Chemotherapy for Thyroid Cancer

As with salivary gland tumors, thyroid cancer constitutes a spectrum of histologic subtypes and clinical Table 22-10. COMBINATION CHEMOTHERAPY IN SALIVARY GLAND CANCER CDDP 5-FU CDDP DOXO 5-FU CDDP EPI 5-FU or CTX CTX DOXO CTX DOXO CDDP Adenoid cystic Mucoepidermoid Mucoepidermoid 'Variable 'Variable 'Variable 'Variable * Variable includes adenoid cystic carcinoma and mucoepidermoid carcinoma as the most common histologies. BLM bleomycin CDDP cisplatin CT chemotherapy CTX cyclophosphamide DOXO...

Rehabilitation and Quality of Life Assessment in Head and Neck Cancer

In 1947, the World Health Organization (WHO) expanded its definition of health beyond the absence of disease and infirmity, to include the state of physical, mental, and social being. This milestone change in connotation elevated the study of health-related quality of life to an accepted endpoint for clinical studies and promulgated investigator interest.1,2 Reflecting its increased use in medical studies, quality of life was introduced as a category in the Index Medicus in 1966.1 Since then,...

Neutron Therapy

This densely ionizing high linear energy transfer particulate radiation has a limited but important role in clinical radiation oncology. Fast neutrons can be contrasted to photons in th following ways 1. the biologic effectiveness is much less influenced by hypoxic environments. 2. lethal effects are less dependent on the cell cycle phase. 3. the ability of malignant cells to repair sublethal damage matters less. 4. is biologically more effective with a relative biologic effectiveness (RBE) of...

References

Orbital tumors Results following the transcra nial operative attack. New York Oskar Priest 1941. 2. Smith RR, Klopp CT, Williams JM. Surgical treatment of cancer of the frontal sinus and adjacent areas. Cancer 1954 7 991-4. 3. Ketcham AS, Wilkins RH, Van Buren JM, Smith RR. A com bined intracranial facial approach to the paranasal sinuses. Am J Surg 1963 106 698-703. 4. Parsons H, Lewis JS. Subtotal resection of the temporal bone for cancer of the ear. Cancer 1954 7 995-1001. 5. Nuss...

Factors Affecting Choice of Treatment

Because of anatomical constraints and the radiosen-sitivity of carcinoma of the nasopharynx, primary surgical resection is not indicated. Radiation therapy is the principal treatment modality for curative therapy and may also be used to palliate local symptoms. Chemotherapy has been studied as an adjuvant to primary radiotherapy and serves as systemic treatment for patients with disseminated disease. The basic treatment of nasopharynx cancer has consisted of radiation therapy alone for many...

Cancer of the Head and Neck

Shah, MD, MS (Surg.), FACS, Hon. FRCS (Edin), Hon. FDSRCS (Lond) Chief, Head and Neck Service E.W. Strong Chair in Head and Neck Oncology Memorial Sloan-Kettering Cancer Center Professor of Surgery, Weill Medical College, Cornell University New York, New York Assistant Editor Snehal G. Patel, MD, MS (Surg.), FRCS Clinical Research Associate Head and Neck Service Memorial Sloan-Kettering Cancer Center New York, New York 2001 BC Decker Inc Hamilton London BC Decker Inc 20 Hughson Street...

Glottic Larynx

Squamous cell carcinoma in situ of the true vocal cords is initially treated surgically, and usually with micro-excision. However, if there is evidence of microinvasive squamous cell carcinoma in the specimen or if there are rapid or multiple recurrences, radiation therapy can be administered with an approach identical to that for T1 invasive lesions. Wang24 reported a 92 percent 5-year local control and a 98 percent 5-year disease-free survival. The results in voice quality are good. T1...

Relationship of Cell Cycle and Ionizing Radiation

The cell cycle (Figure 21-2) has four phases that are distinctly sequenced and describe the life cycle of cells (1) Synthesis (S) DNA synthesis, (2) Gap (G2) a period of apparent cellular inactivity, (3) Mitosis (M) cellular division into two daughter cells, (4) Gap (G1) a period of apparent cellular inactivity. Cells vary in their sensitivity to ionizing radiation and this is dependent on their position within the cell cycle at the time of the exposure to the radiation (Figure 21-3). The most...

Concomitant Chemotherapy

The concomitant integration of chemotherapy and radiation therapy for the treatment of advanced disease has been one of the areas of greatest interest in head and neck oncology during the last decade. Potential radiation enhancement, the simultaneous treatment of both locoregional and distant disease in a dose-intense manner, and shorter treatment times make the approach particularly appealing. Interestingly, the approach is much older than the relatively recent surge in interest would suggest....

Selective Intraarterial Chemotherapy

The selective administration of chemotherapy through intra-arterial infusion offers the advantage of a more direct drug delivery to the tumor site at a higher local concentration than can be achieved with systemic therapy. This technique was initially attempted with modest results similar to those obtained by surgery and postoperative radiation ther-apy.53 Shibuya suggested that one problem was the multiplicity of feeding arteries supplying the maxillary sinus causing an irregular, lower...

