in which thyroid lobectomy is performed and the contralateral lobe is potentially devascularized. These results suggest that radiation therapy is a primary factor in alteration of thyroid function. We recommend that routine thyroid function testing be part of follow-up of all head and neck cancer patients.     

Clinical response to photodynamic therapy in premalignant lesions and advanced head and neck carcinomas

The main advantage of PDT in laryngology seems to be its non-invasiveness and the possibility of using it despite of previous application of conventional methods. In the study application of PDT in two separated groups of patients, i.e. 8 patients previously treated by surgery and radiotherapy with local recurrence (SCC) or with advanced primary lesion and 12 patients with oral leucoplakia. In the first group delta-aminolevulenic acid (ALA) was administered orally, while in second one an ointment containing 10% ALA was applied locally. In the both groups prior to irradiation the tissue level of protoporphyrin IX was verified by adapted Xillix LIFE machine. All treated lesions were irradiated with argon-pumped dye laser. In leucoplakia group complete response was achieved in 10 out of 12 treated patients. In group of advanced cancers the only partial response was obtained--the diminution of cancer ulceration was observed. On the basis of our preliminary results the usefulness of PDT may be suggested in eradication of premalignant lesions of oral cavity and palliation of advanced cancers within pharynx and larynx.     

Nutritional and immunological investigations in head and neck cancer patients before and after therapy

Summary We studied the nutritional and immunological states of 20 patients with advanced head and neck carcinomas. Treatment included chemotherapy with methotrexate, cis-platinum and bleomycin prior to operation and radiotherapy. Nutritional and immunological parameters were examined before and after each therapy given. Most of these parameters decreased during chemotherapy. However, while we found that nutrition improved or normalized by the end of the primary tumor treatment, immunologie parameters failed to change significantly.     

Nutritional and immunological investigations in head and neck cancer patients before and after therapy

We studied the nutritional and immunological states of 20 patients with advanced head and neck carcinomas. Treatment included chemotherapy with methotrexate, cis-platinum and bleomycin prior to operation and radiotherapy. Nutritional and immunological parameters were examined before and after each therapy given. Most of these parameters decreased during chemotherapy. However, while we found that nutrition improved or normalized by the end of the primary tumor treatment, immunologic parameters failed to change significantly.     

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.     

Detection of recurrent head and neck squamous cell carcinomas after radiation therapy with 2-18F-fluoro-2-deoxy-D-glucose positron emission tomography.

OBJECTIVES/HYPOTHESIS: Fluorodeoxyglucose positron emission tomography (FDG-PET) has been proposed as a sensitive method to diagnose and stage various malignancies. We assessed the efficacy of FDG-PET imaging in distinguishing tumor persistence/recurrence from posttreatment changes following radiation therapy for squamous carcinomas of the head and neck STUDY DESIGN: Retrospective analysis of FDG-PET results compared with biopsy results or outcome, or both. METHODS: Twenty-eight patients who had undergone radiation therapy with or without surgery for treatment of squamous cell carcinoma were studied with FDG-PET imaging. There was clinical suspicion for recurrence in each patient, but no obvious mass or lesion to biopsy was found on physical examination or anatomic imaging. The results of FDG-PET imaging were compared with those of biopsy or clinical follow-up of at least 6 months, or both. RESULTS: FDG-PET imaging was positive in 13 patients, and the presence of active disease was confirmed in 12. Two thirds of the 12 received further cancer treatment. There were 15 negative FDG-PET images. Thirteen of these were confirmed true-negative images, but two studies were false-negative images. The sensitivity and specificity of FDG-PET were 86% and 93%, respectively, with positive and negative predictive values of 92% and 87%, respectively. The overall accuracy was 89%. CONCLUSION: FDG-PET imaging is a useful modality to distinguish tumor persistence/recurrence from radiation-induced tissue changes in the neck following treatment for head and neck cancer. FDG-PET can identify patients who may benefit from further treatment, and may lead to improved outcome for individual patients.     

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.     

Multiple malignancies in patients with primary carcinomas of the head and neck

Eight hundred and twenty-five patients with primary carcinomas of the head and neck area were studied. Of these, there were 54 individuals with multiple primary neoplasms. Synchronous lesions occurred in 19 patients while nonsynchronous lesions occurred in 35. The frequency of occurrence of second neoplasms was 6.5%, which nearly doubles that of previously recorded series. A conclusion which can be made from this study is that, as long as the carcinogenic agent (alcohol and/or tobacco) continues to be present, the patient will continue to be affected.     

Advanced techniques in radiation therapy for head and neck cancers.

This article focuses on a number of innovative radiotherapeutic methods to improve local and regional control with increased chances of preservation of normal function compared with the use of standard external beam irradiation alone in the management of selected head and neck cancers. Some of these radiotherapeutic techniques are well established (brachytherapy and neutron therapy in advanced salivary gland tumors); some have a large body of experience accumulated and are currently being investigated in phase III trials (thermoradiotherapy and altered fractionation); whereas the other techniques (intraoperative therapy, charged-particle therapy, and sterotactic radiosurgery) are highly experimental.     

