National Cancer Institute®
Last Modified: June 1, 2002
UI - 11978544
AU - Scully C
TI - Oral squamous cell carcinoma; from an hypothesis about a virus, to concern about possible sexual transmission.
SO - Oral Oncol 2002 Apr;38(3):227-34
AD - International Centres for Excellence in Dentistry, and Eastman Dental Institute for Oral Health Care Sciences UCL, University of London, 256 Gray's Inn Road, WC1X 8LD, London, UK. email@example.com
Nearly two decades ago, we produced the first evidence for the presence of viral nucleic acids in oral squamous cell carcinoma (OSCC) tissues, hypothesising that there may be a viral involvement in at least some OSCC. Subsequently, human papillomaviruses (HPV) in particular have been implicated in OSCC. Antibody responses to HPV are seen and HPV-DNA detected in tumors by us and many others, the virus being mainly HPV-16, the genotype associated with ano-genital cancer. HPV are seen by in situ hybridisation only in tumour and premalignant tissue but not in surrounding normal mucosa suggesting HPV has a causal relationship. HPV may also be integrated in the host genome, further suggesting a causal role. Studies of patients with OSCC have suggested possible sexual transmission of HPV. Recent studies have indicated that HPV may be aetiologically important particularly in some types of oropharyngeal cancer, at least in tonsillar carcinogenesis, and may represent an alternative pathway in carcinogenesis to the established factors of tobacco and alcohol. We have come a very long way in the two decades since our first suggestion of a viral aetiopathogenesis was greeted with incredulity, and data from on-going studies by the International Agency for Research on Cancer, Johns Hopkins Oncology Center and others are eagerly awaited.
UI - 11962004
AU - Plaza G; Fogue L; Martinez San Millan J; Martinez Vidal A; Bellas C
TI - [Diagnostic evaluation of nasopharyngeal carcinoma: role of Epstein-Barr virus]
SO - An Otorrinolaringol Ibero Am 2002;29(1):71-91
AD - Unidad de Otorrinolaringologia, Fundacion Hospital Alcorcon. firstname.lastname@example.org
We present a retrospective series of 27 nasopharyngeal carcinomas, selected from those attended at Ramon y Cajal Hospital between 1977 and 1996, with the aim of review the role of the study of Epstein-Barr virus in the diagnostic process of nasopharyngeal carcinoma. Twenty-seven patients, ranging from 14 to 81 years, with an average age of 50 years were selected. Male/female ratio was 1,7. All but one case were Caucasian. A neck mass was the first symptom in 40% of cases, with a mean diagnostic delay of 17 months. Only 8 cases (23%) did not exhibit neck nodes at the moment of diagnosis. CT and MRI were essential to establish staging: 5 stage I, 7 stage II and 15 stage IV, due to regional extension and/or bone erosion. Radiotherapy was employed in all cases, helped by chemotherapy in 20% of them. With a mean follow-up of 62 months, 5-years survival was 32% (IC 14,06-52,09). Of 27 cases of nasopharyngeal carcinoma 4 were differentiated (type I), 2 moderately differentiated (type II) and 22 undifferentiated (type III). While LMP-1 was only expressed by 41% of cases, PCR detected Epstein-Barr virus genome in 26 cases (96%) and in situ hybridization for EBERs was positive in all cases. Thus, all nasopharyngeal carcinomas were related to Epstein-Barr virus. Expression of LMP-1 seemed to worse the prognosis of nasopharyngeal carcinoma.
UI - 11979459
AU - Preciado MV; Chabay PA; De Matteo EN; Gismondi MI; Rey G; Zubizarreta P
TI - Epstein Barr virus associated pediatric nasopharyngeal carcinoma: its correlation with p53 and bcl-2 expression.
SO - Med Pediatr Oncol 2002 May;38(5):345-8
AD - Virology Laboratory, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina. email@example.com
BACKGROUND: Pediatric nasopharyngeal carcinoma (NPC) is relatively rare. The Epstein Barr virus (EBV) association with the oncogenesis of NPC is well established. Apoptosis-related proteins, p53 and bcl-2, have also been described in adult NPC pathogenesis. PROCEDURE: From 1988 to 1998, 16 patients with NPC were treated at R. Gutierrez Children's Hospital and the National J.P. Garrahan Pediatric Hospital. Their median age was 12 years (range 8-20), 2 females and 14 males. The presence of p53, bcl-2 and latent membrane protein-1 (LMP-1) of EBV expression was studied by immunohistochemistry and Epstein Barr encoded RNAs (EBERs) by in situ hybridization in tissue sections from formalin-fixed, paraffin-embedded NPC biopsies RESULTS: EBV presence and LMP-1 expression in epithelial tumor cells were detected in all the biopsies studied. p53 was expressed in 13/16 NPCs, but the frequency of positive malignant cells differed from case to case, ranging from less than 25 to 100% with heterogeneous staining intensity. Bcl-2 positive staining in tumor epithelial cells was detected in 2/16; whereas 10/16 cases showed bcl-2 positivity in infiltrating lymphocytes. CONCLUSIONS: Although our series is small, we conclude that the pathogenesis of pediatric NPC as a multistep process may well involve EBV infection. This leads to LMP-1 expression and p53 overexpression in epithelial tumor cells, whereas bc-2 seems unrelated to the development of this disorder. Copyright 2002 Wiley-Liss, Inc.
UI - 11955386
AU - Guo J; Qi Y; Xu Z; Yin Y; Zhang S; Zuo H
TI - [Transmaxillary approach for surgical removal of the invasive skull base tumors]
SO - Zhonghua Wai Ke Za Zhi 2002 Feb;40(2):87-9
AD - Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China.
