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Abramson Cancer CenterNCI CANCERLIT® Search: Pharyngeal Cancer - October 2001
National Cancer Institute®
Last Modified: November 21, 2001
Table of Contents
1
UI - 21385156
AU - Ali SM; Olivo M; Yuen GY; Chee SK
TI -
Photodynamic-induced apoptosis of human nasopharyngeal carcinoma cells
using Hypocrellins.
SO - Int J Oncol 2001 Sep;19(3):633-43
AD - Department of Medical Sciences, National Cancer Centre, 11 Hospital
Drive, Singapore 169610. dmssma@nccs.com.sg
It has been reported that novel photosensitizers Hypocrellin A and B,
lipid soluble perylquinone derivatives of the genus Hypericum have a
strong photodynamic effect on tumors and viruses. The molecular
mechanisms of tumor cell death induction by Hypocrellin A and B are
poorly understood. In this study, we have examined the photodynamic
effects of Hypocrellin A and B compounds in poorly differentiated (CNE2)
and moderately differentiated (TW0-1) human nasopharyngeal carcinoma
(NPC) cells. Using these cell lines we investigated the role of the
apoptotic pathway in photosensitized Hypocrellin A and B-mediated cell
death. Tumor cells photoactivated with Hypocrellin A and B showed cell
size shrinkage and an increase in the sub-diploid DNA content. A loss of
membrane phospholipid asymmetry associated with apoptosis was induced by
both tumor cell lines as evidenced by the externalization of
phosphatidylserine (PS). A dose-dependent increase in caspases-3
protease activity inhibitable by the tetrapeptide inhibitor DEVD-CHO was
also observed in both cell lines. Western blot analysis of poly
(ADP-ribose) polymerase, a caspase substrate, showed the classical
cleavage pattern (116 to 85 kDa) associated with apoptosis in
Hypocrellin A and B-treated cell lysates. In addition, caspase
inhibition blocked the externalization of membrane PS, indicating that
the loss of membrane phospholipid asymmetry is a downstream event of
caspases activation. These results demonstrate that tumor cell death
induced by Hypocrellin A and B is mediated by caspase proteases. In
conclusion, this study identifies both Hypocrellins (A and B) as potent
and promising photosensitizers for the treatment of NPC.
2
UI - 21392179
AU - Lai J; Tao Z; Xiao J; Yan Y; Wang X; Wang C; Zhou S; Tian Y
TI -
Effect of photodynamic therapy (PDT) on the expression of pro-apoptotic
protein Bak in nasopharyngeal carcinoma (NPC).
SO - Lasers Surg Med 2001;29(1):27-32
AD - Department of Otolaryngology, Xiang Ya Hospital, Hunan Medical
University, Changsha, Hunan 410008 P.R. China.
jinp.lai@mail.hn.cninfo.net
BACKGROUND AND OBJECTIVE: To investigate the effect of photodynamic
therapy (PDT) on expression of the pro-apoptotic gene Bak in
nasopharyngeal carcinoma (NPC). STUDY DESIGN/MATERIALS AND METHODS:
Apoptosis and expression of the pro-apoptotic gene Bak on the tumor
tissues from both pre- and post-PDT were determined using the in situ
end labeling (ISEL), standard immunohistochemistry technique and western
blot, respectively, in 24 patients with either persistent or recurrent
NPC after radiotherapy. RESULTS: Before PDT, apoptotic index (AI) in
tumor tissue was 1.2 +/- 0.6. At 6, 12, 24 and 48 hours after PDT, AI
were 6.5 +/- 3.1, 23.6 +/- 8.3, 67.2 +/- 14.2 and 89.3 +/- 8.1,
respectively. PDT caused apoptosis in a time-dependent fashion.
Immunohistochemical assay indicated that 75% (18/24) of the patients had
an upgrade expression of Bak protein in their tumor tissues after PDT.
Increases in expression of Bak from PDT were also confirmed by western
blot analysis. CONCLUSIONS: PDT probably causes NPC cell apoptosis
through an upregulation of the pro-apoptotic protein Bak expression.
Copyright 2001 Wiley-Liss, Inc.
3
UI - 21396148
AU - Kim S; Wu HG; Heo DS; Kim KH; Sung MW; Park CI
TI -
Advanced hypopharyngeal carcinoma treatment results according to
treatment modalities.
SO - Head Neck 2001 Sep;23(9):713-7
AD - Department of Therapeutic Radiology, Seoul National University College
of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
BACKGROUND: The purpose of this retrospective study is to compare the
treatment results of locally advanced hypopharyngeal carcinoma according
to treatment modalities. METHODS: Seventy-three patients with locally
advanced hypopharyngeal carcinoma treated at the Department of
Therapeutic Radiology, Seoul National University Hospital, between
patients were treated with radiotherapy (RT) alone, 18 patients were
treated with surgery and postoperative RT, and 32 patients were treated
with neoadjuvant chemotherapy (CTx) and RT. Median follow-up period was
28 months. RESULTS: The overall 5-year survival rates were 15.7% for the
RT alone group, 46.8% for surgery and postoperative RT group, and 43.0%
for neoadjuvant CTx and RT group. The 5-year disease-free survival rates
were 13.9%, 47.4%, and 30.7%, respectively. Surgery and postoperative RT
or neoadjuvant CTx and RT showed superiority over RT alone in terms of
both overall survival and disease-free survival rates. No significant
differences were found in overall and disease-free survival rates
between the surgery and postoperative RT group and neoadjuvant CTx and
RT group (p =.15, p =.13). In the neoadjuvant CTx and RT group, 12
patients (38%) retained their larynx more than 5 years. CONCLUSION:
Neoadjuvant CTx and RT is an effective strategy to achieve organ
preservation without compromising the survival of patients with locally
advanced hypopharyngeal carcinoma. Copyright 2001 John Wiley & Sons,
Inc.
