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Head And Neck Cancer Patients (head + and_neck_cancer_patient)
Selected AbstractsPrevention of wound complications following salvage laryngectomy using free vascularized tissueHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2007FRCS(C), Kevin Fung MD Abstract Background. Total laryngectomy following radiation therapy or concurrent chemoradiation therapy is associated with unacceptably high complication rates because of wound healing difficulties. With an ever increasing reliance on organ preservation protocols as primary treatment for advanced laryngeal cancer, the surgeon must develop techniques to minimize postoperative complications in salvage laryngectomy surgery. We have developed an approach using free tissue transfer in an effort to improve tissue vascularity, reinforce the pharyngeal suture line, and minimize complications in this difficult patient population. The purpose of this study was to outline our technique and determine the effectiveness of this new approach. Methods. We conducted a retrospective review of a prospective cohort and compared it with a historical group (surgical patients of Radiation Therapy Oncology Group (RTOG)-91-11 trial). Eligibility criteria for this study included patients undergoing salvage total laryngectomy following failed attempts at organ preservation with either high-dose radiotherapy or concurrent chemo/radiation therapy regimen. Patients were excluded if the surgical defect required a skin paddle for pharyngeal closure. The prospective cohort consisted of 14 consecutive patients (10 males, 4 females; mean age, 58 years) who underwent free tissue reinforcement of the pharyngeal suture line following total laryngectomy. The historical comparison group consisted of 27 patients in the concomitant chemoradiotherapy arm of the RTOG-91-11 trial who met the same eligibility criteria (26 males, 1 female; mean age, 57 years) but did not undergo free tissue transfer or other form of suture line reinforcement. Minimum follow-up in both groups was 12 months. Results. The overall pharyngocutaneous fistula rate was similar between groups,4/14 (29%) in the flap group, compared with 8/27 (30%) in the RTOG-91-11 group. There were no major wound complications in the flap group, compared with 4 (4/27, 14.8%) in the RTOG-91-11 group. There were no major fistulas in the flap group, compared with 3/27 (11.1%) in the RTOG-91-11 group. The rate of pharyngeal stricture requiring dilation was 6/14 (42%) in the flap group, compared with 7/27 (25.9%) in the RTOG-91-11 group. In our patients, the rate of tracheoesophageal speech was 14/14 (100%), and complete oral intake was achieved in 13/14 (93%) patients. Voice-Related Quality of Life Measure (V-RQOL) and Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) scores suggest that speech and swallowing functions are reasonable following free flap reinforcement. Conclusions. Free vascularized tissue reinforcement of primary pharyngeal closure in salvage laryngectomy following failed organ preservation is effective in preventing major wound complications but did not reduce the overall fistula rate. Fistulas that developed following this technique were relatively small, did not result in exposed major vessels, and were effectively treated with outpatient wound care rather than readmission to the hospital or return to operating room. Speech and swallowing results following this technique were comparable to those following total laryngectomy alone. © 2007 Wiley Periodicals, Inc. Head Neck 2007 [source] Functional results with advanced hypopharyngeal carcinoma treated with circular near-total pharyngolaryngectomy and jejunal free-flap repairHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2006Stephane Temam MD Abstract Background. Patients treated by a circular pharyngolaryngectomy for advanced hypopharyngeal carcinoma have a poor prognosis and disappointing speech restoration. Methods. Three carefully selected patients underwent a near-total laryngectomy circular pharyngectomy with jejunal free flap repair and dynamic tracheopharyngeal shunt for treatment of advanced hypopharyngeal carcinoma. They received induction chemotherapy and postoperative radiotherapy. We assessed the functional outcome. Results. There was no major local complication. One year after the end of radiotherapy, all patients were able to eat solid diets. Two patients were able to speak immediately after the end of the treatment. After speech re-education, a high-quality tracheopharyngeal voice was restored in all three patients. Performance Status Scale for Head and Neck Cancer Patients (PSSHN) showed a mean score equal to 81/100 at 1 year. Conclusions. In selected patients, near-total laryngectomy circular pharyngectomy with tracheopharyngeal shunt and jejunal free-flap repair offers good voice rehabilitation without impairing swallowing function. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Disease control, survival, and functional outcome after multimodal treatment for advanced-stage tongue base cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2004James P. Malone MD Abstract Background. Surgical resection and postoperative radiation for advanced-stage malignancies of the oral cavity, oropharynx, and hypopharynx result in a dismal overall survival of 38%. Patients with carcinoma of the tongue base frequently have advanced disease at the time of presentation, and combined-modality therapy is usually required to achieve cure. Because of the poor survival rates with advanced malignancies with standard therapy, new and innovative approaches continue to be developed in an attempt to have a greater impact on disease control, patient survival, and functional outcome after therapy. This study examines functional outcome, survival, and disease control in patients receiving an intensified treatment regimen with concomitant chemoradiotherapy, surgery, and intraoperative radiotherapy for previously untreated, resectable, stage III and IV squamous cell carcinoma (SCC) of the tongue base. Methods. Forty patients with previously untreated, resectable, stage III and IV squamous cell carcinoma of the tongue base were treated in one of three sequential phase II intensification regimens (IRs). Treatment consisted of perioperative, hyperfractionated radiotherapy (9.1 Gy) with concurrent cisplatin followed by surgical resection with intraoperative radiotherapy boost (7.5 Gy). Postoperative treatment involved concurrent chemoradiotherapy (40 Gy to the primary site and upper neck and 45 Gy to the supraclavicular areas) with cisplatin with or without paclitaxel. Locoregional and distant disease control, 2-year overall, and disease-specific survival rates were calculated. The Performance Status Scale (PSS) for Head and Neck Cancer Patients was administered to 25 of the surviving patients. The effects of the method of surgical reconstruction, surgery involving the mandible and/or larynx, and early versus advanced T stage on PSS score were evaluated with the Wilcoxon rank-sum test. Results. Median follow-up in months for IR1, IR2, and IR3 were 83.6, 75.2, and 26.8. The locoregional control rate was 100%, and the rate of distant metastases was 7.5% for all patients. Two-year overall and disease-specific survival rates for the entire study population were 74.7% and 93.6%, respectively. Mean PSS scores by subscales Eating in Public, Understandability of Speech, and Normalcy of Diet were 55 (range, 0,100), 73 (range, 25,100), and 49 (range, 0,100), respectively. PSS scores were significantly higher in patients with primary closure of the surgical defect, no mandibular surgery, and early T-stage lesions. Conclusions. Although functional outcome may be decreased by certain surgical interventions and advanced T stage, the high rate of locoregional and distant disease control and excellent 2-year disease-specific survival supports an aggressive treatment regimen for advanced tongue base cancer. © 2004 Wiley Periodicals, Inc. Head Neck26: 561,572, 2004 [source] Limited Use of Complementary and Alternative Medicine in Israeli Head and Neck Cancer PatientsTHE LARYNGOSCOPE, Issue 8 2005FACS, Yoav P. Talmi MD Abstract Hypothesis/Objective: The use of complementary or alternative medicine (CAM) is growing among cancer patients. A Medline search failed to reveal any dedicated report of CAM use specifically in patients with head and neck cancer (HNC). Study Design: Use of CAM was evaluated in a cohort of treated HNC patients. Methods: Patients treated for HNC were asked if they had used CAM since their diagnosis. Demographic data and data pertaining to mode of CAM, duration of treatment and effects were obtained. Results: One hundred forty-three patients (mean age 61 years) were included. Only nine patients (6.3%) reported using disease related CAM. This included acupuncture (4), Reiki (2), naturopathy (2), hypnosis (1), shiatsu (1), chiropractic treatment (1), homeopathy (1), and selenium (1). Conclusion: Contrary to the reported use, few of our HNC patients used CAM. Although this could be related to good caregiver-patient relationship, further studies in comparable populations are warranted to evaluate if this is a local or a pervading finding in head and neck cancer patients. [source] Salvage Surgery for Patients With Recurrent Squamous Cell Carcinoma of the Upper Aerodigestive Tract: When Do the Ends Justify the Means?,THE LARYNGOSCOPE, Issue S93 2000W. Jarrard Goodwin Jr. MD Abstract Objectives/Hypotheses: Salvage surgery is widely viewed as a "double-edged sword." It is the best option for many patients with recurrent cancer of the upper aerodigestive tract, especially when original therapy included irradiation, yet it may provide only modest benefit at high personal cost to the patient. The stakes are high because alternatives are of limited value. The primary objective of this study was to fully assess the value of salvage surgical procedures in the treatment of local and regional recurrence. The following hypotheses were developed to focus the study design and data analysis. 1) The efficacy of salvage surgery correlates recurrent stage, recurrent site, and time to presalvage recurrence. 2) The economic and noneconomic costs of salvage surgery increase with higher recurrent stage. 3) Information relating the value of salvage surgery to recurrent stage and recurrent site will be useful to these patients and the physicians who treat them. Study Design: Two complimentary methods of investigation were used: a meta-analysis of the published literature and a prospective observational study of patients undergoing salvage surgery for recurrent cancer of the upper aerodigestive tract. Methods: The meta-analysis combined 32 published reports to obtain an estimate of average treatment effect for salvage surgery with regard to survival, disease-free survival, surgical complications, and operative mortality. The prospective observational study included detailed data in 109 patients who underwent salvage surgery. In addition to parameters studied in the meta-analysis, we obtained baseline and interval quality of life data (Functional Living Index for Cancer [FLIC] scores), baseline and interval performance status evaluations (Performance Status Scale for Head and Neck Cancer Patients [PSS head and neck scores]), length of hospital stay, and hospital and physician charges, and related this data primarily to recurrent stage, recurrent site, and time to presalvage recurrence. Results: The weighted average of 5-year survival in the meta-analysis was 39% in 1,080 patients from 28 different institutions. In the prospective study, median disease-free survival was 17.9 months in 109 patients, and this correlated strongly with recurrent stage, weakly with recurrent site, and not at all with time to presalvage recurrence. Noneconomic costs for patients and economic costs correlated with recurrent stage, but not with site. Baseline FLIC and PSS head and neck scores correlated with recurrent stage, but not with site. After salvage surgery the percentage of patients reaching or exceeding baseline was 51% for FLIC scores, and this differed significantly with recurrent stage. Postoperative interval "success" in PSS head and neck subscale scores for diet and eating in public also correlated with recurrent stage. Conclusions: Overall, the expected efficacy for salvage surgery in patients with recurrent head and neck cancer was surprisingly good, but success was limited and costs were great in stage III and, especially, in stage IV recurrences. A strong correlation of efficacy and noneconomic costs with recurrent stage allowed the creation of expectation profiles that may be useful to patients. Additional systematic clinical research is needed to improve results. In the end, the decision to undergo salvage surgery should be a personal choice made by the patient after honest and compassionate discussion with his or her surgeon. [source] Reply to Emotional Well-Being Does Not Predict Survival in Head and Neck Cancer PatientsCANCER, Issue 10 2008A Radiation Therapy Oncology Group study No abstract is available for this article. [source] Head and neck cancer patients with pulmonary nodules: Value and role of CT-guided transthoracic needle aspiration biopsiesHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2003Benoît Mesurolle MD Abstract Background. To evaluate transthoracic needle aspiration biopsies of pulmonary lesions in patients with squamous cell cancer of head and neck. Methods. Retrospective series of 85 patients