Soft Tissue Tumors

Histologic typing and grading of STS is often difficult and a considerable degree of inter-observer variability exists even among expert pathologists with a reported diagnostic discrepancy in as many as 25 to 40 percent of lesions.12 The routine use of immunohistochemical stains has facilitated histologic classification, but these techniques are by no means definitive, and considerable experience is required in interpreting results. More objective methods such as cytogenetic, molecular and...

Bone Tumors

Orbital Cancer Invasion

Bone tumors are generally classified according to the matrix that their constituent cells produce eg, tumors that produce a cartilaginous matrix are classified as chondrosarcomas, those that produce osteoid are classified as osteosarcomas and others that lack a distinct matrix may be classified as fibrosarcomas. Chondrosarcomas and osteosarco-mas are by far the most common sarcomas involving the facial skeleton, but other rarer types such as Ewing's sarcoma and peripheral primitive...

Outcomes and Results of Treatment

The prognosis for sinonasal malignancies has remained poor for the past several decades despite refinements in both surgical technique and radiation therapy. Stern reviewed the M.D. Anderson experi- Figure 11-16. An intraoral view of a rectus abdominus free flap filling a left total maxillectomy defect. Facial contour following total maxillectomy is improved by the soft-tissue bulk of a rectus abdominus free flap reconstruction. Figure 11-16. An intraoral view of a rectus abdominus free flap...

Treatment Goals and Treatment Alternatives The Role of Multidisciplinary Treatment

Cure is the goal of treatment for most patients without distant metastases. Prognosis depends upon disease stage, histology, and biological factors such as degree of angiogenesis.9,14-16 Palliation of symptoms is a secondary goal for patients with curable disease and a primary goal for patients with distant metasta-tic disease. Palliative approaches range from supportive care to chemotherapy, radiation therapy and, rarely, surgical intervention. The optimal management of nasopharynx cancer...

Rehabilitation

The rehabilitation of function after oral surgery is a critical element in effective oral cancer surgery. After major oral resections the patients need rehabilitation of speech, swallowing, dentition and mastication as well as cosmesis. This process is best accomplished in a multidisciplinary environment which include the head and neck surgeons, plastic surgeons, speech and language therapists, nurses, dentists, prosthodontists and oral and maxillofacial surgeons. Perhaps the most important...

Sequential Chemotherapy

The sequential integration of chemotherapy with locoregional treatment can be done in three main ways as induction or neoadjuvant chemotherapy prior to surgery and or radiation, as an adjuvant after locoregional treatment, or as a combination of these approaches. Given the impressive response rates Table 22-1. PHASE I II TRIALS EVALUATING NEW CHEMOTHERAPEUTIC COMBINATION REGIMENS'ACTIVITY IN PREVIOUSLY UNTREATED PATIENTS WITH LOCALLY ADVANCED HEAD AND NECK CANCER Table 22-1. PHASE I II TRIALS...

Management of Leukoplakia

Effects Smoking Alveolar

During the carcinogenic process, some abnormal clonal populations of mucosal cells form clinical premalignant lesions. These are manifested as leukoplakia or erythroplakia. Leukoplakias are common lesions in smokers and patients with a previous history of head and neck cancer. These are also noted in patients without heavy carcinogenic exposure. In general, dysplastic leukoplakia should be treated while lesions harboring only hyperplasia and hyperkeratosis may be observed. Clinical...

Management of Cervical Metastasis

Postauricular Injection

ANDERSEN, MD, FACS SCOTT SAFFOLD, MD Head and neck cancer represents less than 5 percent of all cancers in the United States and will be responsible for approximately 11,800 deaths in 2001.1 However, worldwide it ranks as the sixth most common cancer,2 thus making head and neck cancer a major health problem. While the term head and neck cancer refers to tumors of myriad sites of origin and histologic types, over 90 percent of these are squamous carcinomas arising from the epithelium of...

The Role of Chemotherapy in Larynx Organ Preservation

Laryngeal Cancer Treatment

The trials evaluating induction chemotherapy, while disappointing with regard to improving survival as an endpoint, did provide the backdrop for current organ preservation strategies. Investigators observed that some patients refused surgery after initial chemotherapy and proceeded with radiation alone.87 Some of these patients were controlled over the long term without surgery, and there appeared to be a positive correlation between initial response at the primary site to induction...

General Principles of Reconstructive Surgery for Head and Neck Cancer

DISA, MD ERIC SANTAMARIA, MD PETER G. CORDEIRO, MD, FACS Current treatment of head and neck cancer follows a multidisciplinary approach. The principle of this combined approach is to provide the patient with the optimal cancer treatment for the stage of disease, and to maximize the quality of life for the patient, with preservation or restoration of form and function. Reconstructive surgical procedures developed over the past several decades have substantially contributed to attain...

General Considerations

Treatment of head and neck cancers has oral sequelae and treatment-related toxicities requiring intervention by dentists. Dental team intervention should begin prior to radiation therapy, surgical resection, and or chemotherapy. For optimal post-treatment oral functional outcomes, regardless of cancer therapies, a comprehensive dental assessment is para-mount.1 The multidisciplinary team should encompass trained dentists with interests and training in comprehensive oral dental care of the...