4
UI - 21396157
AU - Martins AS
TI -
Neck and mediastinal node dissection in pharyngolaryngoesophageal
tumors.
SO - Head Neck 2001 Sep;23(9):772-9
AD - Head and Neck Service, Department of Surgery, Faculty of Medical
Sciences, State University Of Campinas (Unicamp), Rua Roxo Moreira, No.
1234, Cidade Universitaria, 13083-591, Campinas, Sao Paulo, Brazil.
asmartin@mpc.com.br
BACKGROUND: Specific reports about neck node metastasis in cervical
esophageal tumors and mediastinal node metastasis in patients with
pharyngolaryngoesophageal tumors are lacking. This study was undertaken
to evaluate the need for neck and mediastinal lymph node dissection when
dealing with carcinomas of this region. METHODS: A retrospective review
of the records of 34 patients who underwent total
pharyngolaryngoesophagectomy and gastric transposition (TPLEGT) for
squamous cell carcinoma of the pharyngoesophageal junction was done.
Sixteen patients had esophageal carcinomas, 14 had hypopharyngeal
carcinomas, and 4 had laryngeal carcinomas. The mediastinal dissection
was designed to remove mainly the paratracheal and paraesophageal lymph
nodes down to the aortic arch, without thoracotomy. Neck and mediastinal
lymph node metastases were studied with specific reference to main
primary site, and comparison with the literature was undertaken.
RESULTS: Twenty-five neck dissections were performed in 19 patients and
yielded positive nodes in 16 patients (47% of all patients). The neck
nodes were positive in 75%, 64.2%, and 18.7% of the patients with
laryngeal, hypopharyngeal, and esophageal carcinomas, respectively.
Mediastinal dissection data were available on 27 patients, and 16
(59.2%) had mediastinal node metastasis. These mediastinal nodes were
positive in 0%, 72.7%, and 61.5% of the patients with laryngeal,
hypopharyngeal, and esophageal carcinomas, respectively. CONCLUSIONS:
There is little controversy about neck dissections in tumors of the
larynx and hypopharynx when a TPLEGT is contemplated. A similar
situation applies to mediastinal dissections for cervical esophageal
carcinomas. Although we observed a low incidence of positive neck nodes
(18.7%) in patients with cervical esophageal carcinomas, there is a need
for a larger prospective series. Our finding of 72.7% positive
mediastinal nodes in hypopharyngeal carcinomas is high enough to deserve
further study. Laryngeal carcinomas showed no positive mediastinal nodes
in this series. Copyright 2001 John Wiley & Sons, Inc.
5
UI - 21396158
AU - Lam WW; Yuen HY; Wong KS; Leung SF; Liu KH; Metreweli C
TI -
Clinically underdetected asymptomatic and symptomatic carotid stenosis
as a late complication of radiotherapy in Chinese nasopharyngeal
carcinoma patients.
SO - Head Neck 2001 Sep;23(9):780-4
AD - Department of Diagnostic Radiology and Organ Imaging, Prince of Wales
Hospital, Shatin, New Territories, Hong Kong. wynnie@cuhk.edu.hk
BACKGROUND: Carotid artery stenosis is a late complication of
radiotherapy to the neck region. This complication has, however, a
significant impact with increased risk of stroke causing mortality and
morbidity. Clinicians' awareness of this complication and early
detection is therefore important. METHODS: Eighty patients with
nasopharyngeal carcinoma (NPC) who had received radiotherapy were
recruited for color Doppler ultrasonography of the carotid arteries.
fifty-eight patients with newly diagnosed NPC who had never received any
radiotherapy were recruited as controls. All patients with significant
carotid stenosis were referred to the neurology clinic for further
assessment. RESULTS: Twenty-four patients were found to have more than
50% diameter reduction in the extracranial carotid artery. Clinical
assessment by a neurologist showed 9 of 24 patients had a history of
transient ischemic attack, amaurosis fugax, or stroke. Seven of these
patients had clinically detectable neck bruit. CONCLUSIONS: Clinicians
attending to patients after radiotherapy for head and neck cancers
should be aware of this long-term complication of radiotherapy. A
detailed clinical history and incorporation of auscultation of carotid
arteries in routine follow-up of postradiotherapy patients are
recommended. Copyright 2001 John Wiley & Sons, Inc.
6
UI - 21396160
AU - Chua DT; Sham JS; Hung KN; Leung LH; Cheng PW; Kwong PW
TI -
Salvage treatment for persistent and recurrent T1-2 nasopharyngeal
carcinoma by stereotactic radiosurgery.
SO - Head Neck 2001 Sep;23(9):791-8
AD - Department of Clinical Oncology, The University of Hong Kong, Queen Mary
Hospital, Pokfulam, Hong Kong. dttchua@hkucc.hku.hk
OBJECTIVE: To study the efficacy of stereotactic radiosurgery in
salvaging early-stage persistent and recurrent nasopharyngeal carcinoma
(NPC) after primary radiotherapy. METHODS: A prospective single-arm
study evaluating the response and outcome of patients with rT1-2 NPC
treated by stereotactic radiosurgery. Eleven patients with rT1-2 were
were treated for persistent disease occurring within 4 months after
primary radiotherapy, six were treated for first recurrence, and one for
third recurrence. Six patients had rT1 disease and five had rT2 disease.
Most patients had disease not amenable to brachytherapy, surgery, or
external re-irradiation. The median target volume was 5.8 cc (range,
3.3-16.9). Radiosurgery was performed with multiple noncoplanar arcs of
photon, with a median dose of 12.5 Gy delivered to the 80% isodose line
(range, 12-14 Gy). Median follow-up time after radiosurgery was 18
months (range, 9-30). RESULTS: Nine patients had complete regression of
tumor as assessed by imaging, nasopharyngoscopy, and biopsy; one patient
had partial regression of tumor; whereas one patient had static disease.