with squamous cell cancer of head and neck cancer and pulmonary nodules who underwent CT-guided needle aspiration biopsy. Results. Diagnostic samples were obtained in 85% of patients. There were 8 benign and 77 malignant lesions. Among the 73 proved cases, 4 were false-negative cases. CT-guided biopsy had an accuracy of 81%, a sensitivity of 94%, and a negative predictive value of 60%. Accuracies were 68% for lesions of 20 mm or smaller and 89% for lesions greater than 20 mm. In a subset of 45 solitary lesions, among 30 positive biopsies, 15 were categorized as primary malignancies, 3 as metastatic, and 12 as indeterminate malignancies. Conclusions. In head and neck cancer patients, the prevalence of thoracic malignancies is high when a pulmonary lesion is detected. CT-guided biopsy of pulmonary lesion is an accurate procedure. However, a third of positive biopsies were categorized as indeterminate malignancies. © 2003 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source] Cancer cachexia syndrome in head and neck cancer patients: Part II.HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2007Pathophysiology Abstract Cancer cachexia is a morbid wasting syndrome common among patients with head and neck cancer. While its clinical manifestations have been well characterized, its pathophysiology remains complex. A comprehensive literature search on cancer cachexia was performed using the National Library of Medicine's PubMed. The Cochrane Library and Google search engine were also used. Recent evidence and new concepts on the pathophysiology of cancer cachexia are summarized. Targeted therapies are presented, and new concepts are highlighted. Cancer cachexia is characterized by complex, multilevel pathogenesis. It involves up-regulated tissue catabolism and impaired anabolism, release of tumor-derived catabolic factors and inflammatory cytokines, and neuroendocrine dysfunction. These culminate to create an energy-inefficient state characterized by wasting, chronic inflammation, neuroendocrine dysfunction, and anorexia. © 2007 Wiley Periodicals, Inc. Head Neck, 2007 [source] Cancer cachexia syndrome in head and neck cancer patients: Part I. Diagnosis, impact on quality of life and survival, and treatmentHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2007Marion Couch MD Abstract Background Cancer cachexia is a debilitating, wasting condition that affects many cancer patients, including those with head and neck cancer. The overall incidence of cancer cachexia is quite high for some types of cancer, and cachexia will be the main cause of death for more than 20% of all cancer patients. This syndrome uniquely challenges patients with head and neck cancer. This article outlines the diagnosis of cancer cachexia, reviews its impact on patient quality of life (QOL) and survival, and updates the reader on potential therapies that may suppress it. Methods A comprehensive literature search was performed using PubMed of the National Library of Medicine, which includes more than 15 million citations back to the 1950s. The Cochrane Library and Google search engine were used as well. Results This syndrome differs significantly from starvation, and thus accurate and timely diagnosis is essential. Nutritional therapy alone is insufficient. Current management strategies include corticosteroids and megesterol acetate, in conjunction with nutritional therapy. Future strategies may include nutraceuticals, omega-3 fatty acids, inflammatory antagonists, and other targeted treatments. Conclusions Because cancer cachexia differs significantly from starvation, nutritional supplementation must be used in conjunction with other anti-cachexia agents to reverse the chronic systemic inflammatory state and the effects of circulating tumor-derived factors seen in cachexia. Careful identification of patients at risk and those suffering from this syndrome will lead to better outcomes and treatments. Ultimately, more research is needed to better treat this devastating condition. © 2007 Wiley Periodicals, Inc. Head Neck, 2007 [source] Health-related quality of life profiles based on survivorship status for head and neck cancer patients,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2007David P. Goldstein MD Abstract Background. As the methodologies for evaluating health-related quality of life (HRQOL) in head and neck cancer patients have matured over the past 10 years, there has been an increasing focus on reporting longitudinal data. These studies have primarily focused on long-term survivors. This study addresses the HRQOL of both long-term and short-term survivors. Methods. This is a prospective, longitudinal study of 479 head and neck cancer patients followed for at least 3 years after diagnosis. Analysis of longitudinally collected HRQOL scores was based on survivorship status. Results. The HRQOL for 3 survivorship groups: short-term (died <1 year), intermediate-term (died 1-3 years), and long-term survivors (alive >3 years) were different at all time points (pretreatment, 3, 6, and 12 months). Differences were greatest between the short-term and long-term survivors. Long-term survivors demonstrated the best HRQOL and an improving HRQOL trajectory at 12 months. The HRQOL of short-term survivors declined precipitously throughout all available follow-up. Intermediate-term survivors did show some improvement following treatment but had a declining HRQOL trajectory at 12 months. Conclusion. The HRQOL profiles of head and neck cancer patients differed significantly depending on survivorship status. Long-term HRQOL results should be analyzed within the context of the results for all of the patients eligible to have been included in the initial study cohort. © 2006 Wiley Periodicals, Inc. Head Neck, 2007. [source] Presence of a tracheotomy tube and aspiration status in early, postsurgical head and neck cancer patientsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2005Steven B. Leder PhD Abstract Background. We sought to investigate the effects, if any, that the presence of a tracheotomy tube has on aspiration status in early, postsurgical head and neck cancer patients. Methods. Twenty-two consecutive adult, postoperative head and neck cancer patients were prospectively evaluated with fiberoptic endoscopic evaluation of swallowing (FEES) under three conditions: (1) tracheotomy tube present, (2) tracheotomy tube removed and tracheostoma covered with gauze sponge; and (3) tracheotomy tube removed and tracheostoma left open and uncovered. For each condition, the endoscope was first inserted transnasally to determine aspiration status during FEES and then inserted through the tracheostoma to corroborate aspiration status by examining the distal trachea inferiorly to the carina. Three experienced examiners