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Sample records for clinically n0 neck

  1. Effectiveness of the supraomohyoid neck dissection in clinically N0 neck patients with squamous cell carcinoma of buccal mucosa and gingivobuccal sulcus.

    PubMed

    Rahamthulla, S A K Uroof; Priya, P Vani; Hussain, S M D Javeed; Nasyam, Fazil Arshad; Akifuddin, Syed; Srinivas, Velpula Sasidhar

    2015-01-01

    To evaluate the effectiveness of the supraomohyoid neck dissection in clinically N0 neck patients with squamous cell carcinoma of buccal mucosa and gingivobuccal sulcus. This was a prospective study of five patients with squamous cell carcinoma of gingivobuccal mucosa of oral cavity with clinically N0 neck, conducted over a period of 2 years from July 2007 to Oct 2009 in the Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital. The study was conducted in patients irrespective of age, sex, size, thickness, and type of differentiation of the lesion. All patients have clinically non-palpable lymphnodes (N0 neck), while patients with palpable lymphnodes, patients with previous surgery, and patients with previous radiotherapy were excluded from the study. Level I was the commonest site of neck metastasis in our study. Among the five patients, two (40%) patients (case 2 and 3) had occult cervical metastasis (level IB nodes are histopathologically positive nodes) and the remaining three patients (60%) had no occult cervical metastasis. The recurrence rate was 20% for patients who received postoperative radiotherapy. There was no morbidity and postoperative dysfunction and the mortality rate was only 20% in our study. Supraomohyoid neck dissection is the therapeutic procedure in clinically N0 neck patients with squamous cell carcinoma of buccal mucosa and gingivobuccal sulcus of mandible. Supraomohyoid neck dissection, when indicated, contributes to the concept of less-invasive surgery and offers functional and aesthetic advantages without compromising the clearance with minimal morbidity.

  2. An update on the latest evidence for managing the clinically negative neck (cN0) in oral squamous cell carcinoma.

    PubMed

    Brennan, P A; Subramaniam, S; Tsioryannis, C; Green, B

    2017-04-01

    The single most important prognostic indicator for survival in oral squamous cell carcinoma (OSCC) is the presence of lymph node metastases in the neck. While the treatment of the clinically node positive (cN+) neck is well established, the management of the clinically negative neck (cN0) is controversial. Various strategies have been advocated including close observation including regular ultrasound imaging, elective neck dissection and sentinel lymph node biopsy. Neck dissection surgery is not without potential morbidity with shoulder dysfunction being the main complication. A number of factors are associated with increased risk of neck node metastasis including primary tumour thickness and peri-neural invasion. A recent prospective randomised trial has found survival benefit following neck dissection even in patients with a cN0 neck at presentation. We discuss the latest evidence for managing the cN0 in OSCC and include our own experience on the role of neck dissection in certain cases. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Clinical outcome of surgical treatment of T1-2 N0 squamous cell carcinoma of oral tongue with observation for the neck: Analysis of 176 cases

    PubMed Central

    Hakeem, Arsheed Hussain; Pradhan, Sultan Ahmed; Kannan, Rajan; Tubachi, Jagadish

    2016-01-01

    Objective: To analyze various demographic, clinical, and histopathologic factors in T1-2 N0 squamous cell carcinoma (SCC) of the oral tongue to define a high-risk group for regional recurrence that will benefit from elective neck dissection. Materials and Methods: Retrospective outcome analysis of a patient cohort without palpable or ultrasound (USG) detectable nodal metastases undergoing per oral wide glossectomy for T1-2 N0 SCC of oral tongue. Patients were followed up using palpation and serial USG neck and fine-needle aspiration cytology. Results: Of the 176 patients, 69 (39%) showed recurrence during follow-up. Fifty-eight cases developed regional neck node metastases, i.e., overall regional node recurrence rate of 33%. Fifty-three (91%) with regional neck node metastases were salvaged successfully with further treatment. In 110 cases with tumor thickness more than 5 mm, 39% cases developed regional neck node metastases. This association was significant with P = 0.0402. Among 44 cases with perineural invasion, 54% developed regional neck node metastases. Similarly in 39 cases with lymphovascular invasion, 61% developed regional neck node metastases. Association of both of these parameters with the development of regional neck node metastases was significant. Conclusion: We recommend prophylactic selective neck dissection in early stage SCC of oral tongue, especially with depth of invasion more than 5 mm, perineural and lymphovascular invasion. PMID:28299264

  4. The pros and cons of routine central compartment neck dissection for clinically nodal negative (cN0) papillary thyroid cancer.

    PubMed

    Chan, Ai Chen; Lang, Brian Hung Hin; Wong, Kai Pun

    2013-11-01

    Metastatic disease to regional lymph nodes (LNs) is common in papillary thyroid carcinoma (PTC). LN dissection is increasingly performed as part of the surgical management of PTC. The role of prophylactic central neck dissection (pCND) in PTC is unclear. There is limited evidence to support a routine pCND in clinical setting for nodal negative (cN0) PTC. The aim of this review was to examine the pros and cons of prophylactic neck dissection in cN0 PTC. In summary, the advantages of pCND are: removal of the central LNs that potentially harbor micro-metastases, more accurate staging of disease in order to plan more individualized management, reducing the need for re-operation to remove the metastatic LNs which have developed later and possible improvement in overall survival. The disadvantages are: an extensive surgery but lack of evidence of survival benefit, higher incidence of complications with little impact on local recurrence rate, possibility of over treating in cN0 patients and it does not sound like a cost effective approach in the management of small thyroid cancer. Considering low frequency of permanent morbidity, some authors believe that prophylactic neck dissection is safe in experienced hands even though its prognostic benefit has yet to be demonstrated.

  5. The pros and cons of routine central compartment neck dissection for clinically nodal negative (cN0) papillary thyroid cancer

    PubMed Central

    Chan, Ai Chen; Wong, Kai Pun

    2013-01-01

    Metastatic disease to regional lymph nodes (LNs) is common in papillary thyroid carcinoma (PTC). LN dissection is increasingly performed as part of the surgical management of PTC. The role of prophylactic central neck dissection (pCND) in PTC is unclear. There is limited evidence to support a routine pCND in clinical setting for nodal negative (cN0) PTC. The aim of this review was to examine the pros and cons of prophylactic neck dissection in cN0 PTC. In summary, the advantages of pCND are: removal of the central LNs that potentially harbor micro-metastases, more accurate staging of disease in order to plan more individualized management, reducing the need for re-operation to remove the metastatic LNs which have developed later and possible improvement in overall survival. The disadvantages are: an extensive surgery but lack of evidence of survival benefit, higher incidence of complications with little impact on local recurrence rate, possibility of over treating in cN0 patients and it does not sound like a cost effective approach in the management of small thyroid cancer. Considering low frequency of permanent morbidity, some authors believe that prophylactic neck dissection is safe in experienced hands even though its prognostic benefit has yet to be demonstrated. PMID:25083482

  6. Is elective neck dissection in T1-2, N0 patients with lower lip cancer necessary?

    PubMed

    Yilmaz, Sarper; Ercocen, Ali Riza

    2009-04-01

    The significance of elective neck dissection in the early stages of lower lip cancer is generally underestimated. In the classic textbooks of plastic surgery it has been generally accepted that lymphatic spread to neck is negligible and therefore it is not imperative to perform any kind of neck dissection. However, in some recent studies high rates of clinically positive neck that were initially negative began to appear in the literature especially in otorhinolaryngology and head and neck journals. Our clinical series consisted of 21 lower lip cancer cases with T1-2, N0 tumors; the rate of lymphatic spread to neck was found to be 19%. Because of this high rate, we conclude that it is not sound to discard the importance of neck dissection even in the early stages of lower lip cancers. At least, a suprahyoid neck dissection should be performed in all patients with lower lip cancer.

