Vinorelbine, bleomycin and methotrexate as a salvage therapy for patients with head and neck squamous carcinoma in relapse after cisplatin/fluorouracil

Background: Cisplatin (CDDP) and 5-fluorouracil (5-FU) represent the standard chemotherapy for advanced/recurrent head and neck squamous carcinoma (HNSC); however, the duration of response is often short, with a median survival of only five to six months.Patients and methods: Patients with HNSC were treated with vinorelbine 20 mg/m² and methotrexate 50 mg/m² every week and bleomycin 15 mg/m² every two weeks. All patients were previously treated with a CDDP/5-FU regimen.Results: Forty-eight patients were evaluable for response and toxicity. After a median follow-up of 15 months, 16 patients are still alive and 32 have died. We had one complete response (2%), 12 partial responses (25%) (overall response rate 27%; 95% CI: 14%–39%), 11 stabilizations (23%) and 24 progressions (50%) of disease. Neutropenia grade 3–4 was seen in 12 patients; peripheral neurotoxicity in two patients. There were no toxic deaths.Conclusions: This regimen, administered in an outpatient setting, revealed some activity as a second-line treatment in patients with HNSC, with acceptable toxicity.     

Squamous cell carcinomas of the head and neck in Norway, 1953-92: an epidemiologic study of a low-risk population

Trends in incidence, five-year relative survival, and mortality among patients in Norway with squamous cell carcinoma of the oral sites, oro-/hypopharynx, and larynx were studied for the period 1953-92. Throughout the first part of the study period, age-adjusted incidence rates (AAIR) of oral cancer remained stable in both genders. Since the end of the 1960s, AAIRs increased by 13 percent per five-year period in males and 12 percent in females. The figures suggest increased male incidence rates of oral cancer in younger age groups. During the same period, AAIRs of cancers of the oro-/hypopharynx in males increased by 19 percent per five-year period. The AAIRs of laryngeal cancer increased steadily from 1953-92 among both males and females by 17 percent and 21 percent per five-year period, respectively. For all sites, changes in AAIRs for males were greater in rural than in urban areas. No improvement in detection of disease at a localized stage was observed for either gender. There are indications of improvements in the five-year relative survival rates for oral and pharyngeal cancer in both genders. For all sites, relative survival was better in younger than in older patients. Only in the case of pharyngeal cancer in males was an increase in disease-specific mortality rates positive for a time trend.     

细胞因子基因联合放射治疗小鼠头颈部鳞状细胞癌的实验研究

目的观察白细胞介素-2(interleukin-2,IL-2)基因与白细胞介素-12(interleukin-12,IL-12)基因联合放射治疗小鼠头颈鳞状细胞癌(鳞癌)的疗效.方法模拟临床头颈肿瘤治疗方案,利用鳞癌SCCⅦ细胞株在C3H/HeJ小鼠口底建立头颈鳞癌的荷瘤动物模型,在荷瘤部位直接注射多价阳离子脂质体包裹的表达IL-2基因和IL-12基因的真核表达质粒,对照组分别注射无目的基因的空载体和磷酸盐缓冲液(phosphatic buffered saline,PBS).次日给予2 Gy直线加速器的局部肿瘤放射治疗(简称放疗).4 d后重复IL-2基因和IL-12基因局部治疗.观察肿瘤治疗前后大小变化,检测肿瘤组织中CD4+、CD8+的表达、IL-2和 IL-12的表达水平及自然杀伤(natural killer,NK)细胞和细胞毒T淋巴细胞(cytotoxic T-lymphocyte,CTL)的活性.结果 IL-2基因和IL-12基因联合加放疗治疗组肿瘤生长明显受抑制,疗效显著优于单基因加放疗治疗组、单基因治疗组和各对照组.在注射有IL-2基因及IL-12基因的治疗组中,IL-2与IL-12表达水平明显升高,小鼠脾细胞NK细胞活性和CTL杀伤活性增强,肿瘤组织内可见大片坏死,并含有大量的CD4+,CD8+淋巴细胞浸润.结论多价阳离子脂质体携带的IL-2基因和IL-12基因治疗可提高肿瘤局部和机体全身的抗肿瘤免疫应答,能加强放疗的抗肿瘤效果.     

咽旁间隙肿瘤的手术治疗

目的：探讨咽旁间隙肿瘤的诊断、治疗和手术入路的选择。方法：回顾性分析接受手术治疗的34例咽旁间隙肿瘤患者的临床资料，包括症状、体征、组织学诊断、影像学检查和手术进路。结果：88．2％肿瘤为良性。16例起源于腮腺，神经源性肿瘤14例。颈侧进路26例；经口腔进路5例，颈侧及口咽联合进路2例；颞下窝入路1例。32例完全切除肿瘤。术后并发Horner综合征3例，声带麻痹5例，面瘫3例。术侧声带和舌下神经同时麻痹1例。随访13个月～10．5年，34例中30例治愈，1例好转，术后复发3例(均为多形性腺瘤)。结论：采用颈侧进路，能安全彻底切除咽旁间隙肿瘤，经口腔进路仅适合于肿瘤边界清楚、组织明显突出于咽侧且表浅局限者。     