Cancer of the Nasal Cavity and Paranasal Sinuses

KRAUS, MD, FACS Cancers of the nasal cavity and paranasal sinuses are rare, comprising less than 1 percent of all human malignancies and only 3 percent of those arising in the head and neck.1 Sinonasal malignancies occur twice as often in males as in females, and are most often diagnosed in patients 50 to 70 years of age.2 The majority of these tumors are squamous cell carcinoma, although a wide variety of other malignancies including sarcoma, adenoid cystic...

Quality of Life Instruments

As the science of QOL assessment has matured, standardized testing has been implemented to validate QOL instruments, centered on establishing reliability, validity, and normative data.1 Reliability can best be defined as the usability of a particular instrument, which can be divided into four concepts namely test-retest reliability, alternate-form reliability, internal consistency, and interobserver reliability. Test-retest reliability measures the stability of the test over time. Typically,...

Clinical Course of Radiation Therapy

Xerostomia After Radiation

The patient undergoing radiation therapy will need to be seen for routine status evaluation at least once a week. At that time, a pertinent interval history is obtained with special attention paid to the development of a sore mouth or throat, dysphagia, hoarseness, taste problems, xerostomia, skin symptomol-ogy, and even ear symtoms when the portal includes the external auditory canal and or eustachian tube. A directed examination will evaluate the tumor status with measurements and an...

The Larynx Early Stage Disease

Laryngeal Cancer Staging

LYDIATT, MD, FACS DANIEL D. LYDIATT, DDS, MD, FACS The American Cancer Society estimated that in the United States there would be 10,600 cases of laryngeal carcinoma diagnosed in 1999, and 4,200 deaths.1 This accounts for 0.9 percent of cancers from all sites and 0.8 percent of all cancer deaths. Laryngeal carcinoma makes up 1 to 2 percent of cancers worldwide, and the incidence is increasing (Figure 9-1). Spain has one of the highest rates in the world with Basque and Navarra...

Pathology of Head and Neck Tumors

Histology Ducts Scheme

HUVOS, MD TUMORS OF THE UPPER AERODIGESTIVE TRACT MUCOSA Neoplasias of the upper aerodigestive tract histologically tend to mimic the normal constituent cells in this region. The most common neoplasias show differentiation toward lining epithelium. pressure. Synchronous or metachronous association with squamous cell carcinoma as well as progression to it may occur in some patients with inverted Squamous papilloma is a solitary papillary lesion of the squamous...

Thyroid and Parathyroid Tumors

Thyroid Berry Ligament

PATEL, MD, MS, FRCS Diseases of the thyroid gland represent a common medical and surgical problem. A variety of inflammatory lesions and neoplasms are noted by endocri-nologists and surgeons interested in thyroid pathology. Various pathologic conditions include Hashimoto's thyroiditis, nodular goiter, solitary thyroid nodule, adenomas and thyroid cancer. Although thyroid disease is extremely common, thyroid cancer is relatively uncommon and forms less than 2...

Epidemiology and Etiology

Oral Cancer Risk Smoking And Alcohol

The global incidence of cancers of the oral cavity, pharynx and larynx is about 500,000 cases per year with mortality of 270,000 cases per year.1 Excluding skin cancers, this represents about 6 percent of the incidence and 5 percent of the mortality of all cancers.1 About three-fourths of these are cancers of the oral cavity and pharynx and the remainder are laryn-geal cancers. Figure 1-1 describes the incidence of oral and pharyngeal cancers by world region. As demonstrated here, the areas of...

Case 7 Bilobed Flap

Necrotic Wound

The bilobed flap is a random flap but is excellent for coverage of various surgical defects throughout the Figure 4-10. A, The patient had undergone excisional biopsy of a malignant melanoma of the cheek elsewhere. The scar of previous excision was widely encompassed in the surgical incisions which were planned to provide access for a superficial parotidectomy. B An inferiorly based cervical Limberg flap has been elevated and the surgical bed of resection shows the branches of the facial nerve...

Patient Education Home Care Instructions Fluoride Application

Full Mouth Extraction Recovery

Oral hygiene procedures including scaling, polishing, sub-gingival root planing and curettage should be performed and home-care instructions and fluoride prescriptions given between the initial screening appointment and commencement of external beam radiation therapy (EBRT).7 In addition, overhanging and faulty Figure 20-2. Full mouth extractions post-radiation therapy with alveolectomy and primary closure. Figure 20-2. Full mouth extractions post-radiation therapy with alveolectomy and primary...

Surgical Treatment Resection

Pictures Esophageal Reconstruction

The difficulty in surgical treatment of advanced carcinoma of the hypopharynx and cervical esophagus arises from the common requirement for laryngectomy as part of the procedure. The larynx is removed because of direct or submucosal tumor extension and significant risk of chronic or life-threatening aspiration. Histopathologic studies of hypopharyn-geal cancer have shown that assessment of the extent of laryngeal disease based on endoscopic findings in the hypopharynx is inaccurate.50...