  7. Role of prophylactic central neck dissection in cN0 papillary thyroid cancer

    PubMed Central

    Costa, S; Giugliano, G; Santoro, L; Ywata De Carvalho, A; Massaro, MA; Gibelli, B; De Fiori, E; Grosso, E; Ansarin, M; Calabrese, L

    2009-01-01

    Summary Prophylactic central neck dissection in papillary thyroid cancer is controversial. In this retrospective cohort study, the aim was to assess possible advantages of prophylactic central neck dissection with total thyroidectomy in cN0 papillary thyroid cancer. A total of 244 consecutive patients with papillary thyroid cancer, without clinical and ultrasound nodal metastases (cN0), were evaluated out of 1373 patients operated for a thyroid disease at the Istituto Europeo di Oncologia, Milan, Italy from 1994 to 2006. Of these 244 patients, 126 (Group A) underwent thyroidectomy with central neck dissection, while 118 (Group B) underwent thyroidectomy alone. Demographic, clinical and pathological features were analysed. Overall recurrence rate was 6.3% (8/126) in Group A and 7.7% (9/118) in Group B, with a mean follow-up of 47 (Group A) and 64 (Group B) months. In Group A patients, 47% were pN1a and all patients with recurrence had nodal involvement (p = 0.002). Survival rate did not differ in the two groups. Nine patients were lost to follow-up. Group A patients were older and their tumours were larger in size; according to the pT distribution, a higher extra-capsular invasion rate was observed. The two groups were equivalent as far as concerns histological high risk variants and multifocality. Nodal metastases correlated with stage: pT1-2 vs. pT3-T4a, p = 0.0036. A lower risk of nodal metastases was related to thyroiditis (p = 0.0034). In conclusion, central neck metastases were predictive of recurrence without influencing prognosis. From data obtained, possible greatest efficacy of central neck dissection in pT3-4 papillary thyroid cancer without thyroiditis is suggested. PMID:20111614

  8. Elective neck dissection or "watchful waiting": optimal management strategy for early stage N0 tongue carcinoma using decision analysis techniques.

    PubMed

    Song, Tao; Bi, Nan; Gui, Lai; Peng, Zhe

    2008-09-05

    Although tongue cancer is a common disease of the head and neck, the choice of neck treatment between elective neck dissection and "watchful waiting" remains controversial for patients with early stage N0 oral tongue carcinoma. On the basis of the current state of head and neck cancers a decision analysis model was created to compare two treatment strategies for early tongue cancer. Expected value (EV) was calculated according to the literature which met the defined criteria. Sensitivity analyses were performed. The results showed that the decision model favored elective neck dissection (EV = 0.87), over "watchful waiting" (EV = 0.77). One-way sensitivity analyses demonstrated that the outcome was influenced by regional recurrence, threshold value of 0.28 for the elective neck dissection group and 0.17 for the "watchful waiting" group, and a salvage rate threshold value 0.73 for the "watchful waiting" group. These results suggested that elective neck dissection strategy of the neck should be applied for early stage N0 oral tongue carcinoma patients with no clinical nodal metastases. When the occult lymph node metastases rate was less than 0.17 and the salvage rate was more than 0.73, "watchful waiting" strategy would be preferable.

  9. Primary cN0 lip squamous cell carcinoma and elective neck dissection: Systematic review and meta-analysis.

    PubMed

    Bhandari, Kishor; Wang, Dian-can; Li, Shan-chang; Jiang, Bing-hua; Guo, Yu-xing; Koirala, Ujjwal; Du, Xiao-yan

    2015-09-01

    Management of clinically negative lymph nodes (cN0) in primary lip squamous cell carcinoma (SCC) has always been a controversial topic. A systematic review of English-language electronic databases using Medline, Embase, Cochrane library, Google Scholar, SCI, and specific journals on the subject matter was done. Only the studies mentioning primary nonmetastatic lip SCC with cN0 neck treated by surgery only and having at least 2 years of follow-up data were selected. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting systematic reviews and meta-analysis was followed. The pooled estimate of occult metastasis in neck dissected specimen was 0.17 (95% confidence interval [CI], 0.10-0.28) and that of delayed nodal metastasis in patients without neck dissection was 0.08 (95% CI, 0.01-0.18). The results do not prove sufficient to justify elective treatment of the neck in primary cN0 lip SCC and close observation would be a viable option in such cases. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1392-1400, 2015. © 2014 Wiley Periodicals, Inc.

  10. Prospective randomized study of selective neck dissection versus observation for N0 neck of early tongue carcinoma.

    PubMed

    Yuen, Anthony Po-Wing; Ho, Chiu Ming; Chow, Tam Lin; Tang, Lap Chiu; Cheung, Wing Yung; Ng, Raymond Wai-Man; Wei, William Ignace; Kong, Chi Kwan; Book, Kwok Shing; Yuen, Wai Cheung; Lam, Alfred King-Yin; Yuen, Nancy Wah-Fun; Trendell-Smith, Nigel Jeremy; Chan, Yue Wai; Wong, Birgitta Yee-Hang; Li, George Kam-Hop; Ho, Ambrose Chung-Wai; Ho, Wai Kuen; Wong, Sau Yan; Yao, Tzy-Jyun

    2009-06-01

    There are controversies on the benefits of elective neck dissection (END) for oral tongue carcinoma. This is a prospective randomized study of elective selective I, II, III neck dissection versus observation for N0 neck of stage I to II oral tongue carcinoma. There were 35 patients on the observation arm and 36 patients on the END arm. The main outcome assessment parameters are node-related mortality and disease-specific survival rate. There were 11 patients in the observed arm and 2 patients in the END arm who developed nodal recurrence alone without associated local or distant recurrence. All 13 patients were salvaged, and no patient died of nodal recurrence. The 5-year disease-specific survival rate was 87% for the observation arm and was 89% for the END arm; the 2% difference was not significant. Observation may be an acceptable alternative to END if strict adherence to a cancer surveillance protocol is followed. (c) 2009 Wiley Periodicals, Inc.

  11. [Cervical lymph node metastasis in clinical N0 papillary thyroid carcinoma].

    PubMed

    Yan, Dan-gui; Zhang, Bin; An, Chang-ming; Zhang, Zong-min; Li, Zheng-jiang; Xu, Zhen-gang; Tang, Ping-zhang

    2011-11-01

    To study the patterns of cervical lymph nodes metastasis and the surgical managements of cervical lymph nodes in clinical N0 (cN0) papillary thyroid carcinoma. Fifty-one consecutive patients with papillary carcinomas without clinical evidence of cervical lymph node involvement were included in the study between August 2007 and September 2010, in which 53 sides underwent neck lymph node dissection. Preoperative lymphoscintigraphy intra-operative hand-held gamma probe detecting and blue dye technique were used to detect the sentinel lymph node (SLN). SLNs were sent to frozen-section and the results were compared with specimen of routine selective neck dissection. All the pathologic specimens were reviewed by pathologists, counting the numbers of pathologic positive nodes and mapping the localization of positive nodes in level II, III, IV, V and VI respectively. The following criteria were used to study the predictive value of lateral neck compartment lymph node metastasis: age, multifocality of the tumor, extracapsular spread (ECS), tumor size, and the number of central compartment metastasis nodes. Univariate analysis with the χ2 test was used to analyze the statistical correlation between lateral neck compartment lymph node metastasis and the other clinical factors. Multiple logistic regression analysis was used to identify the multivariate correlates of lateral neck compartment metastasis. The occult lymph node metastasis and lateral neck metastasis rates were 77.4% and 58.5% respectively, central compartment metastasis ≥3 nodes was the only independent predictive factor for the metastasis in lateral neck. Twelve sides were pN0 and other 41 sides were pN+ in all 53 side specimens. Of 41 sides with pN+, 17 sides (41.5%) involved single site and 24 sides (58.5%) involved multi-sites. The distribution of metastasis lymph nodes:level VI 62.3%, level III 52.8%, level IV 30.2%, level II 18.9%, and level V 0%. Cervical occult lymph node metastasis in cN0 papillary