OBJECTIVE: To investigate the capable use of transmaxillary approach for surgical removal of invasive skull base tumors, the indications and the 27 consecutive patients with skull base tumor were operated through transmaxillary approach, including 6 patients with nasopharyngeal carcinoma, 5 with nasopharyngeal angiofibroma, 5 with nasopharyngeal cystadenocarcinoma, 2 with olfactory neuroblastoma, 2 with poorly differentiated carcinoma, 2 with sarcoma, 1 with maxillary carcinoma, 2 with schwannoma, and 2 with chordoma. Most of them (18/27) were recurrent tumor and 17/27 tumors involved important intracranial structures. All patients were followed up 2 - 33 months (average 16 months) and the clinical data was reviewed. RESULTS: The tumors could be totally removed in all patients. There were no operative mortality and morbidity. After operation, 2 patients died of cancer recurrence in 5 and 8 months separately. One patient had metastasis to the lungs 11 months after operation. Two patients had local recurrence in 7 and 12 months postoperation seperately and live with the tumor now. The rest patients are back to their routine life. CONCLUSIONS: Transmaxillary approach facilitates the surgical removal of invasive skull base tumors. The exposure is wide. The lesion as well as the important anatomy structures can be viewed directly and clearly. The tumor removal could be done more thoroughly and safely. This approach is suitable for the patients in whom tumor involves the skull base extensively and may be difficult to deal with by other approaches.
UI - 11938839
AU - Lu C; Tu G; Tang P
TI - [Visceral voice training for laryngectomy after hypopharyngectomy and visceral transplant]
SO - Zhonghua Er Bi Yan Hou Ke Za Zhi 1998 Dec;33(6):325-7
AD - Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical Collage, Beijing 100021.
OBJECTIVE: To establish a way to visceral voice after stomach or colon transplantation for patients with hypopharyngeal or cervical esophageal cancer. METHODS: Esophageal voice training was used and modified according to the compliance of the patients. Twenty laryngectomies with replacement of the hypopharynx and esophagus by stomach(13 cases), colon(6 cases) and jejunum (1 case) were trained for voice rehabilitation at the Department of Head and Neck Surgery. RESULTS: The patients with an artificial esophagus from vicera were easy to gain an influx of certain volume of gas into their artificial esophagus (stomach or colon) and to learn to speak. But on the whole the quality of voice was not so satisfactory. In this series nineteen out of 20 patients (95%) could express their idea by speech after a training course of three weeks. CONCLUSION: The literature has emphasized role of cricopharyngeus muscle in the training of esophageal voice. Owing to the fact that this series of patients who had had their cricopharyngeus removed, could easily get their voice rehabilitated, it seems this muscle played no major role in the voice rehabilitation.
UI - 11938850
AU - Han D; Chen X; Wang J
TI - [Endoscopic nasal surgery in treatment of nasopharyngeal angiofibroma]
SO - Zhonghua Er Bi Yan Hou Ke Za Zhi 1998 Dec;33(6):358-60
AD - Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing, 100730.
OBJECTIVE: To avoid complications of the routine surgeries for nasopharyngeal angiofibroma. METHODS: Endoscopic nasal surgery and other new techniques including controlled-hypotension anesthesia and nasopharyngeal angiofibroma were treated by endoscopic sinus surgery. The average age was 16.6 years old. Six accepted preoperative embolism, seven accepted hypotension anesthesia. RESULTS: No complications had occurred. Average intraoperative blood loss was 900 ml. All cases were followed for 1 to 20 months(mean 8 months). Recurrence was found in only one patient three months after operation. The recurrent rate was 12.5%. CONCLUSION: The lesions limited to nasal and nasopharyngeal cavities and with sphnoid and ethmoid invasions can be removed by endoscopic nasal surgery. Endoscopic surgery has advantages in reducing complications and obtaining better post operative functions. Transnasal endoscopic examination is also necessary in the follow-up period. Other techniques such as CT, digital subtract angiography, preoperative feeding artery embolism and controlled-hypotension technique during anesthesia are beneficial.
UI - 11938854
AU - Wang T; Li M; Xu A
TI - [Mandibular swing procedure for resection of pharyngeal and skull base tumors]
SO - Zhonghua Er Bi Yan Hou Ke Za Zhi 1998 Dec;33(6):371-4
AD - First Affiliated Hospital, Shandong Medical University, Jinan 250012.
OBJECTIVE: To seek for a better approach for the resection of pharyngeal and skull base tumors. METHODS: The overall tumor distribution for the entire group was nasopharyngeal 2 cases, oropharyngeal 4, parapharyngeal space 5 and parapharyngeal infratemporal area 2 cases. All 13 cases of pharyngeal and skull base tumors had their tumors thoroughly resected via mandibular swing approaches. Five cases had retropharyngeal node dissections, 2 cases had unilateral modified radical neck dissections, 5 cases with defect oropharynx were reconstructed with the pectoralis major myocutaneous flap, 10 cases with malignant tumors had received adjutant radiotherapy after surgical procedures. RESULTS: Of the 13 cases, 10 were malignant, 3 were benign. The incision in 12 cases healed primarily, one case with malignant fibrocystic tumor got infective necrosis of pectoralis major myocutaneous flap, this case healed completely after more than two months. One case developed dysphagia postoperatively and was recovered by swallow training. One case had minimal occlusion disorder. All patients were followed up from 15 months to 3 years. Three cases with benign tumors achieved good clinical results and are living well. In the malignant group, one died of recurrence at 6 months postoperatively, one died of lung metastasis, 2 cases survived for 3 years, 2 for two years, 4 for one year. CONCLUSION: This procedure provides good exposure of the base of the skull, the pharynx and the parapharyngeal space as well as the clivus and upper cervical vertebrae; it allows dissection along the internal carotid artery and facilitates resection of the tumor en bloc. It provides operative safety and minimal morbidity.