上颌骨外旋入路切除颅底及咽旁间隙肿瘤

目的：探讨颅底及咽旁间隙肿瘤切除的最佳手术入路。方法：2例咽旁间隙肿瘤、1例颅底肿瘤患者均采用上颌骨外旋入路，取Weber-Ferguson-Longmire切口，形成以咬肌为蒂的上颌骨肌皮瓣并外旋，充分暴露鼻咽部及咽旁间隙，直视下完整切除肿瘤。以颊部脂肪堵塞残留空腔，行上颌骨骨瓣复位。结果：3例术后切口愈合良好，颌面部无明显畸形及颌面功能障碍，其中1例术后行放疗。3例术后随访10个月～2年，肿瘤均无复发。结论：上颌骨外旋是切除颅底及咽旁间隙肿瘤的较佳手术入路，能充分暴露颅底及咽旁间隙、鼻咽部，在直视下完整分离切除肿瘤，手术安全，损伤小，术后功能恢复良好。     

A UK multi‐centre pilot study of speech and swallowing outcomes following head and neck cancer

Speech and swallowing are important components of health‐related quality of life following head and neck cancer treatment. The aim of this study was to demonstrate the value of prospective multi‐centre evaluation by Speech and Language Therapists and to compare health‐related quality of life with speech and swallowing impairments. The University of Washington Head and Neck questionnaire version 4 (UW‐QOL) and Therapy Outcome Measures (TOM) were rated before and 6 months after cancer treatment in 95 patients from 12 centres. There was deterioration in TOM scores at 6 months. Pretreatment UW‐QOL swallowing was ranked equal first, with speech fourth. At 6 months speech was first and swallowing second. There were positive correlations between UW‐QOL swallowing and TOM dysphagia and between UW‐QOL speech and TOM laryngectomy, voice, phonology and dysarthria disorders. Both outcome measures are suitable for routine practice. Adaptation of TOM scales for use with head and neck cancer patients may improve sensitivity, validity and therapist compliance.     

Pressure flow analysis may aid in identifying women with outflow obstruction

PURPOSE: We refined recently developed pressure flow cutoff values for female bladder outlet obstruction and applied these values in a consecutive group of women undergoing urodynamic testing for various lower urinary tract symptoms. MATERIALS AND METHODS: A total of 87 women with clinical obstruction determined by history and presenting complaint were enrolled in our prospective evaluation of pressure flow studies. We identified 3 groups of participants according to the suspected cause of obstruction, including prolapse in 33, previous incontinence surgery in 25, and no likely source of obstruction identified from history and physical examination only in 29. An additional 124 patients presenting for evaluation of stress urinary incontinence served as controls. Optimal cutoff values for determining obstruction were developed using receiver operating characteristic curves. To determine the prevalence of bladder outlet obstruction these values were prospectively applied to 106 women undergoing urodynamics for various voiding complaints. RESULTS: In controls the average maximum flow rate was 23 cc per second and average detrusor pressure was 21.9 cm. water, whereas the corresponding values in those with clinical obstruction were 10.7 cc per second and 40.8 cm. water (p <0.001). No differences were noted in the various obstruction groups. Receiver operating characteristics analysis revealed that cutoff values of 11 cc per second or less and 21 cm. water or more optimized the selection of patients with bladder outlet obstruction. Using these values we noted a bladder outlet obstruction prevalence of 20% in a consecutive cohort of women undergoing urodynamic studies at our center. CONCLUSIONS: We propose cutoff pressure flow values for identifying women with bladder outlet obstruction although they should be used only in conjunction with the overall clinical situation. Neither pressure flow data only nor clinical symptoms alone may be sufficient for diagnosing obstruction in women.     

Effects of irradiation on nasal mucociliary clearance in head and neck cancer patients

A prospective longitudinal study was conducted on fifty patients of histopathologically confirmed head and neck cancer with the main aim to assess the nasal mucociliary clearance, pre-and post-irradiation; and to compare the findings with the healthy non-irradiated age and sex-matched controls. All the patients underwent saccharin particle test for nasal mucociliary clearance before commencement of radiation therapy and again within 6 months of completion of radiation therapy. The difference between the saccharin perception times of nasal mucosa in the healthy non-irradiated controls and the pre-irradiated head and neck cancer patients were statistically inssignificant (P>0.05). But, the difference between the saccharin perception times of nasal mucosa in the pre-and post-irradiated head and neck cancer patients was found to be statistically significant (P=0). It is concluded that even indirect irradiation of nasal mucosa in head and neck cancer patients significantly affect its ciliary activity. Significance of total radiation dosage along with chemotherapy in some cases was also studied.     

补肾复活汤治疗48例老年股骨颈骨折的疗效观察

目的:探讨补肾复活汤对老年股骨骨颈骨折患者的治疗效果.方法:用补肾复活汤内服治疗老年股骨颈骨折48例,设对照组48例,通过1～6个月的治疗,观察治疗后骨折的愈合情况.结果:治疗组患者折愈合率达64.6%.结论:补肾复活汤有明显改善骨折端的血液循环,促进骨折愈合的作用.