  12. Surgical complications and recurrence after central neck dissection in cN0 papillary thyroid carcinoma.

    PubMed

    Ahn, Dongbin; Sohn, Jin Ho; Park, Ji Young

    2014-02-01

    To evaluate surgical complications and recurrence patterns after central neck dissection (CND) in papillary thyroid carcinoma (PTC). A retrospective analysis was performed on 361 patients who underwent total thyroidectomy with or without CND for PTC from 2000 to 2007. Clinicopathological results and recurrence were stratified according to treatment modality. Incidence of occult central metastasis of PTC was 64.3%. With respect to surgical morbidities, the total thyroidectomy (TT) with CND group exhibited a significantly higher incidence of transient vocal fold paralysis (10.0% vs 3.4%, p=0.029) and permanent hypocalcaemia (11.4% vs 4.5%, p=0.041), and significantly prolonged mean operating time (195.8min vs 153.0min, p<0.001) than the TT alone group. Analysis of the recurrence patterns revealed that level IV was most commonly involved in both groups. When the location of recurrence was categorised into central and lateral neck, the recurrence rate in the lateral neck was significantly higher than that in the central neck, regardless of initial CND. CND was associated with permanent hypocalcaemia and transient vocal fold paralysis. The lateral neck was mainly involved in recurrence regardless of initial CND, suggesting the clinical benefit of CND may be small. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  13. Is Elective Irradiation to the Lower Neck Necessary for N0 Nasopharyngeal Carcinoma?

    SciTech Connect

    Gao Yunsheng; Zhu Guopei; Lu Jiade; Ying Hongmei; Kong Ling; Wu Yongru; Hu Chaosu

    2010-08-01

    Purpose: To summarize our experience and treatment results in lymph node-negative nasopharyngeal carcinoma treated in a single institution. Methods and Materials: From January 2000 to December 2003, 410 patients with lymph node-negative nasopharyngeal carcinoma were retrospectively analyzed. The T-stage distribution was 18.8% in T1, 54.6% in T2 (T2a, 41 patients; T2b, 183 patients), 13.2% in T3, and 13.4% in T4. All patients received radiotherapy to the nasopharynx, skull base, and upper neck drainage areas, including levels II, III, and VA. The dose was 64-74 Gy, 1. 8-2.0 Gy per fraction over 6.5-7.5 weeks to the primary tumor with {sup 60}Co or 6-MV X-rays, and 50-56 Gy to levels II, III, and VA. Residual disease was boosted with either {sup 192}Ir afterloading brachytherapy or small external beam fields. Results: The median follow-up time was 54 months (range, 3-90 months). Four patients developed neck recurrence, and only 1 patient (0.2%) experienced relapse outside the irradiation fields. The 5-year overall survival rate was 84.2%. The 5-year relapse-free survival rate, distant metastasis-free survival rate, and disease-free survival rate were 88.6%, 90.6% and 80.1%, respectively. Both univariate and multivariate analyses demonstrated that T classification was the only significant prognostic factor for predicting overall survival. The observed serious late toxicities were radiation-induced brain damage (7 cases), cranial nerve palsy (16 cases), and severe trismus (13 cases; the distance between the incisors was {<=}1 cm). Conclusion: Elective levels II, III, and VA irradiation is suitable for nasopharyngeal carcinoma without neck lymph node metastasis.

  14. Outcome of patients with early stage oral cancer managed by an observation strategy towards the N0 neck using ultrasound guided fine needle aspiration cytology: No survival difference as compared to elective neck dissection.

    PubMed

    Flach, Géke B; Tenhagen, Mark; de Bree, Remco; Brakenhoff, Ruud H; van der Waal, Isaac; Bloemena, Elisabeth; Kuik, Dirk J; Castelijns, Jonas A; Leemans, C René

    2013-02-01

    Management of the clinically N0 neck in oral cancer patients remains controversial. We describe the outcome of patients with T1-T2 oral cancer and N0 neck based on ultrasound guided fine needle aspiration cytology (USgFNAC) who were treated by transoral excision and followed by a 'wait and scan' policy (W&S). This retrospective analysis included 285 consecutive patients of whom 234 were followed by W&S and 51 underwent elective neck dissection (END). Survival rates were compared between groups and correction for confounding factors was performed. Of W&S patients, the 5-year disease-specific (DSS) and overall survival (OS) were 94.2% and 81.6% respectively. During follow-up 72.2% remained free of lymph node metastases and 27.8% developed delayed metastases. W&S patients with delayed metastases had a 5-year DSS and OS of 80.0% and 62.8%, respectively. In patients with positive END these rates were 81.3% and 64.2%, respectively. Between the groups, survival rates were not significantly different. Of the W&S patients with delayed metastases, 90.6% needed adjuvant radiotherapy versus 55.0% of patients with positive END. With regard to survival, in patients with early stage oral cancer and cN0 neck a 'wait and scan' policy using strict USgFNAC surveillance is justified as survival is not negatively influenced. Using a 'wait and scan' follow-up strategy instead of elective neck treatment, unnecessary neck dissection and its accompanying morbidity can be avoided in 72.2% of patients. However, for the small proportion of patients with delayed metastases, more extensive treatment with adjuvant radiotherapy is needed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Is an Elective Neck Dissection Necessary for All Cases of N0 Oral Squamous Cell Carcinoma? -Elective Neck Dissection may be Performed for Tongue Cancer with Tumor Thickness More than 4 mm.

    PubMed

    Otsuru, Mitsunobu; Aoki, Takayuki; Ota, Yoshihide; Denda, Yuya; Akiba, Takeshi; Sekine, Riyo; Yoshida, Yoshifumi; Osaka, Ryuta

    2016-09-20

    We investigated whether neck dissection should be performed to prevent T1-2N0M0 tongue cancer by using the Weiss and colleague's decision tree method. The results showed that preventive neck dissection should not be recommended for T1-2N0M0 tongue cancer. However, preventive neck dissection is a suitable approach when treating tongue cancer tumors with a thickness of ≥ 4 mm.

  16. Robot-assisted Supraomohyoid neck dissection via a modified face-lift or retroauricular approach in early-stage cN0 squamous cell carcinoma of the oral cavity: a comparative study with conventional technique.

    PubMed

    Lee, Hyoung Shin; Kim, Won Shik; Hong, Hyun Jun; Ban, Myung Jin; Lee, Dongwon; Koh, Yoon Woo; Choi, Eun Chang

    2012-11-01

    Supraomohyoid neck dissection (SOND) in clinical N0 (cN0) neck of oral cavity squamous cell carcinoma (SCC) is performed by many head and neck surgeons showing improved regional control and disease-specific survival. However, disfiguring neck scars have been accepted to be unavoidable. In this study, we sought to introduce and evaluate the feasibility of our surgical technique to hide the external scar of neck dissection using the robotic system via a modified face-lift or retroauricular approach. Twenty-six patients with cN0 oral cavity SCC were divided into two groups of robot-assisted neck dissection and conventional neck dissection via external cervical incision. The operation time, amount and duration of drainage, length of hospital stay, complications, number of retrieved lymph nodes, and satisfaction scores were compared. Mean operation time was longer in the robot-assisted group (157 ± 22 min) than the conventional group (78 ± 16 min) (P < 0.001). However, the amount and duration of drainage, hospital stay, retrieved lymph nodes, and complications were comparable. Because the postoperative scar was hidden by the auricle and hair, the satisfaction score was significantly higher in the robot-assisted group (P < 0.001). Robot-assisted SOND via a modified face-lift or retroauricular approach in cN0 oral cavity SCC was feasible compared to conventional technique and showed a clear cosmetic benefit. Longer operation time remains the drawback of this procedure. However, it could be considered for patients who require SOND and prefer to avoid external neck scar.