UI - 12014137
AU - Liu C; Liu L; Li P
TI - A survey of researches on synergy and toxicity abatement of traditional Chinese medicine in radiotherapy of nasopharyngeal carcinoma.
SO - J Tradit Chin Med 2001 Dec;21(4):303-11
AD - Municipal Hospital of Traditional Chinese Medicine, Zhaoqing, Guangdong 526020.
UI - 12001120
AU - Hareyama M; Sakata K; Shirato H; Nishioka T; Nishio M; Suzuki K; Saitoh
TI - A; Oouchi A; Fukuda S; Himi T A prospective, randomized trial comparing neoadjuvant chemotherapy with radiotherapy alone in patients with advanced nasopharyngeal carcinoma.
SO - Cancer 2002 Apr 15;94(8):2217-23
AD - Department of Radiology, School of Medicine, Sapporo Medical University, Sapporo, Japan. firstname.lastname@example.org
BACKGROUND: A prospective, randomized study was performed to determine the efficacy of neoadjuvant chemotherapy over radiotherapy alone in patients with locally advanced nasopharyngeal carcinoma. METHODS: From Patients with locoregional carcinoma of the nasopharynx were randomized to receive two courses of chemotherapy, consisting of cisplatin and 5-fluorouracil (CDDP-5FU), that were administered before radiation therapy (CT arm) or radiotherapy alone. The patients who received neoadjuvant chemotherapy were treated with radiation therapy, which was scheduled to commence 2 weeks after the second course chemotherapy. RESULTS: With a median follow-up of 49 months, a trend toward improved overall survival or disease free survival favoring the CT arm was observed (5-year overall survival rate, 60% vs. 48%; 5-year disease free survival rate, 55% vs. 43%), although this difference was not significant. There were no differences in locoregional failure free survival between the two arms. However, metastasis free survival favored the CT arm, although this difference was not significant. The results also demonstrated that most patients in the CT arm who experienced recurrent disease developed locoregional recurrences before distant metastases, suggesting that improvements in locoregional control may lead to improved disease free survival. CONCLUSIONS: The use of CDDP-5FU chemotherapy prior to radiotherapy in patients with nasopharyngeal carcinoma did not result in a significant improvement in disease free survival or overall survival. However, there was a positive tendency in favor of the CT arm for distant metastasis free survival, although there was no improvement in the locoregional recurrence free survival rate. Copyright 2002 American Cancer Society.
UI - 11859978
AU - Johansen LV; Grau C; Overgaard J
TI - Squamous cell carcinoma of the nasopharynx--an analysis of treatment results in 149 consecutive patients.
SO - Acta Oncol 2001;40(7):801-9
AD - Department of Experimental Clinical Oncology, Danish Cancer Society, Aarhus University Hospital. email@example.com
The purpose of this study was to evaluate the outcome of primary treatment and treatment of recurrences in patients with nasopharyngeal carcinoma. The material included 149 consecutive patients seen at the Aarhus University Hospital from 1963 to 1991 (49 females and 100 males). The stage distribution was: Stage I-9%, II-3%, III-28%, and IV-60%. Primary treatment was delivered with curative intent in 145 patients (97%). Persistent or recurrent disease after primary radical treatment was observed in 82 of the patients; 54% at the T-level, 40% at the N-level, and 33% at the M-level. A curative salvage attempt was carried out in 14 patients only, all with nodal recurrence: surgery in 8 patients (4 controlled) and radiotherapy in 6 patients (2 controlled). The 5-year local tumour control, locoregional tumour control, disease-specific survival rate and the overall survival rate for the patients treated with curative intent were 66%, 53%, 50% and 43%, respectively. Most of the patients (88%) had poorly differentiated tumours and these patients had the best prognosis. A major complication in three patients was radiation-induced myelopathy due to high-dose radiation delivered to the brain stem. Significant positive prognostic factors for treatment outcome in univariate analyses were early T-classification, small clinical stage, poor differentiation and low age. The Cox multivariate analysis showed that early T-categories, low N-categories and poor differentiation were independent, positive prognostic factors. Nasopharyngeal carcinoma is curable with primary radiotherapy; patients with poorly differentiated tumours have the best prognosis. Only a few patients were salvaged after recurrence. The factor most essential for success is primary control of the disease at the T- and N-levels.
UI - 11911270
AU - Burgos JS; Vera-Sempere FJ
TI - Analysis of EBV latency by EBER in situ hybridization in nasopharyngeal carcinoma Spanish patients.
SO - Anticancer Res 2001 Nov-Dec;21(6A):3921-4
AD - Centro de Biologia Molecular Severo Ochoa-C.S.I.C., Facultad de Ciencias, Universidad Autonoma de Madrid, Cantoblanco, Spain. firstname.lastname@example.org
BACKGROUND: The aim of this study was to analyse the Epstein-Barr virus (EBV) latency by detecting the EBV-associated latent small nuclear RNAs (EBER), in a group of biopsies from Spanish patients with diagnosed nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: NPC paraffin samples with the presence of EBV demonstrated by non-isotopic in situ hybridization (NISH) and nested-PCR, were analysed for EBV latency using EBER in situ hybridization (EBER-ISH). RESULTS: We detected EBER in 83.3% of samples (10 out of 12 cases), demonstrating the relationships between EBV genome presence with the latent viral infection. We correlated these results of EBV-DNA and -RNA presence with the immunoexpression of latent membrane protein-1 (LMP-1), a viral oncogenic protein (8 out of 12 cases or 66.6%). CONCLUSION: These results indicate that all the types of NPC are variants of an EBV-associated malignancy and that viral latency is a critical phenomenon in the development of this neoplasia.