The overall response rate was 91% (10 of 11) and the complete response
rate was 82% (9 of 11). Two patients with complete response subsequently
had local relapse develop, with one recurrence outside the treated
volume 8 months after radiosurgery, and the other within the treated
volume 6 months after radiosurgery. One patient with a partial response
had neck node recurrence develop. Temporal lobe necrosis occurred in one
patient but probably represents sequelae of primary radiation after
reviewing the dosimetry. Ten patients are still alive, whereas one
patient with local relapse had distant metastases develop and died. The
estimated 1-year local control rate after radiosurgery was 82%.
CONCLUSIONS: Our preliminary results indicate that stereotactic
radiosurgery is an effective treatment modality for persistent and
recurrent T1-T2 NPC, and early control rate seems to be comparable to
other salvage treatments. More clinical experiences and longer follow-up
are still needed to validate our results and to address fully the role
of radiosurgery in salvaging local failures of NPC. Copyright 2001 John
Wiley & Sons, Inc.
7
UI - 21396161
AU - Airoldi M; De Crescenzo A; Pedani F; Marchionatti S; Gabriele AM; Succo
TI -
G; Rosti G; Bumma C
Feasibility and long-term results of autologous PBSC transplantation in
recurrent undifferentiated nasopharyngeal carcinoma.
SO - Head Neck 2001 Sep;23(9):799-803
AD - Department of Medical Oncology, San Giovanni Antica Sede Hospital, Via
Cavour 31, 10123 Torino, Italy.
BACKGROUND: Recurrent undifferentiated nasopharyngeal carcinoma (UNPC)
is a chemosensitive illness. Here we report long-term results of
high-dose chemotherapy (HDC) as late intensification, with autologous
peripheral blood stem cell (PBSC) support. METHODS: Six patients (5 men,
1 woman; median age 41years; median ECOG PS = 0) with recurrent UNPC
(local, 2; local + nodal, 2; bone metastasis, 2) have been enrolled. All
patients had been previously treated with neoadjuvant chemotherapy and
radiotherapy; 3 of 4 local relapses had received a re-irradiation. Every
patient received three courses of cisplatin + epirubicin and 1 cycle of
epirubicin followed by PBSC collection. A median of 7.2 x 10(6)/kg
(range, 4.5-18) CD34+ cells were reinfused. HDC was according ICE
scheme: ifosfamide, 2.5 g/m(2)/d, + carboplatin, 300 mg/m(2)/d, + VP-16,
300 mg/m(2)/d days 1 through 4. RESULTS: After conventional
chemotherapy, we had 1 CR (16%), 3 PR (50%), and 2 NC (34%). After HDC,
we had 4 CR (66%),1 PR (17%), and 1 MR (17%). Toxicity was manageable.
After a median follow-up of 30 months (range, 14-50), two patients are
alive without disease (34%), one is alive with bone disease (16%), and
three (50%) died of disease at 16, 18, and 24 months. CONCLUSIONS: HDC
has an acceptable toxicity, can convert PR in CR, and seems effective,
with long-lasting CRs. Copyright 2001 John Wiley & Sons, Inc.
8
UI - 21436644
AU - Hsu CC; Lai PH; Lee C; Huang WC
TI -
Automated nasopharyngeal carcinoma detection with dynamic
gadolinium-enhanced MR imaging.
SO - Methods Inf Med 2001;40(4):331-7
AD - Department of Computer Science and Engineering, National Sun Yat-Sen
University, Kaohsiung, Taiwan, R.O.C.
OBJECTIVES: The purpose of this research is to develop an automatic
medical diagnosis for segmenting nasopharyngeal carcinoma (NPC) with
dynamic gadolinium-enhanced MR imaging. METHODS: This system is a
multistage process, involving motion correction, head mask generation,
dynamic MR data quantitative evaluation, rough segmentation, and rough
segmentation refinement. Two approaches, a relative signal increase
method and a slope method, are proposed for the quantitative evaluation
of dynamic MR data. RESULTS: The NPC detection results obtained using
the proposed methods had a rating of 85% in match percent compared with
these lesions identified by an experienced radiologist. The match
percent for the two proposed methods did not have significant
differences. However, the computation cost for the slope method was
about twelve times faster than the relative signal increase method.
CONCLUSIONS: The proposed methods can identify the NPC regions quickly
and effectively. This system can enhance the performance of clinical
diagnosis.
9
UI - 21268639
AU - Paris J; Guelfucci B; Moulin G; Zanaret M; Triglia JM
TI -
Diagnosis and treatment of juvenile nasopharyngeal angiofibroma.
SO - Eur Arch Otorhinolaryngol 2001 Mar;258(3):120-4
AD - Department of Oto-Laryngology, Head and Neck Surgery, La Timone
University Hospital Center, Boulevard Jean Moulin, 13385 Marseille,
France.
The aim of this retrospective study was to compare clinical and
radiological findings and discuss optimal surgical approach in patients
with juvenile nasopharyngeal angiofibroma (JNA). Forty-three cases of
JNA were treated at our institution from 1975 to 1999. Thirty-three male
patients aged between 8 and 25 years (mean 15.3) were included.
Twenty-nine patients underwent primary surgical treatment at our
institution and four were treated for recurrence following primary
surgery elsewhere. Tumors were staged according to Fisch's staging.
Preoperative embolization was performed in 22 cases. Surgical techniques
consisted of the transantral approach, lateral rhinotomy approach,
transmaxillary via midfacial degloving approach, and the subtemporal
preauricular infratemporal fossa approach. Tumors were classified stage
I in seven cases, stage II in 11, stage III in 13 and stage IV in two.