  17. Evaluating the influence of prophylactic central neck dissection on TNM staging and the recurrence risk stratification of cN0 differentiated thyroid carcinoma.

    PubMed

    Lin, Xiaodong; Chen, Xiaoyi; Jiru, Yuan; Du, Jialin; Zhao, Gang; Wu, Zeyu

    2016-06-01

    The purpose of this study was to explore the risk factors that were associated with central lymph node metastasis (CLNM) in patients with clinical nodal negative differentiated thyroid carcinoma (cN0 DTC) after prophylactic central neck dissection (pCND). The influence of pCND on TNM staging and recurrence risk stratification (RRS) in patients with cN0 DTC was also evaluated in our study. A total of 153 cN0 DTC patients in Guangdong general hospital who underwent thyroidectomy with pCND from March 2014 to October 2014 were enrolled in this study. The relations of CLNM with clinicopathologic characteristics of cN0 DTC were analyzed by univariate and multivariate logistic regression. The influence of pCND on migration of TNM staging and RRS in cN0 DTC was observed. In the present study, CLNM was found in 42.5% (65 of 153 cases) of patients with cN0 DTC. On univariate analysis, the age less than 45 years old, tumor size more than 2cm, pT staging, and a total number of central lymph nodes dissected more than 3 were significantly associated with CLNM (P<0.05); however, gender, tumors affecting both lobes, multifocality, capsular invasion, and Hashimoto's thyroiditis were not related with CLNM (P>0.05). On multivariate logistic regression, age<45 years (P=0.001) and a total number of central lymph nodes dissected >3 (P=0.002) were significantly associated with CLNM. Because of the identification of CLNM in the implementation of pCND, 15 (9.8%) of 153 cN0 DTC patients were upgraded in TNM staging; all these patients were older than 45 years. Fifty-six patients (36.6%) developed higher RRS (from low to intermediate) after pCND. For younger patients (age<45 years), careful preoperative assessment of the lymph node status must be done; surgeons should consider this risk factor when deciding whether to perform pCND. Thorough lymphadenectomy in the implementation of pCND can avoid residual lymph node metastasis and help to increase the incidence of CLNM. pCND can

  18. Preoperative chemoradiotherapy followed by local excision in clinical T2N0 rectal cancer

    PubMed Central

    Shin, Young Seob; Yoon, Yong sik; Lim, Seok-Byung; Yu, Chang Sik; Kim, Tae Won; Chang, Heung Moon; Park, Jin-hong; Ahn, Seung Do; Lee, Sang-Wook; Choi, Eun Kyung; Kim, Jin Cheon; Kim, Jong Hoon

    2016-01-01

    Purpose To investigate whether preoperative chemoradiotherapy (PCRT) followed by local excision (LE) is feasible approach in clinical T2N0 rectal cancer patients. Materials and Methods Patients who received PCRT and LE because of clinical T2 rectal cancer within 7 cm from anal verge between January 2006 and June 2014 were retrospectively analyzed. LE was performed in case of a good clinical response after PCRT. Patients’ characteristics, treatment record, tumor recurrence, and treatment-related complications were reviewed at a median follow-up of 49 months. Results All patients received transanal excision or transanal minimally invasive surgery. Of 34 patients, 19 patients (55.9%) presented pathologic complete response (pCR). The 3-year local recurrence-free survival and disease free-survival were 100.0% and 97.1%, respectively. There was no recurrence among the patients with pCR. Except for 1 case of grade 4 enterovesical fistula, all other late complications were mild and self-limiting. Conclusion PCRT followed by an LE might be feasible as an alternative to total mesorectal excision in good responders with clinical T2N0 distal rectal cancer. PMID:27730804

  19. [Analysis of the patterns of cervical lymph node recurrence in patients with cN0 papillary thyroid carcinoma after central neck lymph node dissection].

    PubMed

    Huang, Hui; Xu, Zhengang; Wang, Xiaolei; Wu, Yuehuang; Liu, Shaoyan

    2015-10-01

    To retrospectively analyze the long-term results of prophylactic central lymph node dissection in cN0 papillary thyroid carcinoma (PTC), and investigate the treatment method of the cervical lymph nodes for cN0 PTC. One hundred and thirty-six patients with cN0 PTC were treated by surgery at the Cancer Hospital of Chinese Academy of Medical Sciences from 2000 to 2006. Their clinicopathological characteristics, surgical procedures and survival outcomes were collected and analyzed. The occult lymph node metastasis rate in central compartment was 61.0%. The average number of positive lymph nodes was 2.47 (1-13), in which 54 patients had 1-2 and 29 patients had ≥ 3 positive lymph nodes. Multiple logistic regression analysis showed that age less than 45 (P=0.001, OR 3.571, 95% CI 1.681-7.587)and extracapsular spread (ECS) (P=0.015, OR 2.99, 95% CI 1.241-7.202)were independent risk factors for lymph node metastasis in the central compartment. The ten-year cumulative overall survival rate was 98.3% and cumulative lateral neck metastasis rate was 25.2%. Multivariate analysis with Cox regression model showed that ECS (P=0.001, OR 5.211, 95% CI1.884-14.411) and positive lymph nodes in the central compartment ≥ 3 (P=0.009, OR 4.005, 95% CI 1.419-11.307) were independent risk factors for lymph node recurrence in the lateral neck region. The distribution of recurrent lymph nodes: level IV (82.4%), level III (64.7%), level II (29.4%) and level V (11.8%). Routine central lymph node dissection, at least unilateral, should be conducted for cN0 papillary thyroid carcinoma. Attention should be paid to the treatment of lateral neck region in patients with cN0 papillary thyroid carcinoma. Selective neck dissection is suggested for cN0 PTC with ECS or positive central lymph nodes ≥ 3, or both. The range of dissection should include level III and IV at least.

  20. Neoadjuvant chemoradiation therapy is beneficial for clinical stage T2 N0 esophageal cancer patients due to inaccurate preoperative staging.

    PubMed

    Zhang, Jennifer Q; Hooker, Craig M; Brock, Malcolm V; Shin, James; Lee, Sue; How, Remealle; Franco, Noreli; Prevas, Helen; Hulbert, Alicia; Yang, Stephen C

    2012-02-01

    It remains unclear if patients with clinical stage T2 N0 (cT2 N0) esophageal cancer should be offered induction therapy vs surgical intervention alone. This was a retrospective cohort study of cT2 N0 patients undergoing induction therapy, followed by surgical resection, or resection alone, at the Johns Hopkins Hospital from 1989 to 2009. Kaplan-Meier analysis was used to compare all-cause mortality in cT2 N0 patients who had resection alone vs those who had induction chemoradiation therapy, followed by resection. A study cohort of 69 patients was identified and divided into two groups: 55 patients (79.7%) received induction therapy and 14 (20.3%) did not. No statistically significant difference in 5-year survival rate was observed for the two groups: 49.5% for the resection-only group and 53.8% for the induction group. More than 50% of cT2 N0 patients were understaged. For cT2 N0 esophageal cancer patients, the benefit of neoadjuvant therapy is still unclear. Induction therapy for cT2 N0 did not translate into a statistically significant improvement in survival. However, due to the significant understaging of T2 N0 patients, we recommend neoadjuvant therapy to all cT2N0 patients before operation. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Neoadjuvant Chemoradiation Therapy Is Beneficial for Clinical Stage T2 N0 Esophageal Cancer Patients Due to Inaccurate Preoperative Staging

    PubMed Central

    Zhang, Jennifer Q.; Hooker, Craig M.; Brock, Malcolm V.; Shin, James; Lee, Sue; How, Remealle; Franco, Noreli; Prevas, Helen; Hulbert, Alicia; Yang, Stephen C.