UI - 11979436
AU - Zheng BJ; Ng SP; Chua DT; Sham JS; Kwong DL; Lam CK; Ng MH
TI - Peripheral gamma delta T-cell deficit in nasopharyngeal carcinoma.
SO - Int J Cancer 2002 May 10;99(2):213-7
AD - Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, People's Republic of China.
Previous studies identified CD56(+) and CD56(-) subsets of peripheral gamma delta T cells from healthy donors. Both subsets responded to stimulation by a myeloma cell line, XG-7 and undergo vigorous ex vivo expansion in the presence of exogenous IL-2. They are cytotoxic for different tumor targets including nasopharyngeal carcinoma, but they differ from one another in that the CD56(-) subset has an additional growth requirement for IL-7 and exhibited greater cytotoxicity against nasopharyngeal carcinoma (NPC) targets. These immune cells were further shown to retard tumor growth in a nude mice NPC model. To assess if these immune cells might contribute to host defense against NPC, we compared gamma delta T-cell status of NPC patients with healthy donors and survivors who had been in clinical remission of the cancer. It was found that peripheral gamma delta T cells of patients were impaired in their response to the stimulatory effects of XG-7 and exhibited weak or essentially no cytotoxicity for the NPC targets. The deficits were present in early and advanced stages of the cancer but were restored among survivors after successful treatment of the cancer. These findings support a role for peripheral gamma delta T cells in host defense against NPC. It was noted that these immune cells comprise less than 5% of peripheral blood monocytic cells and hence it was not surprising that this component of host defense was breached early in the development of the cancer. Copyright 2002 Wiley-Liss, Inc.
UI - 12000691
AU - Mould RF; Tai TH
TI - Nasopharyngeal carcinoma: treatments and outcomes in the 20th century.
SO - Br J Radiol 2002 Apr;75(892):307-39
AD - Department of Radiation Oncology, Allan Blair Cancer Centre, 4101 Dewdney Avenue, Regina, Saskatchewan, S4T 7T1 Canada.
Nasopharyngeal carcinoma (NPC), although rare in Europe and North America, is not uncommon in parts of Asia such as southern China and Hong Kong. Consequently, very few oncologists in the Western world have extensive experience in treating this neoplasm. Treatment using external beam therapy and/or brachytherapy evolved greatly during the 20th century and is still evolving, particularly with the use of adjunctive chemotherapy regimes. Diagnosis of NPC has also improved with the availability of CT and MRI. This worldwide review is divided into historical, transitional and modern eras, with the latter concerning 1971-2000. Currently, the most controversial aspects of NPC are recommendations for treatment of recurrent disease and the role of chemotherapy in the overall framework of treatment. Comparison of results from different centres is not possible without an understanding of the various staging systems that are, and have been, used; a comparison is given in this review. In the future, early diagnosis, adequate radiation dose to the primary with boost to bulky disease, and regular follow-up with biopsy of any suspicious residual or recurrent disease, are likely to become key issues to improve outcome. Also, apart from direct/indirect nasopharyngoscopy, the role of follow-up CT needs to be studied for early detection of residual or recurrent disease. More clinical trials on chemo-radiation are also required, in order to study optimum doses and agents.
UI - 12000693
AU - To EW; Yuen EH; Tsang WM; Lai EC; Wong GK; Sun DT; Chan DT; Lam JM;
TI - Ahuja A; Poon WS The use of stereotactic navigation guidance in minimally invasive transnasal nasopharyngectomy: a comparison with the conventional open transfacial approach.
SO - Br J Radiol 2002 Apr;75(892):345-50
AD - Division of Head and Neck-Plastic and Reconstructive Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
The purpose of this paper is to study the efficacy of applying stereotactic navigation guidance to nasopharyngectomy via a minimally invasive transnasal approach as compared with the conventional open transfacial approaches. The nasopharynx is the centre of the anterior skull base, which is remote from the surface of the facial skeleton. It is well known that there are several surgical approaches for access to resect tumours from the nasopharynx. However, the open techniques have been associated with much morbidity and only provide access to, and identification of, the ipsilateral internal carotid artery that forms the lateral boundary and resection limit of the nasopharynx. The coupling of stereotactic navigation guidance and a minimally invasive transnasal approach for nasopharyngectomy allows the surgeon to identify and protect the internal carotid artery bilaterally at the nasopharynx. This technique reduces operating time and morbidity to a minimum and yet is oncologically sound for resecting nasopharyngeal lesions. We compare 15 patients who underwent the stereotactic navigation guidance approach with 20 patients who received a conventional open transfacial approach.
UI - 12023137
AU - Chua DT; Sham JS; Au GK; Choy D
TI - Concomitant chemoirradiation for stage III-IV nasopharyngeal carcinoma in Chinese patients: results of a matched cohort analysis.