The mean delay between the initial symptom and surgery was 14 months
overall, 18 months for stage I, 14 for stage II, 13 for stage III and 12
for stage IV. The transantral approach was used in 11 patients, lateral
rhinotomy approach in 11 cases, transmaxillary via midfacial degloving
approach in three patients, and pre-auricular infra-temporal approach in
eight patients. Mean follow-up after surgery was 56 months. Six patients
had recurrent tumors. Surgery is the gold standard for treatment of JNA.
Modern imaging techniques allow accurate diagnosis and staging of JNA.
Our experience and a review of the literature shows that the surgical
approach should be selected according to tumor stage.
10
UI - 21401855
AU - Stranadko EF; Garbuzov MI; Zenger VG; Nasedkin AN; Markichev NA; Riabov
TI -
MV; Leskov IV
[Photodynamic therapy of recurrent and residual oropharyngeal and
laryngeal tumors]
SO - Vestn Otorinolaringol 2001;(3):36-9
Photodynamic therapy (PDT) was given to 61 patients with recurrent
cancer of the tongue, oral mucosa, lower lip, oro- and nasopharynx,
larynx. Photosensitizers photogem and photosens of Russian produce were
employed. The radiation was given twice with the interval 24 and 48
hours, the exposure to light 3 to 30 min. The impact was external,
through the instrumental canal of the fibroscope, by intracavitary and
interstitial techniques. The response was assessed within 4-6 weeks
after the PDT course. The effect was observed in 95.1% patients. Its
duration ranged from 4 months to 5 years. Complete resorption of the
tumor was achieved in 57.4%. The treatment failed in 4.9% patients.
11
UI - 21411333
AU - Lessard JL; Robinson RA; Hoffman HT
TI -
Differential expression of ras signal transduction mediators in
verrucous and squamous cell carcinomas of the upper aerodigestive tract.
SO - Arch Pathol Lab Med 2001 Sep;125(9):1200-3
AD - Department of Pathology, University of Iowa, Iowa City, IA 52243, USA.
CONTEXT: ras gene mutations and expression of its gene product have been
described in verrucous and squamous cell carcinomas. Other downstream
signal-transduction mediators, extracellular signal-regulated kinases 1
and 2 (ERK-1 and ERK-2) and Raf-1, have not yet been as extensively
studied. OBJECTIVE: To determine patterns of expression of ERK-1, ERK-2,
and Raf-1 in verrucous and squamous cell carcinomas of the upper
aerodigestive tract. DESIGN: Seventeen verrucous carcinomas and 10
squamous cell carcinomas of the upper aerodigestive tract were examined
for the immunohistochemical expression of ERK-1, ERK-2, and Raf-1
product. RESULTS: Raf-1 expression was intensely expressed in the most
basal portions of the epithelium in verrucous carcinomas, but was
minimally expressed in the suprabasalar areas. Anti-Raf-1 staining of
the squamous cell carcinomas was diffuse and patchy throughout the tumor
cells and was weak in intensity. There was no geographic preference of
staining. The cytoplasmic expression of both ERK-1 and ERK-2 was
predominantly negative in the most basal layers of the epithelium in the
verrucous carcinomas, but was positive in the suprabasalar region of the
epithelium. Immunohistochemical expression of ERK-1 and ERK-2 in the
squamous carcinomas was diffuse throughout the tumor. CONCLUSION: There
is strong correlation of the geographic expression of these mediators of
ras signal transduction in verrucous and squamous carcinomas, but the
cause of these differences remains unclear at present. The expression of
these mediator proteins may have potential for diagnosis, as well as in
understanding the biologic behavior of these lesions.
12
UI - 21453605
AU - Howard DJ; Lloyd G; Lund V
TI -
Recurrence and its avoidance in juvenile angiofibroma.
SO - Laryngoscope 2001 Sep;111(9):1509-11
AD - Institute of Laryngology & Otology, University College London, UK.
OBJECTIVE: Angiofibroma is a highly vascular lesion for which a wide
range of surgical approaches has been recommended. Irrespective of the
approach, a significant and often rapid recurrence rate is reported in
all major series. AIM: To consider the impact of lessons learned from
imaging on the recurrence rate of angiofibroma. MATERIAL AND METHODS:
From a cohort of 90 male patients with histologically proven
angiofibroma, 40 individuals were studied. The recurrence rate in 20
treated thereafter. In the latter group, an additional exploration of
the basisphenoid had been undertaken. RESULTS: The two cohorts were
comparable in age range (7-27 y and 11-24 years, respectively), and all
had been treated by midfacial degloving. In the first group, 8
recurrences occurred which were multiple in 1 patient. In the next 19
patients, the area of the pterygoid canal was meticulously explored and
the basisphenoid drilled to remove all residual tumor. No recurrences
have occurred in this group during a follow-up of between 6 months to 3
years. CONCLUSION: Meticulous removal of angiofibroma infiltrating the
pterygoid canal and basisphenoid is paramount to avoid "recurrence."
13
UI - 21453602
AU - Schramm VL Jr; Imola MJ
TI -
Management of nasopharyngeal salivary gland malignancy.
SO - Laryngoscope 2001 Sep;111(9):1533-44
AD - Center for Craniofacial-Skull Base Surgery, Denver, Colorado, USA.
OBJECTIVE: The objective of this study was to evaluate the oncological
outcome and complication rate following surgical treatment of
nasopharyngeal salivary gland malignancy. STUDY DESIGN: Retrospective
case review at tertiary care skull base center. METHODS: Pertinent
medical records were reviewed from 23 patients presenting with minor
salivary gland malignancy. Clinical presentation, prior treatment,
histological type and grade, clinical stage, details of surgical
treatment, and postoperative adjuvant radiation therapy were studied.