determined aspiration status under each condition and endoscope placement. Results. There was 100% agreement on aspiration status between FEES results and endoscopic examination through the tracheostoma. Specifically, 13 of 22 patients (59%) swallowed successfully and nine of 22 (41%) aspirated. There was also 100% agreement on aspiration status for tracheotomy tube present, decannulation and tracheostoma covered by gauze sponge, and decannulation and tracheostoma left open and uncovered. Conclusions. Neither presence of a tracheotomy tube nor decannulation affected aspiration status in early, postsurgical head and neck cancer patients. The clinical impressions that a tracheotomy or tracheotomy tube increases aspiration risk or that decannulation results in improved swallowing function are not supported. Rather, need for a tracheotomy indicates comorbidities (eg, respiratory failure, trauma, stroke, advanced age, reduced functional reserve, and medications used to treat the critically ill) that by themselves predispose patients for dysphagia and aspiration. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Numeracy and the shortcomings of utility assessment in head and neck cancer patients,,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2004Seth R. Schwartz MD Abstract Background. Because survival differences between surgical and nonsurgical treatment for head and neck cancer (HNC) are hard to detect, increasing focus has been placed on quality of life (QOL) differences after treatment. Utility assessment provides insight into QOL. Evidence suggests that a patient's comfort with numerical concepts ("numeracy") may influence utility measures. We hypothesize that patients who are nonnumerate provide inconsistent utility data in QOL studies. Methods. New HNC (n = 18) patients were recruited to participate. Patients completed a numeracy questionnaire, a utility assessment, and a global QOL questionnaire. Higher scores reflect better function. Interviewers rated the functional level of each patient. For both numerate and nonnumerate patients, utility scores were compared with global QOL (good vs poor) and observer-rated function. Results. Half of the patients were numerate. Numerate patients who rated their QOL as good had significantly higher utility scores than did patients with poor global QOL (0.95 vs 0.43, p = .03). In contrast, nonnumerate patients with good QOL had lower utility scores than did patients with poor QOL (0.45 vs 0.77, NS). Utility scores for numerate patients correlated well with observer-rated function (r = 0.41 to r = 0.57), whereas those of nonnumerate patients did not (r = ,0.16 to r = 0.06). Conclusions. QOL evaluation through utility assessment may provide inaccurate and contradictory data about patient functioning for nonnumerate patients. This may confound QOL assessment when interpreting utility data. © 2004 Wiley Periodicals, Inc. Head Neck26: 401,407, 2004 [source] Head and neck cancer patients with pulmonary nodules: Value and role of CT-guided transthoracic needle aspiration biopsiesHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2003Benoît Mesurolle MD Abstract Background. To evaluate transthoracic needle aspiration biopsies of pulmonary lesions in patients with squamous cell cancer of head and neck. Methods. Retrospective series of 85 patients with squamous cell cancer of head and neck cancer and pulmonary nodules who underwent CT-guided needle aspiration biopsy. Results. Diagnostic samples were obtained in 85% of patients. There were 8 benign and 77 malignant lesions. Among the 73 proved cases, 4 were false-negative cases. CT-guided biopsy had an accuracy of 81%, a sensitivity of 94%, and a negative predictive value of 60%. Accuracies were 68% for lesions of 20 mm or smaller and 89% for lesions greater than 20 mm. In a subset of 45 solitary lesions, among 30 positive biopsies, 15 were categorized as primary malignancies, 3 as metastatic, and 12 as indeterminate malignancies. Conclusions. In head and neck cancer patients, the prevalence of thoracic malignancies is high when a pulmonary lesion is detected. CT-guided biopsy of pulmonary lesion is an accurate procedure. However, a third of positive biopsies were categorized as indeterminate malignancies. © 2003 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source] Psychosocial adjustment in head and neck cancer: The impact of disfigurement, gender and social supportHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2003FRCPC, Mark R. Katz MD Abstract Background. The purpose of this study was to examine the psychosocial impact of disfigurement, gender, and social support after surgical treatment of head and neck cancer. Method. Eighty-two ambulatory head and neck cancer patients, 6 months or more after treatment and free of active disease were assessed. Ratings of disfigurement were obtained using a valid and reliable 9-point scale developed for the study. Standardized measures of social support, depressive symptoms, well-being, and life happiness were used. Results. The sample as a whole displayed high levels of life happiness, low levels of depression, and positive feelings of well-being. Women demonstrated higher levels of depression and lower life happiness; subjects with greater disfigurement were more depressed. Social support seemed to buffer the impact of greater levels of disfigurement on well-being for women but not for men. Conclusion. These results suggest that women with head and neck cancer who experience low social support and face disfiguring treatment are at greatest risk for psychosocial dysfunction. © 2003 Wiley Periodicals, Inc. Head Neck 25: 103,112, 2003 [source] A pilot study evaluating the safety and microbiologic efficacy of an economically viable antimicrobial lozenge in patients with head and neck cancer receiving radiation therapyHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2002FRCPC, Samy El-Sayed MD Abstract Background Mucositis occurs in almost all radiotherapy-treated head and neck cancer patients, in approximately 75% of patients receiving hematopoietic marrow transplantation, and in approximately 40% of all patients who receive chemotherapy. Mucositis is painful, may affect all oral functions, and is a dose- and rate-limiting toxicity of therapy for cancer. Radiation-associated mucositis (onset, intensity, and duration) has been shown in recent clinical trials to be modified by the use of antibacterial/antifungal lozenges. Purpose The aim of this collaborative two-center phase II study was to assess the toxicity and microbiologic efficacy of an economically viable antimicrobial lozenge in the management of patients receiving radiation therapy for head and neck cancer. Materials and Methods Seventeen patients scheduled to receive radical or