    2014-01-01

    Background It remains unclear if patients with clinical stage T2 N0 (cT2 N0) esophageal cancer should be offered induction therapy vs surgical intervention alone. Methods This was a retrospective cohort study of cT2 N0 patients undergoing induction therapy, followed by surgical resection, or resection alone, at the Johns Hopkins Hospital from 1989 to 2009. Kaplan-Meier analysis was used to compare all-cause mortality in cT2 N0 patients who had resection alone vs those who had induction chemoradiation therapy, followed by resection. Results A study cohort of 69 patients was identified and divided into two groups: 55 patients (79.7%) received induction therapy and 14 (20.3%) did not. No statistically significant difference in 5-year survival rate was observed for the two groups: 49.5% for the resection-only group and 53.8% for the induction group. More than 50% of cT2 N0 patients were understaged. Conclusions For cT2 N0 esophageal cancer patients, the benefit of neoadjuvant therapy is still unclear. Induction therapy for cT2 N0 did not translate into a statistically significant improvement in survival. However, due to the significant understaging of T2 N0 patients, we recommend neoadjuvant therapy to all cT2N0 patients before operation. PMID:22269708

  2. Predictive Significance of Tumor Depth and Budding for Late Lymph Node Metastases in Patients with Clinical N0 Early Oral Tongue Carcinoma.

    PubMed

    Hori, Yukiko; Kubota, Akira; Yokose, Tomoyuki; Furukawa, Madoka; Matsushita, Takeshi; Takita, Morihito; Mitsunaga, Sachiyo; Mizoguchi, Nobutaka; Nonaka, Tetsuo; Nakayama, Yuko; Oridate, Nobuhiko

    2017-04-03

    In clinical N0 early oral tongue carcinoma, treatment of occult lymph node metastasis is controversial. The purpose of this study was to assess the histopathological risk factors for predicting late lymph node metastasis in early oral tongue carcinoma. We retrospectively reviewed 48 patients with early oral tongue squamous cell carcinoma. Associations between the histopathological factors (depth of tumor, differentiation, blood vessel invasion, lymphatic invasion, and tumor budding) and late lymph metastasis were analyzed. Although the univariate analysis identified blood vessel invasion, lymphatic invasion, and high-grade tumor budding as predictive factors for neck recurrence (p < 0.001), the Cox proportional hazards model identified high-grade tumor budding as an independent predictive factor (p < 0.01). The combination of a tumor depth ≥ 3 mm and high-grade tumor budding yielded high diagnostic accuracy. Tumor depth and budding grade were identified as histopathological risk factors for late neck recurrence in clinical N0 early oral tongue carcinoma.

  3. Minimally invasive selective neck dissection: a prospective study of endoscopically assisted dissection via a small submandibular approach in cT(1-2_N(0) oral squamous cell carcinoma.

    PubMed

    Fan, Song; Liang, Fa-Ya; Chen, Wei-Liang; Yang, Zhao-Hui; Huang, Xiao-Ming; Wang, You-Yuan; Lin, Zhao-Yu; Zhang, Da-Ming; Zhou, Bin; Chen, Wei-Xiong; Chai, Qiang; Wang, Hui-Jin; Pan, Chao-Bin; Liang, Qi-Xiang; Yu, Xin; Dias-Ribeiro, Eduardo; Feng, Yu-Huan; Li, Jin-Song

    2014-11-01

    Selective neck dissection (SND) in clinical N0 (cN0) cases of oral squamous cell carcinoma (SCC) has been performed by surgeons using a retroauricular or modified facelift approach with robotic or endoscopic assistance. However, these procedures provide cosmetic satisfaction at the cost of possible maximal invasiveness. In this prospective study, we introduced and evaluated the feasibility as well as surgical invasiveness and cosmetic outcome of endoscopically-assisted SND via a small submandibular approach. Forty-four patients with cT1-2N0 oral SCC (OSCC) were randomly divided into two groups of endoscopically-assisted SND and conventional SND. Perioperative and postoperative outcomes of patients were evaluated, including the length of the incision, operating time for neck dissection, estimated blood loss during the operation, amount and duration of drainage, total hospitalization period, total number of lymph nodes retrieved, satisfaction scores based on the cosmetic results, perioperative local complications, shoulder syndrome, and follow-up information. The mean operation time in the endoscopically-assisted group (126.04 ± 12.67 min) was longer than that in the conventional group (75.67 ± 16.67 min). However, the mean length of the incision was 4.33 ± 0.76 cm in the endoscopically-assisted SND group, and the amount and duration of drainage, total hospital stay, postoperative shoulder pain score, and cosmetic outcomes were superior in the endoscopically-assisted SND group. Additionally, the retrieved lymph nodes and complications were comparable. Endoscopically-assisted SND via a small submandibular approach had a longer operation time than the conventional approach. However, endoscopically-assisted SND was feasible and reliable while providing minimal invasiveness and satisfactory appearance.

  4. Prognosis of neutrophil-to-lymphocyte ratio in clinical early-stage tongue (cT1/T2N0) cancer

    PubMed Central

    Wu, Ching-Nung; Chuang, Hui-Ching; Lin, Yu-Tsai; Fang, Fu-Min; Li, Shau-Hsuan; Chien, Chih-Yen

    2017-01-01

    Background Inflammation plays a role in the development of cancer. This study aims to analyze the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and other clinicopathological determinants in early-stage (cT1/T2N0) tongue cancer. Materials and methods A total of 262 patients were selected from our institute’s cancer database between 2004 and 2011. Optimal cutoff value of NLR and lymph node density (LND) were determined statistically using receiver operating characteristic curve analysis for survival prediction. The 5-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) rates were estimated using the Kaplan–Meier method. Results The results showed that, in this cohort, the optimal cutoff value of NLR was 2.95 and for LND, it was 0.031. Patients with NLR ≥2.95 correlated significantly with positive N classification (P=0.011), T2 classification (P=0.007), positive perineural invasion (P<0.001), and a tumor thickness of >5 mm (P=0.005). The 5-year OS among patients with NLR <2.95 was much higher than that in patients with NLR ≥2.95 (P<0.001). Similarly, the 5-year DSS among patients with NLR <2.95 was much higher than that in patients with NLR ≥2.95 (P=0.002). The 5-year DFS among patients with NLR <2.95 was much higher than that in patients with NLR ≥2.95 (P=0.004). The 5-year OS, DSS, and DFS were significantly reduced among patients with LND >0.031 compared to those with LND <0.031, respectively. In multivariate analysis, NLR, LND, and tumor thickness were independent prognostic factors for OS. Conclusion Pretreatment NLR ≥2.95 is significantly correlated with a larger tumor, positive neck lymph node metastasis, and positive perineural invasion. Importantly, it indicates reduced survival rate. Therefore, if the NLR ≥2.95 in early-stage (cT1/T2N0) tongue cancer is noted preoperatively, it reveals more invasive tumor behavior clinically. Then, aggressive treatments, including elective neck dissection

  5. Review of sentinel node procedure in cN0 head and neck squamous cell carcinomas. Guidelines from the French evaluation cooperative subgroup of GETTEC.

    PubMed

    Garrel, R; Poissonnet, G; Temam, S; Dolivet, G; Fakhry, N; de Raucourt, D

    2017-04-01

    The reliability of the sentinel lymph node (SN) technique has been established for more than ten years in T1-T2 oral cavity and oropharynx squamous cell carcinoma. Although most authors stress the necessity of rigorous implementation, there are no agreed guidelines. Moreover, other indications have been described, in other anatomical areas of the upper aerodigestive tract and in case of previous surgery or radiotherapy. SN expert teams, under the GETTEC head and neck tumor study group, conducted a review of the key points for implementation in head and neck cancers through guidelines and a review of classical and extended indications. Reliability depends on respecting key points of preoperative landmarking by lymphoscintigraphy, and intraoperative SN sampling and histological analysis. The SN technique is the best means of diagnosing occult lymph node involvement, whatever the primary tumor location, T stage or patient history.