Survival and recurrence data were analyzed using the Kaplan-Meier and
Cox proportional hazards methods. RESULTS: Histological types included
11 adenoid cystic carcinomas, 8 mucoepidermoid carcinomas, and 4 cases
of adenocarcinoma not otherwise specified. All patients underwent
primary surgical resection, and the lateral infratemporal middle fossa
approach was used in 20 patients. Prior radiation therapy had been
administered in 6 patients who presented for treatment of recurrent
disease, and the remaining 17 patients underwent planned postoperative
radiation therapy. Elective neck dissection was undertaken in 15
patients, and occult neck disease was present in 47%. Disease specific
survival was 67% at 5 years and 48% at 10 years. High-grade tumors had a
significantly poorer outcome (P =.035) with a relative risk of 4.6
compared with low-grade disease. Local control was seen to be 77% at 5
years. CONCLUSIONS: Planned combined surgery and radiation therapy
achieves survival outcomes and recurrence rates in nasopharyngeal
salivary gland malignancy comparable to results reported using the same
treatment for minor salivary gland tumors cancer originating elsewhere
in the head and neck. Because of the high rate of occult neck
metastases, we recommend elective neck dissection as part of the
surgical treatment with this disease entity. The lateral infratemporal
middle fossa approach provides safe and adequate access to resect the
vast majority of these tumors with acceptable complication rates. A
reliable form of vascularized reconstruction is necessary to prevent
serious postoperative complications, and we currently prefer the
gastro-omental free flap.
14
UI - 21453616
AU - Deng YF; Tian F; Lu YD; Chen ZC; Xie DH; Yang XM; Shao XY
TI -
Mutation and abnormal expression of the fragile histidine triad gene in
nasopharyngeal carcinoma.
SO - Laryngoscope 2001 Sep;111(9):1589-92
AD - Department of Otorhinolaryngology, Second Affiliated Hospital, Xiang-Ya
Medical College of Central South University, Changsha, Hunan, China.
dyanfei@hotmail.com
OBJECTIVE: To determine alterations of fragile histidine triad (FHIT)
gene in nasopharyngeal carcinoma and the correlation of FHIT gene with
nasopharyngeal carcinogenesis. STUDY DESIGN: Prospective study. METHODS:
A total of 28 nasopharyngeal carcinoma and 16 normal nasopharyngeal
epithelium specimens were examined for abnormalities of FHIT gene by
nested reverse-transcriptase-polymerase chain reaction and DNA
sequencing. RESULTS: The deletion of FHIT gene was not observed in 16
normal nasopharyngeal epithelium specimens. In 28 cases of
nasopharyngeal carcinoma tissues, 12 (42.9%) exhibited FHIT aberrant
transcripts. Complementary DNA sequencing revealed exonic deletion,
small DNA insertion, synonymous mutation in exon 8, or frameshift
mutation in exon 5. CONCLUSIONS: The present results suggest that the
FHIT gene may play an important role in the pathogenesis of
nasopharyngeal carcinoma and may be one of the candidate tumor
suppressor genes in nasopharyngeal carcinoma.
15
UI - 21453626
AU - Dedo HH; Yu KC
TI -
CO(2) laser treatment in 244 patients with respiratory papillomas.
SO - Laryngoscope 2001 Sep;111(9):1639-44
AD - Department of Otolaryngology-Head and Neck Surgery, University of
California, San Francisco, San Francisco, California 94117, USA.
OBJECTIVE: Respiratory papillomas (RP) tend to recur and the difficulty
in eradicating the disease makes their treatment frustrating. Meticulous
CO(2) laser excisions every 2 months has been the most effective
treatment to date. This article analyzes the results of this plan in 244
patients with RP in the nose, nasopharynx, pharynx, hypopharynx, larynx,
trachea, lung parenchyma, and skin. METHODS: Two hundred forty-four
patients with recurrent RP were treated by the senior author with CO(2)
laser excisions and, in some cases, podophyllum and alpha interferon.
Demographics, initial distribution of papillomas, number of operations
performed on each patient, and current results were evaluated. RESULTS:
Careful laser excisions of RPs every 2 months achieved "remission" of
disease (no visible RP on indirect or often direct laryngoscopy 2 mo
after last removal) in 37% of patients, "clearance" of the disease
process (no RP clinically apparent for 3 y after last removal) in 6%,
and "cure" (no clinical recurrence for 5 y after last removal) in 17%.
Juvenile-onset RP tends to follow a more aggressive course than
adult-onset RP. Four patients (1.6%) developed malignant transformation
of their papillomas. Except for ones in lung parenchyma, RP in areas
other than the true vocal cords tend to be cleared faster because
aggressive removal does not cause hoarseness. Lung parenchyma RPs are
eventually fatal because of pulmonary failure from abscesses and cysts
resulting from a lack of effective treatment. CONCLUSION: Frequent and
meticulously performed CO(2) laser excisions can achieve significant
voice and airway improvement, and some clinical "cures." However,
effective antiviral medicines and/or immunologic agents are needed to
achieve true cures with elimination of all human papilloma virus 6 and
11 viruses.
16
UI - 21449310
AU - Zito J; Fitzpatrick P; Amedee R
TI -
Juvenile nasopharyngeal angiofibroma.
SO - J La State Med Soc 2001 Aug;153(8):395-8
AD - Department of Otolaryngology-Head and Neck Surgery at Tulane University
Health Sciences Center, New Orleans, Louisiana, USA.
Juvenile nasopharyngeal angiofibroma is a rare yet potentially
destructive vascular tumor that typically affects adolescent males.
While the etiology of these tumors remains unknown, great advances have
been made in their diagnosis and treatment. When juvenile nasopharyngeal
angiofibroma is diagnosed at an early stage, the prognosis is generally
very good, as patients can be treated with a combination of
pre-operative embolization and surgical resection. Advanced juvenile
nasopharyngeal angiofibroma is much more difficult to treat, since
orbital and intracranial involvement are common in the natural
progression of the disease. However, due to the rather innocuous
presenting symptoms (commonly, nasal obstruction and epistaxis),
diagnosis most often occurs in the later stages of the disease. For this
reason, it is important for all physicians to have a high degree of
suspicion for juvenile nasopharyngeal angiofibroma when evaluating a
male adolescent with these symptoms.