postoperative radiotherapy were provided with bacitracin, clotrimazole, and gentamicin (BCoG) lozenges (one lozenge dissolved in the mouth qid from day 1 of radiotherapy until completion). Ease of use and palatability of the lozenges, patients' symptoms (swallowing and pain), and quantitative and qualitative microbiologic evaluation of an oral rinse collection was conducted at least once weekly during radiation therapy. Results No significant side effects were reported from the use of the lozenges. The lozenges were well tolerated at the beginning of treatment by all patients, with some minor difficulty associated with oral discomfort toward the end of the treatment. Microbiologic evaluation showed consistent elimination of yeast organisms in all patients. In four patients there was no growth of gram-negative bacilli on culture, whereas in two patients, fluctuating counts were seen, and one patient had increased counts. The remaining patients had significant reduction in the gram-negative bacilli counts. Conclusions This study demonstrated that the BCoG lozenge is tolerable and microbiologically efficacious, achieving elimination of Candida in all patients and reduction in gram-negative flora in most patients. A phase III study is underway to evaluate the clinical efficacy of this lozenge. © 2002 John Wiley & Sons, Inc. Head Neck 24: 6,15, 2002. [source] Management of advanced mandibular osteoradionecrosis with free flap reconstructionHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2001David W. Chang MD Abstract Background The purpose of this study was to assess the effectiveness of free tissue transfer for treatment of advanced mandibular osteoradionecrosis (ORN) in head and neck cancer patients. Methods We reviewed 29 patients who were treated for advanced mandibular ORN by radical resection and reconstruction with free flaps at our institution. All patients had either failed to respond to conservative treatment, including hyperbaric oxygen therapy and debridement or had pathological fracture due to ORN. Results Twenty-four vascularized bone (17 fibula, five iliac, and two scapula), four rectus abdominis myocutaneous, and one radial forearm fasciocutaneous free flaps were used. The complications occurred in 6 of 29 patients (21%). A total of four flaps (14%) were lost. The mean follow-up was 2 years 9 months. All patients had complete resolution of ORN symptoms. No evidence of ORN recurrence was observed in any patient. Conclusion For advanced osteoradionecrosis of the mandible, radical resection followed by reconstruction using free flap provides a reliable means of obtaining good wound healing with acceptable aesthetic and functional results. © 2001 John Wiley & Sons, Inc. Head Neck 23: 830,835, 2001. [source] Preoperative risk assessment for gastrostomy tube placement in head and neck cancer patientsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2001John M. Schweinfurth MD Abstract Background The presentation and definitive surgical treatment of head and neck malignancies have varying impact on postoperative recovery and return of swallowing function, which heretofore has not been well defined. Methods We performed a retrospective chart review of 142 patients who underwent extirpative surgery for head and neck cancer. Results Factors significantly associated with the need for long-term postoperative nutritional support (p < .05) included heavy alcohol use, tongue base involvement and surgery, pharyngectomy, composite resection, reconstruction with a myocutaneous flap, radiation therapy, tumor size, and moderately-to-poorly differentiated histology. Heavy alcohol users were at an absolute risk for gastrostomy tube dependence; patients who underwent radiation therapy, flap reconstruction, tongue base resection, and pharyngectomy were at a two to sevenfold increased risk for gastrostomy tube dependence, respectively. Conclusions High-risk patients based on these criteria should receive a feeding gastrostomy at the time of their initial surgical therapy. © 2001 John Wiley & Sons, Inc. Head Neck 23: 376,382, 2001. [source] Randomized study of percutaneous endoscopic gastrostomy versus nasogastric tubes for enteral feeding in head and neck cancer patients treated with (chemo)radiationJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 5 2008J Corry Summary Percutaneous endoscopic gastrostomy (PEG) tubes have largely replaced nasogastric tubes (NGT) for nutritional support of patients with head and neck cancer undergoing curative (chemo)radiotherapy without any good scientific basis. A randomized trial was conducted to compare PEG tubes and NGT in terms of nutritional outcomes, complications, patient satisfaction and cost. The study was closed early because of poor accrual, predominantly due to patients' reluctance to be randomized. There were 33 patients eligible for analysis. Nutritional support with both tubes was good. There were no significant differences in overall complication rates, chest infection rates or in patients' assessment of their overall quality of life. The cost of a PEG tube was 10 times that of an NGT. The duration of use of PEG tubes was significantly longer, a median 139 days compared with a median 66 days for NGT. We found no evidence to support the routine use of PEG tubes over NGT in this patient group. [source] Demographic and risk factors in patients with head and neck tumorsJOURNAL OF MEDICAL VIROLOGY, Issue 5 2009Ruth Tachezy Abstract The association between human papillomavirus (HPV) infection and the development of head and neck cancer has been documented recently. In this study on 86 head and neck cancer patients and 124 controls, data regarding demographics, behavioral risk factors, and risks related to HPV exposure were collected. HPV detection was carried out using polymerase chain reaction in the tumors and in oral exfoliated cells, and HPV typing by a reverse line blot assay specific for 37 HPV types. Sera were tested by an enzyme-linked immunosorbent assay specific for HPV proteins. Head and neck cancer cases report significantly more oral-anal contact (P,=,0.02) and tobacco and alcohol use than controls (P,=,0.001; P,=,0.02, respectively). High-risk HPV DNA was detected in 43% of oral washings of cases and 4% of controls (P,<,0.0001). The association between the presence of high-risk HPV DNA in oral exfoliated cells and in tumor tissues was statistically significant (adjusted P,<,0.0001). The prevalence of HPV-specific antibodies was significantly higher in cases than in controls (adjusted P,<,0.0001). These results provide epidemiological and immunological evidence for HR HPV as a strong risk factor (OR,=,44.3, P,<,0.0001) for head and neck cancer, even after controlling for age, tobacco and alcohol use. The detection of high-risk HPV DNA in oral exfoliated cells and HPV-specific antibodies in serum can be considered as clinically relevant surrogate markers for the presence of a HPV-associated head and neck cancer, with a high sensitivity (83%) and specificity (88%). J. Med. Virol. 