SO - Int J Radiat Oncol Biol Phys 2002 Jun 1;53(2):334-43
AD - Department of Clinical Oncology, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China. email@example.com
PURPOSE: To evaluate the toxicity and efficacy of concomitant chemoirradiation (CRT) followed by adjuvant chemotherapy compared with radiotherapy (RT) alone in Chinese patients with locoregionally advanced nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: Between March and IV (n = 38, 81%) NPC were treated with by CRT using cisplatin 100 mg/m(2) on Days 1, 22, and 43 of RT, plus adjuvant chemotherapy using cisplatin 80 mg/m(2) for 1 day and 5-fluorouracil 1 g/m(2) for 4 days on Days 71, 99, and 127. These patients were then compared with a cohort of 47 patients treated between 1990 and 1993 with RT alone, who were matched with respect to T stage, N stage, nodal bilaterality, nodal level, and nodal size. The RT techniques were similar in the two groups but different dose and fractionation schemes were used. The median biologic equivalent dose to 2 Gy per fraction delivered to the nasopharynx was 68 Gy in the CRT group and 65.3 Gy in the RT-alone group. RESULTS: The compliance rates were 62% for concomitant chemotherapy and 40% for adjuvant chemotherapy. No treatment-related deaths occurred. At the end of treatment, 96% of the CRT group and 79% of the RT-alone group achieved a complete response (p = 0.013). With a median follow-up of 26 months, the 3-year relapse-free survival, disease-specific survival, overall survival, local relapse-free survival, nodal relapse-free survival, and distant metastasis-free survival rate for the CRT group and the RT-alone group was 62% vs. 44% (p = 0.048), 67% vs. 71% (p = 0.88), 65% vs. 69% (p = 0.93), 87% vs. 75% (p = 0.059), 95% vs. 80% (p = 0.026), and 75% vs. 70% (p = 0.84), respectively. CONCLUSION: Our experience indicates that concomitant CRT improves locoregional control in Chinese patients with locoregionally advanced NPC, but our analyses failed to detect any impact on distant failure and survival. The failure to reduce distant metastasis and improve survival may have related in part to the more advanced disease stage in our patients and the relatively low compliance rate of adjuvant chemotherapy. Our findings suggest caution should be exercised in extrapolating the findings of the Intergroup Study 0099 to Chinese patients, and confirmatory results from prospective randomized studies in the endemic population are needed.
UI - 12023138
AU - Jian JJ; Cheng SH; Tsai SY; Yen KC; Chu NM; Chan KY; Tan TD; Cheng JC;
TI - Lin YC; Leu SY; Hsieh CI; Tsou MH; Lin CY; Huang AT Improvement of local control of T3 and T4 nasopharyngeal carcinoma by hyperfractionated radiotherapy and concomitant chemotherapy.
SO - Int J Radiat Oncol Biol Phys 2002 Jun 1;53(2):344-52
AD - Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Pei-Tou, Taipei, Taiwan. firstname.lastname@example.org
PURPOSE: When the primary tumor of nasopharyngeal carcinoma (NPC) is treated at the base of skull and intracranium with conventional radiotherapy, the result is generally poor. In this report, we investigated whether hyperfractionated radiotherapy (HFRT) and concomitant chemotherapy (CCT) could achieve better local control and survival in NPC patients with T3 and T4 lesions. PATIENTS AND METHODS: Forty-eight patients (11 T3 and 37 T4 NPC) were treated with HFRT and CCT. HFRT was administered at 1.2 Gy per fraction, two fractions per day, Monday-Friday for 62 fractions for a total dose of 74.4 Gy. Concomitant chemotherapy consisting of cis-diamino-dichloroplatinum (CDDP) alone or CDDP and 5-fluorouracil was delivered simultaneously with radiotherapy during Weeks 1 and 6. Adjuvant chemotherapy consisted of CDDP and 5-fluorouracil for 2 to 3 cycles and was given monthly beginning 1 month after completion of radiation. RESULTS: With a median follow-up of 57 months (range: 28-94 months), the 3-year locoregional control rate was 93%, the disease-free survival rate was 71%, and the overall survival rate was 72%. For T4 patients, the 3-year locoregional control rate was 91%, disease-free survival was 62%, and overall survival was 63%. The major acute toxicity was Grade 3 mucositis in 73% and Grade 2 weight loss in 31% of patients. Fifty percent of patients were tube fed. Most patients tolerated the combined modality treatments relatively well; 88% of patients completed their radiation treatment within 8 weeks. CONCLUSION: HFRT and CCT for T3 and T4 NPC were associated with excellent local control and improved survival. The treatment-related toxicity was acceptable and reversible. We would recommend using HFRT with CCT for advanced T-stage NPC if the three-dimensional conformal radiation planning shows a significant portion of the brainstem to be inside the treatment field.
UI - 12035485
AU - Noel G; Dessard-Diana B; Vignot S; Mazeron JJ
TI - [Treatment of nasopharyngeal cancer: literature review]
SO - Cancer Radiother 2002 Apr;6(2):59-84
AD - Centre de protontherapie d'Orsay, BP 65, 91402 Orsay, France. email@example.com
The conventional radiotherapy and the associated treatments improved the prognostic of nasopharyngeal cancer. A better selection of the patients who must have a more aggressive treatment also probably contributed to this improvement. Even if a relation could be found between the locoregional relapse rate and the distant relapse rate, these two events remain often independent. It results from it that the improvement of local control rate necessarily does not result in a better control of the disease. The patients with a locally advanced tumor, with or not an invasion of the base of the skull and/or neurological symptoms, must have an aggressive locally treatment. This probably includes the increase in dose delivered to the tumor via a more conformational radiotherapy, a brachytherapy, radiotherapy in stereotaxic conditions or other techniques. Dose within the tumor must be at least 70 Gy and the prophylactic nodal dose, at least 50 Gy. CT scan and MRI are essential for delineating the volumes of interest. The protocols of hyperfractionated radiotherapy did not give convincing results. Association with chemotherapy allowed, on the other hand, an improvement of the prognostic locally advanced cancers. Neoadjuvant or adjuvant chemotherapy was largely used to attempt to limit the risks of systemic dissemination, but an improvement of results was not clearly demonstrated. An improvement of the rates of survival and control of the disease, on the other hand, was observed in a certain number of studies with the chemoradiotherapy. In the event of locoregional relapse, an aggressive attitude can allow the control of the disease in the absence of systemic dissemination. Salvage treatments are, however, disappointing for when distant relapse occurs which suggests a difference in chemosensitivity between primary tumor and metastasis.