17
UI - 21453157
AU - O'Sullivan B; Warde P; Grice B; Goh C; Payne D; Liu FF; Waldron J;
TI -
Bayley A; Irish J; Gullane P; Cummings B
The benefits and pitfalls of ipsilateral radiotherapy in carcinoma of
the tonsillar region.
SO - Int J Radiat Oncol Biol Phys 2001 Oct 1;51(2):332-43
AD - Department of Radiation Oncology, Wharton Head and Neck Centre, The
Princess Margaret Hospital, University Health Network, University of
Toronto, Toronto, Ontario, Canada. brian.osullivan@rmp.uhn.on.ca
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.
18
UI - 21453158
AU - Jen YM; Hsu WL; Chen CY; Hwang JM; Chang LP; Lin YS; Su WF; Chen CM; Liu
TI -
DW; Chao HL
Different risks of symptomatic brain necrosis in NPC patients treated
with different altered fractionated radiotherapy techniques.
SO - Int J Radiat Oncol Biol Phys 2001 Oct 1;51(2):344-8
AD - Department of Radiation Oncology, Tri-Service General Hospital, National
Defense Medical Center, Taipei, Taiwan, Republic of China.
ymjen@seed.net.tw
PURPOSE: To report our observation of excessive temporal lobe necrosis
in nasopharyngeal carcinoma (NPC) patients treated with 160 cGy b.i.d.
radiotherapy technique. During the same period, patients treated with
120 cGy b.i.d. have not shown a similar tendency. Our experience may be
useful for designing unconventional radiotherapy regimens for NPC
fractionated radiotherapy. Seventy patients were treated with the
hyperfractionated technique, and 11 were treated using the
accelerated-hyperfractionated scheme. Hyperfractionated radiotherapy was
delivered using 120 cGy b.i.d. separated by 6-h intervals throughout the
course. A minimum tumor dose of 8000 cGy was the standard dose over an
8-week period. With the accelerated-hyperfractionated scheme, 160 cGy
was given twice daily, also with an interval of 6 h. The minimum tumor
dose ranged between 6840 and 7640 cGy, with 7 of the 11 patients
receiving 7000 cGy. The arrangement of portals was the same for both
regimens. The follow-up period for patients alive was from 32 to 102
months with a median of 61 months for the hyperfractionated patients.
For the accelerated-hyperfractionated group, it ranged from 67 to 82
months with a median of 72 months. No patient was lost to follow-up.
RESULTS: At the time of analysis, 49 of the 70 patients in the
hyperfractionated group were alive. In the accelerated group, 8 of the
11 patients were alive. The estimated radiation dose to the temporal
lobe for the hyperfractionated group was 6000-7440 cGy with a median of
7080 cGy. For the accelerated-hyperfractionated group, the dose range
was 4480-6700 cGy with a median of 6400 cGy. Of the 70 patients treated
with hyperfractionated radiotherapy, none developed symptomatic brain
necrosis, despite the higher total dose to the temporal lobe in general.
In contrast, 3 of the 11 (27%) patients irradiated using the
accelerated-hyperfractionated regimen suffered from temporal lobe
necrosis at 16, 19, and 40 months after completion of radiotherapy.
CONCLUSION: An excessive incidence of temporal lobe necrosis was noted
when an accelerated-hyperfractionated regimen with 160 cGy b.i.d. was
used in NPC patients with a median brain dose of 6400 cGy. There has
been no such event in patients treated using a hyperfractionated regimen
with 120 cGy and a median brain dose of 7000 cGy. The real causes of
this discrepancy are not known. However, a high sensitivity of the human
brain to a change in fraction size may play a role.
19
UI - 21458876
AU - Chien CR; Chen SW; Hsieh CY; Liang JA; Yang SN; Huang CY; Lin FJ
TI -
Retrospective comparison of the AJCC 5th edition classification for
nasopharyngeal carcinoma with the AJCC 4th edition: an experience in
Taiwan.
SO - Jpn J Clin Oncol 2001 Aug;31(8):363-9
AD - Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su
Memorial Hospital, Taipei, Taiwan.
OBJECTIVE: The aim of this study was to compare the new AJCC 5th edition
classification system for nasopharyngeal carcinoma (NPC) with the AJCC
4th edition by re-evaluating the staging of patients treated in Taiwan.
METHODS: From 1992 through 1996, 117 NPC patients without distant
metastasis were treated using complete courses of radiotherapy. All
patients had complete CT examinations of the nasopharynx and neck. Each
patient was re-staged according to the 5th edition of the AJCC
classification system. Their overall survival (OS), loco-regional
relapse-free survival (LRRFS), distant metastasis-free survival (DMFS)
and disease-free survival (DFS) were compared between the two staging
systems, using the Kaplan-Meier method, log-rank test, Wilcoxon test and
Cox proportional hazard model. RESULTS: After a median follow-up of 58.3
months, the 5-year OS for stage I, II, III and IV was 88, 86, 61 and
48%, respectively, according to the new staging. A more even
distribution of patients was noted among the patients classified
according to the AJCC 5th edition than the 4th edition. The distribution
of stages I, II, III and IV was 13.7, 37.6, 15.4 and 33.3%,
respectively, using the new staging system, whereas it was 0.8, 14.5,
20.5 and 64.2%, respectively, using the old staging system. More
statistically significant differences among 5th edition stages and T
classifications than the 4th edition were also noted. CONCLUSIONS: The
5th edition of the AJCC staging system appears to have a more even
distribution of patients and more statistically significant differences
in predicting prognosis than the 4th edition, mostly in stages and T
classification.