81:878,887, 2009. © 2009 Wiley-Liss, Inc. [source] Low-dose weekly platinum-based chemoradiation for advanced head and neck cancer,,THE LARYNGOSCOPE, Issue 2 2010John M. Watkins MD Abstract Objectives/Hypothesis: The optimal concurrent chemoradiotherapy regimen for definitive treatment of locoregionally advanced head and neck cancer remains to be determined. The present investigation reports toxicities, disease control, patterns of failure, and survival outcomes in a large mature cohort of patients treated with low-dose weekly platinum-based concurrent chemoradiotherapy. Study Design: Retrospective single-institution series. Methods: Toxicity and outcome data for locoregionally advanced head and neck cancer patients treated with low-dose weekly platinum-based chemotherapy concurrent with standard fractionation radiotherapy were retrospectively collected and analyzed from a clinical database. Survival analysis methods, including Kaplan-Meier estimation and competing risks analysis, were used to assess locoregional disease control, freedom from failure, and overall survival. Results: Ninety-six patients were eligible for the present analysis. Nearly all patients had American Joint Committee on Cancer clinical stage III to IVB disease (99%). Severe acute toxicities included grade 3 mucositis (61%), grade 3/4 nausea (27%/1%), and grade 3 neutropenia (8%). Thirty-seven patients (38%) required hospitalization for a median of 7 days (range, 1,121). Ninety-two percent of patients completed the fully prescribed course of radiotherapy, and 87% completed ,6 cycles of chemotherapy. At a median survivor follow-up of 40 months (range, 8,68), 47% of patients were without evidence of disease recurrence. The estimated 4-year freedom from failure and overall survival were 48% and 58%, respectively. Initial site(s) of disease failure were locoregional for 22 patients, locoregional and distant (five patients), and distant only (14 patients). Conclusions: Weekly low-dose platinum-based chemotherapy with full-dose daily radiotherapy is a tolerable alternative regimen for locoregionally advanced head and neck cancers, with comparable efficacy and patterns of failure to alternative regimens. Laryngoscope, 2010 [source] Limited Use of Complementary and Alternative Medicine in Israeli Head and Neck Cancer PatientsTHE LARYNGOSCOPE, Issue 8 2005FACS, Yoav P. Talmi MD Abstract Hypothesis/Objective: The use of complementary or alternative medicine (CAM) is growing among cancer patients. A Medline search failed to reveal any dedicated report of CAM use specifically in patients with head and neck cancer (HNC). Study Design: Use of CAM was evaluated in a cohort of treated HNC patients. Methods: Patients treated for HNC were asked if they had used CAM since their diagnosis. Demographic data and data pertaining to mode of CAM, duration of treatment and effects were obtained. Results: One hundred forty-three patients (mean age 61 years) were included. Only nine patients (6.3%) reported using disease related CAM. This included acupuncture (4), Reiki (2), naturopathy (2), hypnosis (1), shiatsu (1), chiropractic treatment (1), homeopathy (1), and selenium (1). Conclusion: Contrary to the reported use, few of our HNC patients used CAM. Although this could be related to good caregiver-patient relationship, further studies in comparable populations are warranted to evaluate if this is a local or a pervading finding in head and neck cancer patients. [source] Efficacy of Concomitant Chemoradiation and Surgical Salvage for N3 Nodal Disease Associated With Upper Aerodigestive Tract Carcinoma,THE LARYNGOSCOPE, Issue 11 2000Khwaja A. Ahmed MD Abstract Objectives/Hypothesis To determine whether an aggressive approach using trimodality therapy would improve the outcome in head and neck cancer patients with advanced (N3) nodal disease. Study Design In this retrospective, nonrandomized review, we analyzed a subset of patients who were treated in a targeted chemoradiation therapy protocol, consisting of 31 patients who received treatment between June 1993 and June 1997. Methods Patients received selective intra-arterial infusions of cisplatin (150 mg/m2/wk for 4 weeks) and concomitant radiation therapy (2 Gy/fraction × 35 daily fractions over a 7-wk period) to the primary and clinically positive nodal disease. The patients were re-evaluated 2 months later and underwent salvage neck dissections if there was any residual disease. Results Classification of disease in the primary site was as follows: T1 in 2 patients, T2 in 6 patients, T3 in 14 patients, and T4 in 9 patients. Among the 31 patients who were assessed for response at the nodal site, 4 of 31 (13%) had a complete response, 21 of 31 (68%) had a partial response, and 1 of 31 (3%) had no response. Excluding the 5 patients who could not be evaluated, 4 of 26 patients (15%) had a complete response, 21 of 26 (81%) had a partial response, and 1 of 26 (4%) had no response. Nineteen patients subsequently underwent neck dissection, and five patients had histological evidence of residual disease. The remaining seven patients included four who had a complete response in their necks and three who died of intercurrent disease before re-staging. Among the 23 patients who were rendered disease free, there were no recurrences within the neck, whereas 1 patient had recurrence at the primary site and 11 patients had recurrence at distant sites. With a median follow-up of 15 months (range, 4,41 mo), the 3-year overall survival and disease-specific survival were 41% and 43%, respectively. Conclusions Targeted chemoradiation therapy followed by surgical salvage is a highly effective approach for regional control of patients with N3 nodal disease, whereas additional strategies are required to address the problem of distant metastases. [source] Avoiding Transfusion in Head and Neck Surgery: Feasibility Study of Erythropoietin,THE LARYNGOSCOPE, Issue 1 2000Erich M. Sturgis MD Abstract Objective: To determine the feasibility of perioperative erythropoietin to avoid blood transfusion in head and neck cancer surgery. Study Design: Retrospective chart review. Methods: Ninety-nine patients undergoing surgical resection of head and neck tumors at our institution were assessed for demographic data, nutritional parameters, tumor/surgical information, hematological/transfusion data, and contraindications to erythropoietin. Each transfusion was classified as to its appropriateness, and the potential benefit of erythropoietin was assessed in each patient. A cost analysis