Lymph node response and its relationship to prognosis in carcinomas of the head and neck

The lymph nodes of 32 patients operated on for carcinomas of the larynx and pharynx, were evaluated for the pattern of lymph node response. Pattern 1 (predominantly lymphocytes) and pattern 2 (predominantly germinal centres) showed a fewer number of nodal metastases than pattern 3 (non-stimulated nodes). Well-differentiated carcinomas predominated in patterns 1 and 2, whereas moderately and poorly differentiated predominated in pattern 3. Patterns 1 and 2 predominated in clinical stages I-III, and pattern 3 in stage IV. The survival decreased progressively from pattern 1 to pattern 3.     

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.     

Prognostic factors of survival in head and neck cancer patients treated with surgery and postoperative radiation therapy

CONCLUSIONS: Given that radiation therapy (RT) is currently initiated as soon as possible after surgery, our results indicate that the main prognostic factors of survival are pT and pN stages in patients treated with surgery and postoperative RT for locally advanced head and neck squamous cell carcinoma (HNSCC). OBJECTIVES: To determine the prognostic factors for survival in patients treated with surgery and postoperative RT for locally advanced HNSCC. PATIENTS AND METHODS: A retrospective study was performed on 308 consecutive patients treated from 1990 to 1998 with surgery and postoperative RT. In addition to histological factors, time-related factors were considered. RESULTS: The median age of the whole cohort was 56 years (range 35-83). Median follow-up was 98 months. Median interval from surgery to the start of RT was 44 days (range 18-157), while median RT duration was 52 days (range 22-115). From univariate analysis of overall survival, statistically significant prognostic factors were pT stage (p<0.0001), pN stage (p=0.008), RT duration (p=0.01) and total treatment time (p=0.02). Perineural invasion, perivascular invasion, extranodal spread and positive resection margins did not appear to be related to survival. From multivariate analysis, the only statistically independent prognostic factors appeared to be pT and pN stages.     

The effect of head and neck radiation therapy on voice quality.

Twenty-five patients with squamous cell carcinoma of the head and neck who received radiation therapy as their only form of treatment underwent a computer-assisted voice analysis before, and 6 months following treatment. Those with early laryngeal tumors had a significant improvement in intelligibility (P = .07), percent of sound voiced (P = .04), and sound perturbation. Those with nonlaryngeal tumors had no change in any measured parameters. Head and neck radiation therapy can significantly improve the voice quality of patients with laryngeal tumors, while having a minimal effect on the voice quality of those with nonlaryngeal tumors.     

Feasibility and efficacy of subcutaneous amifostine therapy in patients with head and neck cancer treated with curative accelerated concomitant-boost radiation therapy

OBJECTIVE: To assess the feasibility and efficacy of subcutaneous amifostine therapy in patients with head and neck cancer treated with curative accelerated radiotherapy (RT). DESIGN: Retrospective study. SETTING: University of Lausanne, Lausanne, Switzerland. PATIENTS: Thirty-three consecutive patients (male-female ratio, 4.5; median age, 54 years [age range, 39-76 years]). INTERVENTIONS: Between November 2000 and January 2003, the 33 patients were treated with curative definitive (n = 19) or postoperative (n = 14) RT with (n = 26) or without (n = 7) chemotherapy. All patients received conformal RT. Fractionation schedule consisted of concomitant-boost (Friday afternoon session) accelerated RT using 70 Gy (2 Gy per fraction) in 6 weeks in patients treated with definitive RT and 66 Gy (2 Gy per fraction) in 5 weeks and 3 days in the postoperative setting. Parotid glands received at least 50 Gy in all patients. Amifostine was administered to a total dose of 500 mg subcutaneously, 15 to 30 minutes before morning RT sessions. RESULTS: All patients received their planned treatment (including chemotherapy). Ten patients received the full schedule of amifostine (at least 25 injections), 9 received 20 to 24 doses, 4 received 10 to 19 doses, 5 received 5 to 9 doses, and 5 received fewer than 5 doses. Fifteen patients (45%) did not show any intolerance related to amifostine use. Amifostine therapy was discontinued because of nausea in 11 patients (33%) and hypotension in 6 patients (18%), and 1 patient refused treatment. No grade 3, amifostine-related, cutaneous toxic effects were observed. Radiotherapy-induced grade 3 acute toxic effects included mucositis in 14 patients (42%), erythema in 14 patients (42%), and dysphagia in 13 patients (39%). Late toxic effects included grade 2 or more xerostomia in 17 patients (51%) and fibrosis in 3 patients (9%). Grade 2 or more xerostomia was observed in 8 (42%) of 19 patients receiving 20 injections or more vs 9 (64%) of 14 patients receiving fewer than 20 injections (P = .15). CONCLUSIONS: Subcutaneous amifostine administration in combination with accelerated concomitant-boost RT with or without chemotherapy is feasible. The major adverse effect of subcutaneous administration was nausea despite prophylactic antiemetic medication, and hypotension was observed in only 6 patients (18%).     

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.     

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.