20
UI - 92133256
AU - Laterza E; Inaspettato G; Ricci F; Macri A; Veraldi GF; Cordiano C
TI -
[Treatment of malignant stenosis of the cervical esophagus]
SO - Acta Otorhinolaryngol Ital 1991;11(3):265-73
AD - Cattedra di Chirurgia d'Urgenza e Pronto Soccorso, Universita di Verona.
21
UI - 21469556
AU - Triboulet JP; Mariette C; Chevalier D; Amrouni H
TI -
Surgical management of carcinoma of the hypopharynx and cervical
esophagus: analysis of 209 cases.
SO - Arch Surg 2001 Oct;136(10):1164-70
AD - Service de Chirurgie Digestive et Generale, Clinique Chirurgicale
Adultes est, Chru Lille Hopital Huriez, Place de Verdun, 59037 Lille
CEDEX, France. jp-triboulet@chru-lille.fr
BACKGROUND: Free jejunal transfer has become the standard technique for
reconstruction of the pharynx and hypopharynx, especially with proximal
neoplastic lesions, whereas gastric tube interposition is the technique
of choice for reconstruction of the hypopharynx and cervical esophagus
when resection extends below the thoracic inlet. HYPOTHESIS: Surgical
ablation is a viable option for advanced hypopharyngeal and cervical
esophageal neoplasms, with stomach interposition a safe and preferred
method of reconstruction. DESIGN: Retrospective analysis. SETTING:
University hospital that is a regional referral institution for
esophageal cancer treatment and complex digestive reconstructions after
esophagectomy. PATIENTS: We reviewed the records of 209 patients who
majority of patients had advanced cancer: hypopharyngeal in 131 cases
and cervical esophageal in 78 cases. INTERVENTIONS: Pharyngolaryngectomy
and total esophagectomy with pharyngogastric anastomoses (n = 127);
pharyngolaryngectomy, cervical esophagectomy, and reconstruction with
free jejunal transplant (n = 77); and pharyngolaryngectomy and total
esophagectomy with pharyngocolic anastomoses (n = 5). MAIN OUTCOME
MEASURES: Postoperative mortality and morbidity, long-term survival, and
prognostic factors influencing survival. RESULTS: The postoperative
in-hospital mortality rate was 4.8% (10 patients), with a postoperative
morbidity rate of 38.3%. Alimentary continuity was achieved using the
stomach (127 patients), colon (5 patients), or free jejunal autograft
(77 patients). The 1-year and 5-year survival rates were 62% and 24%,
respectively. There was no significant difference with regard to the
survival between gastric transposition and free jejunal autograft, but
there were fewer complications in the gastric pull-up group (33% vs 47%,
P<.05). The significant adverse factors affecting survival were tumor
cervical localization, postoperative complications, disease stages pT3
and pT4 for the cervical esophageal tumors, microscopic pharyngeal
penetration, or incomplete resection. The significant beneficial factors
were tumor hypopharyngeal localization and postoperative radiotherapy.
CONCLUSIONS: Surgical ablation is a viable option for advanced
hypopharyngeal and cervical esophageal neoplasms, with stomach
interposition the preferred method of reconstruction. Although the
prognosis is poor, satisfactory short-term palliation can be achieved.
The significant adverse factors affecting survival should be taken into
account to select the candidates for surgery.
22
UI - 21301905
AU - Chiesa F; De Paoli F
TI -
Distant metastases from nasopharyngeal cancer.
SO - ORL J Otorhinolaryngol Relat Spec 2001 Jul-Aug;63(4):214-6
AD - Head and Neck Division, European Institute of Oncology, Milan, Italy.
fausto.chiesa@ieo.it
Undifferentiated carcinoma is the most frequent nasopharyngeal cancer;
it has a typical pathognomonic histological pattern, a close
relationship to Epstein-Barr virus (EBV), a peculiar natural history and
a good prognosis. It has an early tendency to locally spread to the
parapharyngeal space. Nodal involvement is highly frequent (70-90%) and
bulky regardless of the size of the primary. Literature reports up to
11% distant metastases at presentation and up to 87% at autoptic
studies. Pretreatment work-up should include: personal history, clinical
and fiberscopic examination, magnetic resonance imaging (MRI) or
computed tomography (CT) scan of the base of the skull and neck,
histology of the primary and cytology of neck lumps, bone marrow
aspiration and biopsy, and EBV serological profile. Clinical and
pathological factors predicting possible distant spread are primary
tumor and node extension, and treatment failure. Up to now no reliable
predictive biological markers have been identified. After treatment,
distant metastases are found in about 30% of patients within 5 years and
generally have a bad prognosis. Metastatic nodes above the clavicle, in
absence of locoregional failure, aggressively treated with
chemoradiotherapy, have a disease-free survival longer than 5 years. The
following is the suggested posttreatment work-up for early diagnosis of
these salvageable patients: clinical and fiberscopic evaluation every 3
months for 2 years and later on every 6 months; skull base and neck MRI
or CT scan, and chest CT scan at 6, 12, 18, 24, 36, 48 and 60 months;
EBV serological evaluation. Copyright 2001 S. Karger AG, Basel
23
UI - 21301907
AU - Goodwin WJ
TI -
Distant metastases from oropharyngeal cancer.
SO - ORL J Otorhinolaryngol Relat Spec 2001 Jul-Aug;63(4):222-3
AD - Department of Otolaryngology, University of Miami, FL 33136, USA.
jgoodwin@miami.edu
Distant metastasis is a significant problem in patients with carcinoma
of the oropharynx, occurring in approximately 15-20% off all patients
over the course of the disease. It is, however, a relatively uncommon
first site of failure, as compared to local and regional recurrence.
Distant spread occurs most commonly to the lungs, in patients who
present with advanced disease, and especially in those with
pathologically proven lymph nodes at multiple levels of the neck or in
the lower neck. Metastasis to distant sites also occurs more often in
patients who recur locally or in the neck. Copyright 2001 S. Karger AG,
Basel
24
UI - 21301908
AU - Spector GJ
TI -
Distant metastases from laryngeal and hypopharyngeal cancer.