was also performed. Results: Most transfused patients (63%) received too many units. A subgroup at high risk of transfusion was identified who would benefit most from perioperative erythropoietin. Assuming that perioperative erythropoietin therapy is equivalent to the transfusion of 4 units, we estimate that the majority (74%) of transfused patients would not have required a transfusion if more stringent transfusion criteria were followed and those at high risk were given perioperative erythropoietin. Although the cost for transfusing 4 units is equivalent to that of a perioperative course of erythropoietin, the overall direct cost of erythropoietin treatment would actually have been more expensive. Conclusions: Perioperative erythropoietin therapy may be appropriate for a subgroup of head and neck cancer patients, but a prospective randomized controlled study in such a subgroup is needed to better define those most likely to benefit from it and to assess actual cost/benefit ratios. [source] Awake fibrecapnic intubation: a novel technique for intubation in head and neck cancer patients with a difficult airway,ANAESTHESIA, Issue 5 2006J. M. Huitink Summary Awake fibreoptic intubation is the gold standard for difficult airway management but failures are reported in the literature in up to 13% of cases. In case of failure, a tracheotomy is often indicated. We describe a novel technique for intubation in head and neck cancer patients with a difficult airway that we call awake fibrecapnic intubation. The aim of this study was to investigate the feasibility of this technique. We studied prospectively 15 consecutive intubations in head and neck cancer patients before diagnostic or therapeutic surgical procedures. After topical anaesthesia, a fibrescope was introduced into the pharynx. Spontaneous respiration was maintained in all patients. Through the suction channel of the fibrescope a special suction catheter was advanced into the airway for carbon dioxide measurements. When four capnograms were obtained, the fibrescope was railroaded over the catheter and after identification of tracheal rings, a tracheal tube was placed. Tracheal intubation was successful in all patients without bleeding or complications, with a median (range) time to intubation of 3 (2,15) min. Identification of the vocal cords and glottis was difficult in four patients due to extensive anatomical abnormalities or poor visibility; even in these patients, a capnogram was obtained within 4 s. [source] Elective gastrostomy, nutritional status and quality of life in advanced head and neck cancer patients receiving chemoradiotherapyANZ JOURNAL OF SURGERY, Issue 10 2009Randall P. Morton Abstract Background:, Chemoradiotherapy for treatment of advanced head and neck cancer (HNC) is used to achieve organ preservation without compromising survival. Because chemoradiotherapy usually impacts adversely on nutritional and functional status, feeding by percutaneous endoscopic gastrostomy (PEG) is often part of the management regimen for these patients, but the presence of a PEG tube can also be associated with reduced quality of life (QOL). This study aimed to examine the factors associated with PEG insertion and the effects of PEG use on QOL and functional outcomes in HNC patients receiving chemoradiotherapy. Method:, Survey of 36 consecutive patients treated by primary chemoradiotherapy for HNC. Patient weight, age, tumour type, details of PEG insertion, feeding regimens and treatment were noted. The survey comprised the Performance Status Scale, the Functional Measure for Swallowing, Nutritional Mode and a self-assessment of QOL. Results:, PEG insertion within 1 month of treatment was associated with smaller fall in body mass index at 12 months than PEG insertion 1 month or more after the start of the treatment (P < 0.05). Body mass index change was inversely correlated with health-related quality of life and significantly related to lower speech and swallowing function scores. Longer PEG duration correlated with poorer performance status and swallowing function (P < 0.01). Longer PEG duration also predicted poorer overall QOL (P < 0.01) and poorer swallowing (P < 0.01) and speech (P < 0.05). Nutritional mode was related to overall QOL (P < 0.01). Conclusions:, Nutritional support for HNC patients undergoing chemoradiotherapy is an essential component of patient care. Early PEG insertion and shorter PEG duration are associated with more favourable QOL-related outcomes. [source] Optimization of an enrichment process for circulating tumor cells from the blood of head and neck cancer patients through depletion of normal cellsBIOTECHNOLOGY & BIOENGINEERING, Issue 2 2009Liying Yang Abstract The optimization of a purely negative depletion, enrichment process for circulating tumor cells (CTCs) in the peripheral blood of head and neck cancer patients is presented. The enrichment process uses a red cell lysis step followed by immunomagnetic labeling, and subsequent depletion, of CD45 positive cells. A number of relevant variables are quantified, or attempted to be quantified, which control the performance of the enrichment process. Six different immunomagnetic labeling combinations were evaluated as well as the significant difference in performance with respect to the blood source: buffy coats purchased from the Red Cross, fresh, peripheral blood from normal donors, and fresh peripheral blood from human cancer patients. After optimization, the process is able to reduce the number of normal blood cells in a cancer patient's blood from 4.05,×,109 to 8.04,×,103 cells/mL and still recover, on average, 2.32 CTC per mL of blood. For all of the cancer patient blood samples tested in which CTC were detected (20 out of 26 patients) the average recovery of CTCs was 21.7 per mL of blood, with a range of 282 to 0.53 CTC. Since the initial number of CTC in a patient's blood is unknown, and most probably varies from patient to patient, the recovery of the CTC is unknown. However, spiking studies of a cancer cell line into normal blood, and subsequent enrichment using the optimized protocol indicated an average recovery of approximately 83%. Unlike a majority of other published studies, this study focused on quantifying as many factors as possible to facilitate both the optimization of the process as well as provide information for current and future performance comparisons. The authors are not aware any other reported study which has achieved the performance reported here (a 5.66 log10) in a purely negative enrichment mode of operation. Such a mode of operation of an enrichment process provides significant flexibility in that it has no bias with respect to what attributes define a CTC; thereby allowing the researcher or clinician to use any maker they choose to define whether the final, enrich product contains CTCs or other cell type relevant to the specific question (i.e., does the CTC have predominately epithelial or mesenchymal characteristics?). Biotechnol. Bioeng. 