UI - 12017885
AU - Oestreicher-Kedem Y; Ad-el D; Gore E; Feinmesser R; Spitzer T
TI - [Jejunal free flap for reconstruction of the hypopharynx]
SO - Harefuah 2002 Apr;141(4):340-3, 411, 410
AD - Department of Otolaryngology, Rabin Medical Center, Petach-Tikva.
Squamous cell carcinoma of the hypopharynx is an aggressive tumor with a bad prognosis. When the tumor is resected it is necessary to reconstruct the hypopharynx and the esophagus. Today, reconstruction with a jejunal free flap is considered to be the preferred option. We present a series of five patients with squamous cell carcinoma of the hypopharynx operated on at the Department of Otolaryngology in the Rabin Medical Center. All underwent total laryngopharyngectomy and reconstruction with a jejunal free flap. Three patients resumed total enteral nutrition about two weeks post surgery. One patient suffered from a pharyngocutaneous fistula and continued parenteral nutrition via a jejunostomy. One patient suffered from necrosis of the flap, which necessitated its resection. Despite the morbidity which follows surgery of the hypopharynx and despite the low cure rates, a successful reconstruction with jejunal free flap enables the resumption of oral nutrition and improvement in the patients quality of life.
UI - 12018564
AU - Rao BN; Shewalkar BK
TI - Clinical profile and multimodality approach in the management of juvenile nasopharyngeal angiofibroma.
SO - Indian J Cancer 2000 Dec;37(4):133-9
AD - Department of Radiotherapy, Government Medical College and Hospital, Aurangabad, Maharashtra, India.
Our experience with 19 cases of juvenile nasopharyngeal angiofibroma (JNA) over a period of 10 years is discussed. All cases are managed with combined modalities which include pre-operative hormonal therapy, radiotherapy and/or surgical resection via transpalatal approach. All patients became asymptomatic with these treatment modalities. The use of combined modalities of treatment is advocated so as to achieve decreased intraoperative blood loss and cure, a reality.
UI - 12016041
AU - Sarini J; Bocciolini C; Fournier C; Penel N; Kara A; Van JT; Lefebvre JL
TI - [Induction chemotherapy and larynx preservation: is such practice useful?]
SO - Bull Cancer 2002 Apr;89(4):411-7
AD - Departement de cancerologie cervico-faciale, Centre Oscar-Lambret, 3, rue Frederic-Combemale, 59020 Lille Cedex.
BACKGROUND: Surgery followed by irradiation is considered to be the standard treatment but require frequently a total laryngectomy. Chemotherapy followed by irradiation is available in larynx and hypopharynx squamous cell carcinoma (SCC) treatment. Are results obtained in daily induction chemotherapy usefulness identical to results obtained in larynx preservation studies? PATIENTS AND METHOD: We conducted a retrospective study on patients treated at centre Oscar-Lambret, Lille, from 1986 to 1995, by chemotherapy followed by definitive radiotherapy or by surgery and radiotherapy for laryngeal or hypopharyngeal cancer treatment. All patients were naive of previous head and neck SCC and a surgical treatment, requiring total laryngectomy, should be proposed with curative intent. Induction chemotherapy associated cisplatin (100 mg/m2) on day 1 and 5-fluorouracil (5FU)(1,000 mg/m2) on days 1-4 or 1-5. Irradiation was performed for responders (complete or partial > 50%). If case of non-responder, patients underwent surgical treatment followed by irradiation. We compared results obtained with patients enrolled in clinical trial and with patients whom benefited from this protocol out of trial. RESULTS: Hundred-eight patients were evaluable for purposes of this study. Fifty-two patients were included in clinical trial (group 1) while 56 patients (group 2) were not. There was no statistical difference as regard neither to sex nor to node (palpable or not palpable) and metastasis status between the groups. We found a higher frequency of laryngeal tumour in group 2 (31 vs 17; p =.03). We observed more stage III and less stage IV in group 1. For chemotherapy-related toxic reactions, the exclusive statistical difference observed was haematological toxicity grade III and IV after the second cycle (0 pt in group 1 vs 8 pts in group 2; p =.02). After initial treatment, complete response was achieved without statistical difference between the groups (88.2% vs 78%; p =.27). A surgical procedure was performed in 46 cases without difference according to the reference group and functional larynx preservation was 55.8% (29/52) in group 1 and 53.6% (30/56) in group 2. Whatever the group, causes of death were similarly distributed. Cancer was the first cause of death in both groups. The overall survival of the population (108 patients) was 81.5% at one year, 49.6% at 3 years and 35.3% at 5 years with a median survival of 3 years. There was no statistical difference between both groups. Some parameters influenced the overall survival like T (p =.04), response to chemotherapy (p=.006), extra capsular spread (p = 0.03) and response after completion treatment. CONCLUSION: Induction chemotherapy is available for larynx preservation but cannot be considered as a standard treatment. Nevertheless, results should be reproduced in daily practice with experimented teams as found with non included patient's results. The long-term side effects of such protocols should be evaluated. Recent publication, on increase postoperative infection after chemotherapy, should be evaluated in clinical trial. If confirmed, cost effectiveness of such complication must be integrated in larynx preservation protocols. Larynx preservation remains an interesting point of view for patients but stay an optional procedure and not a reference.