  6. Head and neck paragangliomas: clinical and molecular genetic classification

    PubMed Central

    Offergeld, Christian; Brase, Christoph; Yaremchuk, Svetlana; Mader, Irina; Rischke, Hans Christian; Gläsker, Sven; Schmid, Kurt W; Wiech, Thorsten; Preuss, Simon F; Suárez, Carlos; Kopeć, Tomasz; Patocs, Attila; Wohllk, Nelson; Malekpour, Mahdi; Boedeker, Carsten C; Neumann, Hartmut PH

    2012-01-01

    Head and neck paragangliomas are tumors arising from specialized neural crest cells. Prominent locations are the carotid body along with the vagal, jugular, and tympanic glomus. Head and neck paragangliomas are slowly growing tumors, with some carotid body tumors being reported to exist for many years as a painless lateral mass on the neck. Symptoms depend on the specific locations. In contrast to paraganglial tumors of the adrenals, abdomen and thorax, head and neck paragangliomas seldom release catecholamines and are hence rarely vasoactive. Petrous bone, jugular, and tympanic head and neck paragangliomas may cause hearing loss. The internationally accepted clinical classifications for carotid body tumors are based on the Shamblin Class I–III stages, which correspond to postoperative permanent side effects. For petrous-bone paragangliomas in the head and neck, the Fisch classification is used. Regarding the molecular genetics, head and neck paragangliomas have been associated with nine susceptibility genes: NF1, RET, VHL, SDHA, SDHB, SDHC, SDHD, SDHAF2 (SDH5), and TMEM127. Hereditary HNPs are mostly caused by mutations of the SDHD gene, but SDHB and SDHC mutations are not uncommon in such patients. Head and neck paragangliomas are rarely associated with mutations of VHL, RET, or NF1. The research on SDHA, SDHAF2 and TMEM127 is ongoing. Multiple head and neck paragangliomas are common in patients with SDHD mutations, while malignant head and neck paraganglioma is mostly seen in patients with SDHB mutations. The treatment of choice is surgical resection. Good postoperative results can be expected in carotid body tumors of Shamblin Class I and II, whereas operations on other carotid body tumors and other head and neck paragangliomas frequently result in deficits of the cranial nerves adjacent to the tumors. Slow growth and the tendency of hereditary head and neck paragangliomas to be multifocal may justify less aggressive treatment strategies. PMID:22584701

  7. Clinical applications of Telerobotic ENT-Head and Neck surgery.

    PubMed

    Arora, Asit; Cunningham, Aileen; Chawdhary, Gaurav; Vicini, Claudio; Weinstein, Gregory S; Darzi, Ara; Tolley, Neil

    2011-01-01

    To review the published clinical data in Telerobotic ENT-Head and Neck surgery, evaluate the benefit of existing clinical applications and identify areas for potential development. A qualitative review was performed of publications in PubMed, Medline and the Cochrane Database identified from the following keyword searches: Telerobotic/Robotic ENT, Otorhinolaryngology, Head and Neck surgery, Thyroid and Parathyroid surgery. Preclinical studies and non-clinical review articles were excluded. Forty-five publications were identified including 7 review articles. Transoral robotic surgery (TORS) was reported in 20 clinical studies, robotic-assisted thyroidectomy in 13 studies, parathyroidectomy in 4 studies and skull base surgery in 1 study. The majority of TORS publications relate to oropharyngeal malignancy which were Stage III and IV. Clinical benefits include avoidance or dose reduction of adjuvant chemoradiotherapy and improved swallow function. The primary clinical advantage of robotic-assisted neck surgery is the avoidance of a neck scar. The learning curve for robotic thyroidectomy is 50 cases. Body habitus is an important factor for assessment of robotic feasibility in transoral and neck surgery. The application of robotic-assisted parathyroidectomy, thyroidectomy and TORS suggests promising improvements in patient care. Randomised control trials are needed to assess clinical outcome, cost effectiveness and patient benefit in the existing applications. Continued development of robotic technology will expand the viable clinical applications in this specialty. Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  8. The n = 0 Discovery

    NASA Astrophysics Data System (ADS)

    Witten, Thomas A.

    We describe Pierre-Gilles de Gennes' 1972 letter explaining polymer swelling as a form of critical phenomenon. We trace the impact of this "n = 0" discovery on polymer theory and experiment. We discuss later developments in mainstream statistical physics that reflect the n = 0 insight of this paper. We collect the views of several leading statistical physicists on the significance of the discovery.

  9. Clinical Practice Guideline: Evaluation of the Neck Mass in Adults.

    PubMed

    Pynnonen, Melissa A; Gillespie, M Boyd; Roman, Benjamin; Rosenfeld, Richard M; Tunkel, David E; Bontempo, Laura; Brook, Itzhak; Chick, Davoren Ann; Colandrea, Maria; Finestone, Sandra A; Fowler, Jason C; Griffith, Christopher C; Henson, Zeb; Levine, Corinna; Mehta, Vikas; Salama, Andrew; Scharpf, Joseph; Shatzkes, Deborah R; Stern, Wendy B; Youngerman, Jay S; Corrigan, Maureen D

    2017-09-01

    Objective Neck masses are common in adults, but often the underlying etiology is not easily identifiable. While infections cause most of the neck masses in children, most persistent neck masses in adults are neoplasms. Malignant neoplasms far exceed any other etiology of adult neck mass. Importantly, an asymptomatic neck mass may be the initial or only clinically apparent manifestation of head and neck cancer, such as squamous cell carcinoma (HNSCC), lymphoma, thyroid, or salivary gland cancer. Evidence suggests that a neck mass in the adult patient should be considered malignant until proven otherwise. Timely diagnosis of a neck mass due to metastatic HNSCC is paramount because delayed diagnosis directly affects tumor stage and worsens prognosis. Unfortunately, despite substantial advances in testing modalities over the last few decades, diagnostic delays are common. Currently, there is only 1 evidence-based clinical practice guideline to assist clinicians in evaluating an adult with a neck mass. Additionally, much of the available information is fragmented, disorganized, or focused on specific etiologies. In addition, although there is literature related to the diagnostic accuracy of individual tests, there is little guidance about rational sequencing of tests in the course of clinical care. This guideline strives to bring a coherent, evidence-based, multidisciplinary perspective to the evaluation of the neck mass with the intention to facilitate prompt diagnosis and enhance patient outcomes. Purpose The primary purpose of this guideline is to promote the efficient, effective, and accurate diagnostic workup of neck masses to ensure that adults with potentially malignant disease receive prompt diagnosis and intervention to optimize outcomes. Specific goals include reducing delays in diagnosis of HNSCC; promoting appropriate testing, including imaging, pathologic evaluation, and empiric medical therapies; reducing inappropriate testing; and promoting appropriate

  10. Long-term results of 100 consecutive comprehensive neck dissections: implications for selective neck dissections.

    PubMed

    Sivanandan, Ranjiv; Kaplan, Michael J; Lee, Kimberly J; Lebl, Darren; Pinto, Harlan; Le, Quyhn-Thu; Goffinet, Don R; Fee, Willard E

    2004-12-01

    The optimal surgical procedure for the neck in patients with squamous head and neck cancers is controversial. Selective neck dissections have replaced modified radical neck dissections as the procedure of choice for the clinically negative (N0) neck and are now being considered for patients with early-stage neck disease. We report the long-term local recurrence rates in 100 consecutive patients undergoing a radical or modified radical neck dissection for clinically positive (N+) and N0 neck disease and review comprehensively the literature reporting and comparing regional control rates for both neck dissection types. The clinical records of 100 consecutive patients who underwent a comprehensive neck dissection (levels I-V) for squamous head and neck cancers with a minimum of a 2-year follow-up were retrospectively reviewed for primary site of disease, clinical and pathologic neck status, histopathologic grade, neck dissection type, and the site and time of recurrence. Complete data were available for 97 patients on whom 99 neck dissections were performed. Three patients died from unknown causes. Seventy-six patients with N+ disease underwent a therapeutic neck dissection, while 24 patients with clinically N0 disease underwent an elective dissection. The overall neck recurrence rate in patients with controlled primary disease was 7%. The neck or regional failure rate for patients completing the recommended adjuvant radiotherapy was 4%. Six (25%) of 24 patients with clinically N0 disease had occult metastases. The recurrence rate for this group was 4%. Further study is needed to determine the optimal surgical management of the N0 and limited N+ neck.