2009;102: 521,534. © 2008 Wiley Periodicals, Inc. [source] Complications of radiotherapy in laryngopharyngeal cancer,CANCER, Issue 19 2009Effects of a prospective smoking cessation program Abstract BACKGROUND: Radiotherapy (XRT) is effective as the primary treatment modality for laryngopharyngeal cancer; however, complications of XRT can result in significant morbidity. Few previous studies have examined the effect of continued smoking on complications of XRT. The authors of this report hypothesized that patients with laryngopharyngeal cancer who successfully quit smoking would have fewer complications of primary XRT. METHODS: All patients with head and neck cancer who were smokers at the time of diagnosis were referred prospectively to the Tobacco Treatment Program (TTP). From this group, the patients with laryngopharyngeal cancer who received XRT as the primary treatment modality were retrospectively selected and studied. RESULTS: Eighty-six patients were identified and were divided into 3 groups: Seventeen patients attended TTP and quit smoking before the start of XRT (Group 1), 33 patients attended TTP but continued to smoke during XRT (Group 2), and 37 patients refused TTP (Group 3). On the basis of a review of medical records for patients in Group 3, 20 patients quit smoking before starting XRT and were included in Group 1 (abstainers), 11 patients continued to smoke and were included in Group 2 (continued smokers), and 6 patients had incomplete data and were omitted from further analysis. Analyses both with and without Group 3 patients yielded similar results. Abstainers and continued smokers had similar demographic and clinical characteristics. With the exception of skin changes, all complications (mucositis, need for feeding tube, duration of feeding tube, need for hospitalization, pharyngeal stricture, and osteoradionecrosis) were more common in the patients who continued to smoke, although the only complications that were significantly more common were the need for hospitalization (P = .04) and osteoradionecrosis (P = .03). Patients who continued to smoke were more likely to develop osteoradionecrosis (relative risk [RR], 1.32; 95% confidence interval [CI], 1.09-1.6; P = .03) and to require hospitalization during treatment (RR, 1.46; 95% CI, 1.05-2.02; P = .04). CONCLUSIONS: Continued smoking during treatment appeared to increase the risk for complications of XRT for patients with laryngopharyngeal cancer and possibly increased hospitalizations. This hypothesis-generating study emphasized the importance of smoking cessation programs in the management of patients with head and neck cancer patients who receive XRT. Cancer 2009. © 2009 American Cancer Society. [source] Interleukin-6 predicts recurrence and survival among head and neck cancer patients,CANCER, Issue 4 2008Sonia A. Duffy PhD Abstract BACKGROUND. Increased pretreatment serum interleukin (IL)-6 levels among patients with head and neck squamous cell carcinoma (HNSCC) have been shown to correlate with poor prognosis, but sample sizes in prior studies have been small and thus unable to control for other known prognostic variables. METHODS. A longitudinal, prospective cohort study determined the correlation between pretreatment serum IL-6 levels, and tumor recurrence and all-cause survival in a large population (N = 444) of previously untreated HNSCC patients. Control variables included age, sex, smoking, cancer site and stage, and comorbidities. Kaplan-Meier plots and univariate and multivariate Cox proportional hazards models were used to study the association between IL-6 levels, control variables, and time to recurrence and survival. RESULTS. The median serum IL-6 level was 13 pg/mL (range, 0-453). The 2-year recurrence rate was 35.2% (standard error, 2.67%). The 2-year death rate was 26.5% (standard error, 2.26%). Multivariate analyses showed that serum IL-6 levels independently predicted recurrence at significant levels [hazard ratio (HR) = 1.32; 95% confidence interval (CI), 1.11 to 1.58; P = .002] as did cancer site (oral/sinus). Serum IL-6 level was also a significant independent predictor of poor survival (HR = 1.22; 95% CI, 1.02 to 1.46; P = .03), as were older age, smoking, cancer site (oral/sinus), higher cancer stage, and comorbidities. CONCLUSIONS. Pretreatment serum IL-6 could be a valuable biomarker for predicting recurrence and overall survival among HNSCC patients. Using IL-6 as a biomarker for recurrence and survival may allow for earlier identification and treatment of disease relapse. Cancer 2008. © 2008 American Cancer Society. [source] Emotional well-being does not predict survival in head and neck cancer patientsCANCER, Issue 10 2008A Radiation Therapy Oncology Group study No abstract is available for this article. [source] ,When will I see you again?' Using local recurrence data to develop a regimen for routine surveillance in post-treatment head and neck cancer patientsCLINICAL OTOLARYNGOLOGY, Issue 6 2009S.E. Lester Objective:, To develop an evidence-based regimen for routine surveillance of post-treatment head and neck cancer patients. Design:, Review of 10 years of prospectively collected patient data. Main outcome measures:, Time of first presentation of ,new cancer event' (either first recurrence or second primary tumour). We did not evaluate whether or not the detected new cancer events were curable. Results:, Data from patients with primary squamous cell carcinoma of the larynx, oropharynx and hypopharynx were analysed. A total of 676 previously undiagnosed squamous cell carcinomas were recorded in these regions. In these patients there were 105 recurrences and 20 second primary cancers were recorded; 95th percentile of "time to a new cancer event" was calculated in years. These were for larynx 4.7 years, oropharynx 2.7 years, hypopharynx 2.3 years. The time to new cancer event was similar for early and late laryngeal cancers. Only 36 (47%) of the hypopharyngeal cancers were treated with curative intent and of these 36% had a previously undiagnosed cancer event. Conclusion:, Local data and published evidence support a follow-up duration of 7 years for laryngeal primaries and 3 years for both oropharyngeal and hypopharyngeal primaries. Late stage oropharyngeal cancers may require longer follow up than early cancers. Patients who continue to smoke may need longer follow up. A change in local follow-up protocol to this regimen would save 10 patient slots every week with no detriment to patient care. Clin. Otolaryngol. 2009, 34, 546,551. [source] | |||||||||||||||||||||||||