UI - 12016042
AU - Menegoz F; Lesec'H JM; Rame JP; Reyt E; Bauvin E; Arveux P; Buemi A;
TI - Raverdy N; Schaffer P [Lip, oral cavity and pharynx cancers in France: incidence, mortality and trends (period 1975-1995)]
SO - Bull Cancer 2002 Apr;89(4):419-29
AD - Registre du cancer de l'Isere, 21, chemin des Sources, 38240 Meylan. firstname.lastname@example.org
With 10,882 estimated new cases in 1995 in France, lip, oral cavity and pharynx tumours rank 4th, representing 8.1% of all cancers in men. They are less frequent in women, with a sex ratio of 7. Based on the French cancer registries data which cover 13% of the metropolitan territory in 2000, both incidence and mortality increased until early 1980s to decrease thereafter. The main hypothesis proposed to explain the French leadership world-wide for these tumours deals with alcohol and tobacco consumption. Important differences observed between several areas within Europe, for some subsites, in connection with age or sex, are pointing toward the need of new studies about environment and/or genetics. Until now, comparisons between countries were made at the level of lip, oral cavity and pharynx category as a whole or by large subgroups. In this work we attempt to establish more accurate statistics, in order to comply with the situation of this cancer in France. Present results should encourage the scientific community to conduct site specific epidemiological studies.
UI - 12045559
AU - Werker PM
TI - The prepuce free flap in 10 patients: modifications in flap design and surgical technique.
SO - Plast Reconstr Surg 2002 Jun;109(7):2330-5; discussion 2336-7
AD - Centre for Plastic, Reconstructive and Hand Surgery, Isala Klinieken, Locatie Sophia, 8000 GK Zwolle, The Netherlands. email@example.com
The prepuce free flap was used in 10 oral and oropharyngeal reconstructions. During the course of this study, various modifications took place. Residual penile skin necrosis and skin island necrosis early in the series led to modification of flap design. This solved the donor-site problem by placing the skin island more proximally, to consist of the outer layer of the prepuce and an equidimensional area of penile skin proximal to the prepuce. Identification of the vascular pedicle was greatly facilitated by changing to retrograde dissection, making skin incision in the mons veneris superfluous. Incongruence between donor and recipient artery, together with microsurgical arrogance, resulted in (resolvable) inflow problems in four patients. One flap was lost. After modification, marginal necrosis still occurred in one flap, most likely because of an episode of venous congestion. Although much care was taken to not harvest more skin than in a regular circumcision, penile skin shortage, especially during erection, appeared to be the major long-term shortcoming of this flap. Flap thinness and pliability, both expected strongholds of the flap, were evident during flap inset, but less apparent during follow-up because of postoperative radiotherapy in the majority of the cases. The best indications for this flap include defects in the tonsillar area extending into the soft palate, tongue, lateral oropharynx, retromolar trigonum, gums, and vallecula.
UI - 11481076
AU - Cara Terribas CJ; Lopez Garcia A
TI - [Commentary on the letter: "Azathioprine and cavum carcinoma in a male patient with autoimmune hepatitis and Crohn's disease"]
SO - Gastroenterol Hepatol 2001 Aug-Sep;24(7):366-7
UI - 11963786
AU - Gottschlich S; Koch R; Gorogh T; Holtmeyer C; Hoffmann M; Rudert H;
TI - Maune S [Collagenase 3 mRNA expression in squamous epithelial carcinomas of the oropharynx]
SO - HNO 2002 Jan;50(1):43-7
AD - Klinik fur Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitatsklinikum Kiel, Arnold-Heller-Strasse 14, 24105 Kiel.
BACKGROUND: Metalloproteinases (MMP) are endopeptidases, which are able to degrade extracellular matrix. It is assumed that MMP play an important role in invasion and metastasis of malignomas. The expression of collagenase-3, also named MMP-13, was already detected in squamous cell carcinoma of the head and neck, but the significance in the process of metastasis is still unclear. PATIENTS AND METHODS: 36 tumor biopsies of oropharyngeal squamous cell carcinoma (10 cases N0, 26 patients N+) and 12 biopsies of normal oropharyngeal mucosa were analysed with reverse transcriptase-PCR and Northern Blot for their mRNA-expression of MMP-13 and TIMP-1, the physiological inhibitor of MMP-13. RESULTS: In 30 of 36 (83.3%) tumor biopsies a MMP-13-mRNA-expression was detected. In 9 of 10 (90%) cases with N0-status and 21 of 26 (80.7%) cases with N(+)-neck the mRNA-expression could be shown. There was no correlation between MMP-13-mRNA-expression and N-status. In 34 tumor biopsies (94.4%) a TIMP-1-expression was detected. MMP-13-mRNA was not detected in normal oropharyngeal mucosa. CONCLUSIONS: It seems that MMP-13-mRNA-expression is not a prognostic factor for metastatic behavior of oropharyngeal cancer and therefore not helpful for further decisions on the therapy.
UI - 12014111
AU - Wang N; Xu YH
TI - [Study on the mechanism of basic fibroblast growth factor (bFGF) release induced by phorbol ester PMA]
SO - Shi Yan Sheng Wu Xue Bao 1998 Mar;31(1):41-8
AD - Shanghai Institute of Cell Biology, Academia Sinica, Shanghai 200031, China.