  11. Local-Regional Recurrence With and Without Radiation Therapy After Neoadjuvant Chemotherapy and Mastectomy for Clinically Staged T3N0 Breast Cancer

    SciTech Connect

    Nagar, Himanshu; Mittendorf, Elizabeth A.; Strom, Eric A.; Perkins, George H.; Oh, Julia L.; Tereffe, Welela; Woodward, Wendy A.; Gonzalez-Angulo, Ana M.; Hunt, Kelly K.; Buchholz, Thomas A.; Yu, Tse-Kuan

    2011-11-01

    Purpose: The purpose of this study was to determine local-regional recurrence (LRR) risk according to whether postmastectomy radiation therapy (PMRT) was used to treat breast cancer patients with clinical T3N0 disease who received neoadjuvant chemotherapy (NAC) and mastectomy. Methodsand Materials: Clinicopathology data from 162 patients with clinical T3N0 breast cancer who received NAC and underwent mastectomy were retrospectively reviewed. A total of 119 patients received PMRT, and 43 patients did not. The median number of axillary lymph nodes (LNs) dissected was 15. Actuarial rates were calculated using the Kaplan-Meier method and compared using the log-rank test. Results: At a median follow-up of 75 months, 15 of 162 patients developed LRR. For all patients, the 5-year LRR rate was 9% (95% confidence interval [CI], 4%-14%). The 5-year LRR rate for those who received PMRT was 4% (95% CI, 1%-9%) vs. 24% (95% CI, 10%-39%) for those who did not receive PMRT (p <0.001). A significantly higher proportion of irradiated patients had pathology involved LNs and were {<=}40 years old. Among patients who had pathology involved LNs, the LRR rate was lower in those who received PMRT (p <0.001). A similar trend was observed for those who did not have pathology involved LN disease. Among nonirradiated patients, the appearance of pathologic LN disease after NAC was the only clinicopathologic factor examined that significantly correlated with the risk of LRR. Conclusions: Breast cancer patients with clinical T3N0 disease treated with NAC and mastectomy but without PMRT had a significant risk of LRR, even when there was no pathologic evidence of LN involvement present after NAC. PMRT was effective in reducing the LRR rate. We suggest PMRT should be considered for patients with clinical T3N0 disease.

  12. Current clinical immunotherapeutic approaches for head and neck cancer

    PubMed Central

    Soto Chervin, Carolina; Brockstein, Bruce

    2016-01-01

    It was estimated that 59,340 new cases of head and neck cancer would be diagnosed in the US alone in 2015 and that 12,290 deaths would be attributed to the disease. Local and regional recurrences may be treated with chemotherapy and radiation; however, metastatic head and neck cancer is fatal and is treated with chemotherapy for palliation. Recent successful treatment of a variety of solid and hematological malignancies by immunotherapeutic approaches (i.e. harnessing the body’s own immune system to combat disease) has added a fourth therapeutic option for the treatment of cancer. This commentary will review the status of immunotherapies in clinical development for the specific treatment of head and neck cancer. PMID:27239282

  13. Diagnostic yield of a one-stop neck lump clinic.

    PubMed

    Al Hamarneh, Osama; Liew, Lenny; Shortridge, Richard J

    2013-05-01

    Diagnostic clinics for patients with neck lumps were established across the UK in response to NICE guidance on cancer services. The guidance stated that a surgeon and a cytopathologist among its other key recommendations should staff each clinic. The aim of this study was to establish the diagnostic yield of this clinic at Wolverhampton. A prospective cohort study was conducted of patients attending a one-stop neck lump clinic over a period of 30 months. Patients' characteristics, diagnostic tests and outcomes were recorded and the data analysed. Of 333 patients, n = 65 (20 %) had no lump, n = 214 (64 %) had a benign lump and n = 54 (16 %) had a malignant lump. Older age of patients and a history of smoking were found to be significantly higher when a malignant lump was diagnosed when compared with a benign lump. In the benign lump group, freehand FNAC had an accuracy of 87 % (n = 48/55), while USS-guided FNAC had an accuracy of 74 % (n = 32/43). Diagnosis was confirmed on the same day for the majority of patients (n = 178, 84 %). In the malignant lump group, freehand FNAC had an accuracy of 82 % (n = 28/34), while USS-guided FNAC had an accuracy of 81 % (n = 17/21). Diagnosis on the same day was confirmed for 74 % of the patients (n = 40). The clinic in our unit achieved an overall diagnostic yield of 84 %. Outcomes regarding age, sex, smoking, size and site of neck lumps and accuracy of FNAC were in line with published data. The study showed that this one-stop neck lump clinic was better at excluding malignancy than diagnosing it.

  14. Images of deep neck space infection and the clinical significance.

    PubMed

    Wang, Bing; Gao, Bu-Lang; Xu, Guo-Ping; Xiang, Cheng

    2014-10-01

    Deep neck infection is not difficult to diagnose clinically, but correct localization of the involved space for timely incision and drainage is not easy without assistance of imaging. To investigate the images of deep neck space infection of phlegmon and abscess and the role of imaging examination in correct localization and treatment. Between June 2004 and June 2010, 28 patients were diagnosed with deep neck infection (14 men, 14 women; age range, 17-72 years; mean age, 46 years). Clinical presentations included neck swelling, pain, dysphagia, fever, and elevated white blood cell count. Of the 28 cases, 20 had computed tomography (CT) scans, 18 had magnetic resonance imaging (MRI) examinations, and 10 had both CT and MRI. All 28 patients were confirmed by CT and/or MRI to have deep neck infection, with 11 cases in the retropharyngeal space, five in the parapharyngeal space, four in the masseteric space, and eight in multiple spaces. Thirteen cases had abscesses that were successfully treated with incision and drainage under CT guidance in combination with large doses of antibiotics, and 15 had phlegmon managed with large doses of antibiotics. Followed up for 5-20 months, all patients recovered completely. Two patients were confirmed by imaging examination to have retropharyngeal infection spreading to the superior mediastinum with abscess formation and another two patients had multiple space infection because inappropriate puncture or incision for drainage without imaging guidance in these patients caused the spread of infection. Clinical diagnosis was not accurate with only 12 patients (42.9%) being correctly diagnosed of the exact deep neck space involved before imaging confirmation. CT and/or MRI made the correct diagnosis in all 28 patients. CT and/or MRI also directly changed the treatment plan in seven patients and contributed to the recovery of these patients. CT and MRI play a crucial role in both the diagnosis and correct puncture and incision for

  15. A Model Predicting Lymph Node Status for Patients with Clinical Stage T1aN0-2M0 Nonsmall Cell Lung Cancer

    PubMed Central

    Zang, Ruo-Chuan; Qiu, Bin; Gao, Shu-Geng; He, Jie

    2017-01-01

    Background: Lymph node status of patients with early-stage nonsmall cell lung cancer has an influence on the choice of surgery. To assess the lymph node status more correspondingly and accurately, we evaluated the relationship between the preoperative clinical variables and lymph node status and developed one model for predicting lymph node involvement. Methods: We collected clinical and dissected lymph node information of 474 patients with clinical stage T1aN0-2M0 nonsmall cell lung cancer (NSCLC). Logistic regression analysis of clinical characteristics was used to estimate independent predictors of lymph node metastasis. The prediction model was validated by another group. Results: Eighty-two patients were diagnosed with positive lymph nodes (17.3%), and four independent predictors of lymph node disease were identified: larger consolidation size (odds ratio [OR] = 2.356, 95% confidence interval [CI]: 1.517–3.658, P < 0.001,), central tumor location (OR = 2.810, 95% CI: 1.545–5.109, P = 0.001), abnormal status of tumor marker (OR = 3.190, 95% CI: 1.797–5.661, P < 0.001), and clinical N1–N2 stage (OR = 6.518, 95% CI: 3.242–11.697, P < 0.001). The model showed good calibration (Hosmer–Lemeshow goodness-of-fit, P < 0.766) with an area under the receiver operating characteristics curve (AUC) of 0.842 (95% [CI]: 0.797–0.886). For the validation group, the AUC was 0.810 (95% CI: 0.731–0.889). Conclusions: The model can assess the lymph node status of patients with clinical stage T1aN0-2M0 NSCLC, enable surgeons perform an individualized prediction preoperatively, and assist the clinical decision-making procedure. PMID:28218211

  16. [Clinical analysis on giant lymph node hyperplasia on neck].