SO - ORL J Otorhinolaryngol Relat Spec 2001 Jul-Aug;63(4):224-8
AD - Department of Otolaryngology--Head and Neck Surgery, Washington
University, St. Louis, MO 63110, USA. spectorg@msnotes.wustl.edu
A retrospective tumor registry analysis of patients with squamous cell
carcinoma (SCC) of the larynx and hypopharynx who were treated with
curative intent in the Department of Otolaryngology--Head and Neck
Surgery at Washington University School of Medicine and Barnes Hospital
sex and tumor differentiation did not affect the incidence of distant
metastases. The overall incidence of distant metastases was 8.5%
(217/2,550 patients) with the following distribution: glottis 4.4%,
supraglottis 3.6%, subglottis 14%, aryepiglottic fold 16%, pyriform
sinus 17% and posterior hypopharynx 17.6%. The overall 5-year
disease-specific survival for distant metastases was 6.4%. Distant
metastases were related to advanced local disease (T3 + T4), lymph node
metastases at presentation (N+), tumor location (hypopharynx) and
locoregional tumor recurrence (p < or = 0.028). A meta-analysis of
variables which predispose to a higher incidence of distant metastases
indicate that tumor location (hypopharynx > larynx), advanced primary
disease (T3 + T4), regional disease (N+), locoregional recurrences, and
advanced regional metastases (N2 + N3) are statistically significant.
Copyright 2001 S. Karger AG, Basel
25
UI - 21341700
AU - Yoshizaki T; Horikawa T; Qing-Chun R; Wakisaka N; Takeshita H; Sheen TS;
TI -
Lee SY; Sato H; Furukawa M
Induction of interleukin-8 by Epstein-Barr virus latent membrane
protein-1 and its correlation to angiogenesis in nasopharyngeal
carcinoma.
SO - Clin Cancer Res 2001 Jul;7(7):1946-51
AD - Department of Otolaryngology, School of Medicine, Kanazawa University,
Kanazawa 920-8641, Japan. tomoy@med.kanazawa-u.ac.jp
PURPOSE: The EBV latent membrane protein-1 (LMP-1) is a multifunctional
protein. Recently, the contribution of LMP-1 to the metastasis of
nasopharyngeal carcinoma (NPC) has been suggested. Angiogenesis is a key
step for metastasis. Thus, the association of LMP-1 to
neovascularization of NPC was examined in this study. EXPERIMENTAL
DESIGN: The association of LMP-1 to angiogenesis in 39 patients with NPC
was evaluated by immunohistochemical study, and then induction of
angiogenic factors by LMP-1 was examined by ELISA and luciferase
reporter assay. RESULTS: In an immunohistochemical study, the expression
of LMP-1 was significantly correlated to microvessel counts (P =
0.0003), suggesting that LMP-1 may induce some angiogenic factors.
Therefore, we studied the relationship between LMP-1 expression and
interleukin-8 (IL-8), vascular endothelial growth factor (VEGF), and
basic fibroblast growth factor (bFGF) expression by immunohistochemical
analysis. IL-8, VEGF, and bFGF expression were correlated to microvessel
counts, but only IL-8 expression was significantly correlated to LMP-1
expression (P < 0.0001). Transfection with LMP-1 expression plasmid
induced IL-8 protein expression in C33A cells. The expression of LMP-1
transactivated IL-8 promoter, as demonstrated by IL-8 promoter
luciferase reporter assay. Mutation of the nuclear factor kappaB
responsive element in the IL-8 promoter region completely abolished
transactivation by LMP-1, whereas mutation of the activator protein
responsive element did not affect promoter activity. CONCLUSION: These
results suggested that LMP-1 induces expression of IL-8 through the
nuclear factor kappaB binding site, which may contribute in part to
angiogenesis in NPC.
26
UI - 21453579
AU - Major MS; Bumpous JM; Flynn MB; Schill K
TI -
Quality of life after treatment for advanced laryngeal and
hypopharyngeal cancer.
SO - Laryngoscope 2001 Aug;111(8):1379-82
AD - Division of Otolaryngology, Department of Surgery, University of
Louisville School of Medicine, Louisville, KY 40292, U.S.A.
OBJECTIVES: To compare health-related quality of life measures after
treatment for advanced (stages III and IV) laryngeal and hypopharyngeal
cancers. STUDY DESIGN: Retrospective chart review and patient response
to Health Status Questionnaire-12 (HSQ-12). METHODS: Our study included
54 patients identified from the Tumor Registry of the University of
Louisville Brown Cancer Center who were diagnosed and treated between
1995 and 2000. Demographics, tumor data, and treatment information were
obtained from the Tumor Registry database. Questionnaires were mailed to
all patients and included telephone follow-up. Comparative data and
responses were analyzed for the 24 patients who responded to the survey.
RESULTS: Fifteen patients were treated with chemotherapy and radiation
therapy (CRT). Six patients underwent surgery with postoperative
radiation therapy (SRT). The remaining three patients were treated with
radiation therapy but were not used in this analysis. The average
follow-up was 35 months after treatment. The CRT and SRT groups were
statistically similar regarding age, sex, duration of follow-up, tumor
grade, and tumor stage. Laryngeal primary tumors were more common in the
SRT group than in the CRT group (P =.005). Eight domains were assessed
by the HSQ-12: physical functioning, role-physical, bodily pain, health
perception, energy/fatigue, social functioning, role-mental, and mental
health. No statistical differences were found between the CRT and SRT
groups, except for role limitations attributable to physical health (P
=.007). CONCLUSIONS: These results indicate that only one of eight
domains differs significantly between treatment groups when using the
HSQ-12. Two-year survival end-point analysis of global he
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