Basic fibroblast growth factor (bFGF) is a strong mitogenic factor and inducer of angiogenesis. It may play an important role in the growth of solid tumors. Whereas bFGF is known to act extracellularly, the protein lacks a transient signal peptide. No defined mechanism for bFGF secretion has been characterized besides release from dead or injured cells. To explore molecular mechanism that modulates bFGF release, we treated CNE-2 cells with PMA for two days and found that the treatment increased bFGF gene expression in the cytoplasm and bFGF release significantly after 48 hours. This result suggests that protein kinase C is very likely to be involved in the bFGF release regulation. Our results have also shown that PKC-alpha activated by PMA in CNE-2 cells can phosphorylate bFGF (18 KDa) in CNE-2 cells. The result suggests that PKC-alpha translocation and activation can phosphorylate bFGF in CNE-2 cells and increase bFGF release.
UI - 12040275
AU - Huncharek M; Kupelnick B
TI - Combined chemoradiation versus radiation therapy alone in locally advanced nasopharyngeal carcinoma: results of a meta-analysis of 1,528 patients from six randomized trials.
SO - Am J Clin Oncol 2002 Jun;25(3):219-23
AD - Division of Radiation Oncology, Department of Clinical Oncology, Marshfield Clinic Cancer Center, Wisconsin, USA.
It is currently unclear whether the addition of chemotherapy to standard radiation therapy improves clinical outcome in patients with locoregionally advanced nasopharyngeal cancer. A meta-analysis was performed to evaluate the impact of integrating chemotherapy with external beam radiation therapy in this clinical setting. Using previously described methods, a protocol was developed outlining a meta-analysis examining the influence of chemoradiation versus radiation alone (control arm) in locoregionally advanced nasopharyngeal carcinoma. The outcomes of interest were disease-free/progression-free and overall survival. Literature search techniques, study inclusion criteria, and statistical procedures were prospectively defined. Data from all available randomized controlled trials was pooled using a fixed effects model (Peto). Results were expressed as summary relative risks. Statistical tests for heterogeneity were performed. If statistical heterogeneity was demonstrated, sensitivity analyses were performed to evaluate possible sources of heterogeneity across the included studies. The literature search identified six randomized controlled trials enrolling more than 1,500 patients. All trials compared standard radical external beam radiation therapy (control arm) with radiation plus chemotherapy delivered either adjuvantly, neoadjuvantly, or concurrently with radiation. Pooling all six studies using disease-free/progression-free survival as the endpoint demonstrated that the addition of chemotherapy to radiation therapy increased disease-free/progression-free survival by 37% at 2 years, 40% at 3 years, and 34% at 4 years after treatment. Likewise, the summary relative risk for overall survival at 2 years after treatment with the addition of chemotherapy to the treatment regimen was 0.80 (0.63-1.02), reflecting a 20% increase in 2-year survival. This finding was marginally non-statistically significant. Three- and 4-year survival was increased by 19% and 21%, respectively, with the data for 4-year survival being statistically significant. The addition of chemotherapy to standard radical radiation therapy for locoregionally advanced nasopharyngeal cancer increases both disease-free/progression-free and overall survival by 19 to 40% at 2 to 4 years after treatment, depending on the endpoint of interest. Future trials are needed to confirm these results and determine the most effective regimen for integrating chemotherapy with radiation therapy in this setting.
UI - 11975077
AU - Weber A; Tannapfel A; Kosling S; Bootz F
TI - [Parapharyngeal space-occupying lesions. Differential diagnosis based on case examples]
SO - HNO 2002 Mar;50(3):223-9
AD - Klinik fur Hals-Nasen-Ohren-Heilkunde, plastische Operationen, Universitatsklinikum Leipzig, Liebigstrasse 18a, 04103 Leipzig.
INTRODUCTION: Parapharyngeal tumors account for only 0.8% of all head and neck tumors which often presents the problem of preoperative diagnosis. Up to 80% of parapharyngeal tumors are benign. PATIENTS: tumors and 1 retropharyngeal abscess were treated. The median age was 54 years. Only 2 patients demonstrated peripheral nerve lesions preoperatively. RESULTS: 17 tumors and the retropharyngeal abscess were excised via transcervical approach, with an extension by parotidectomy and temporary mandibular split in 1 case. Histological entities were pleomorphic adenomas in 5 cases, a ganglioneurinoma, neurinoma of the vagal nerve and metastasis of a squamous cell carcinoma in 2 patients each, furthermore neuroblastoma, extramedullary plasmocytoma, T-cell lymphoma, and hemangioma in 1 patient each. CONCLUSIONS: We demonstrate the differential diagnosis of parapharyngeal tumors as well as their diagnostic and therapeutic management. The tumors should be excised by a transcervical approach to protect cervical vessels and nerves, which is limited by a transoral approach.
UI - 12043214
AU - Chatani M
TI - [Current status of radiation therapy--evidence-based medicine (EBM) of radiation therapy. Radiotherapy for pharyngeal and laryngeal cancer]
SO - Nippon Igaku Hoshasen Gakkai Zasshi 2002 Mar;62(4):126-31
AD - Department of Radiology, Osaka Rosai Hospital.
Radiation therapy is the first choice of treatment for early pharyngeal and laryngeal cancers, especially those of the glottic larynx and nasopharynx. For advanced lesions without distant metastasis, more intensive treatments, i.e., chemoradiotherapy, multiple fractions per day, and conformal radiotherapy are introduced to improve local control and survival. However, the level of evidence-based medicine is different for each treatment modality