    PubMed

    Ma, Shi-hong; Liu, Qin-jiang; Wang, Jun; Yang, Rong

    2009-03-01

    To improve the diagnosis and management level of giant lymph node hyperplasia (Castleman's disease). To retrospective analyze 10 misdiagnosed cases with Castleman's disease in order to give some suggestions for clinical diagnosis and differential diagnosis. Ten patients with neck giant lymph node hyperplasia underwent surgical treatment after misdiagnosis. There were 8 localized Castleman's disease constituted of 6 cases with hyaline vascular type and 2 cases with mixture type and 2 multicentric Castleman's disease constituted of 1 cases with plasma cell type and 1 cases with mixture type were classified according to the criteria described by Frizzera. Ten cases were diagnosed by secondary operation after misdiagnosis and were clinically characterized by painless neck lymphadenectasis, 2 cases with multicentric Castleman's disease accompanied with aspecific systemic symptom and (or) multi-system damage. Ten cases survived for 4 - 17 years during follow-up periods in which 1 case with plasma cell type, multicentric Castleman's disease was recurrent 2 years later and underwent lymphadenectomy and chemotherapy and have no local recurrence so far. Castleman's disease on neck is seldom seen and liable to misdiagnose. The diagnosis of Castleman's disease is based on its histopathological characteristics by lymph node resection biopsy. It should be considered in the differential diagnosis with lymph node tuberculosis, lymphadenitis, sarcoidosis and granuloma. Operation is the first choice for patient with localized type and multicentric type without serious involvement of multiple system functions.

  17. Acquired Bilateral Dyspigmentation on Face and Neck: Clinically Appropriate Approaches

    PubMed Central

    2016-01-01

    Facial dyspigmentation in Asian women often poses diagnostic and therapeutic challenges. Recently, a distinctive bilateral hyperpigmentation of face and neck has occasionally been observed. This study was performed to investigate the clinico-pathological features of this dyspigmentation as well as proper treatment approaches. We retrospectively investigated the medical records including photographs, routine laboratory tests, histopathologic studies of both lesional and peri-lesional normal skin and patch test of thirty-one patients presented acquired bizarre hyperpigmentation on face and neck. The mean age of patients was 52.3 years and the mean duration of dyspigmentation was 24.2 months. In histologic evaluations of lesional skin, a significantly increased liquefactive degeneration of basal layer, pigmentary incontinence and lymphocytic infiltration were noted, whereas epidermal melanin or solar elastosis showed no statistical differences. Among 19 patients managed with a step-by-step approach, seven improved with using only topical anti-inflammatory agents and moisturizer, and 12 patients gained clinical benefit after laser therapy without clinical aggravation. Both clinical and histopathologic findings of the cases suggest a distinctive acquired hyperpigmentary disorder related with subclinical inflammation. Proper step-by-step evaluation and management of underlying subclinical inflammation would provide clinical benefit. PMID:27822947

  18. Interchangeable neck shape-specific coils for a clinically realizable anterior neck phased array system.

    PubMed

    Beck, Michael J; Parker, Dennis L; Bolster, Bradley D; Kim, Seong-Eun; McNally, J Scott; Treiman, Gerald S; Hadley, J Rock

    2017-02-10

    To demonstrate the interchangeable neck shape-specific (NSS) coil concept that supplements standard commercial spine and head/neck coils to provide simultaneous high-resolution (hi-res) head/neck imaging with high signal-to-noise ratio (SNR). Two NSS coils were constructed on formers designed to fit two different neck shapes. A 7-channel (7ch) ladder array was constructed on a medium neck former, and a 9-channel (9ch) ladder array was constructed on large neck former. Both coils were interchangeable with the same preamp housing. The 7ch and 9ch coils demonstrate SNR gains of approximately 4 times and 3 times over the Siemens 20-channel head/neck coil in the carotid arteries of our volunteers, respectively. Coupling between the Siemens 32-channel spine coil, Siemens 20-channel head/neck coil, and the NSS coils was negligible, allowing for simultaneous hi-res head/neck imaging with high SNR. This study demonstrates that supplementing existing commercial spine and head/neck coils with an NSS coil allows uniform simultaneous hi-res imaging with high SNR in the anterior neck, while maintaining SNR of the commercial coil in the head and posterior neck. Magn Reson Med, 2017. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

  19. Head and Neck Lymphomas in HIV Patients: a Clinical Perspective.

    PubMed

    Oishi, Natsuki; Bagán, José Vicente; Javier, Karla; Zapater, Enrique

    2017-10-01

    Introduction  Because of the many HIV-related malignancies, the diagnosis and treatment of lymphoma in patients infected with human immunodeficiency virus are challenging. Objective  Here, we review current knowledge of the pathogenesis, epidemiology, symptomatology, diagnosis, and treatment of head and neck lymphomas in HIV patients from a clinical perspective. Data Synthesis  Although Hodgkin's lymphoma is not an AIDS-defining neoplasm, its prevalence is ten times higher in HIV patients than in the general population. NHL is the second most common malignancy in HIV patients, after Kaposi's sarcoma. In this group of patients, NHL is characterized by rapid progression, frequent extranodal involvement, and a poor outcome. HIV-related salivary gland disease is a benign condition that shares some features with lymphomas and is considered in their differential diagnosis. Conclusion  The otolaryngologist may be the first clinician to diagnose head and neck lymphomas. The increasing survival of HIV patients implies clinical and epidemiological changes in the behavior of this disease. Early diagnosis is important to improve the prognosis and avoid the propagation of HIV infection.

  20. Hematoporphyrin-mediated photodynamic therapy for treatment of head and neck cancer: clinical update 1996

    NASA Astrophysics Data System (ADS)

    Schweitzer, Vanessa G.

    1996-04-01

    From 1983 to 1996 Phase II and III clinical studies at Henry Ford Hospital demonstrated complete or partial responses in 55 of 56 patients treated with hematoporphyrin-derivative or PHOTOFRIN-mediated photodynamic therapy (HPD-PDT) for a variety of benign and malignant upper aerodigestive tract disease: (1) superficial 'condemned mucosa' or 'field cancerization' of the oral cavity and larynx (7 cases); (2) Stage III/IV head and neck cancer (25 cases); (3) mucocutaneous AIDS-associated Kaposi's sarcoma of the upper aerodigestive tract and non AIDS-related Kaposi's sarcoma of the lower extremity (15 cases); (4) recurrent laryngotracheal papillomatosis (3 cases); (5) severe dysplasia/adenocarcinoma or squamous cell carcinoma in situ in Barrett's esophagus (4 cases); (6) partial or completely obstructing terminal esophageal cancer (9 cases). At the time of this report, HPD-PDT produced complete responses in 24 patients (follow up 6 months to 9 years) with 'field cancerization' (CIS, T1N0M0) of the oral cavity and larynx (6 cases), adenocarcinoma in situ in Barrett's esophagus (3 cases), mucocutaneous Kaposi's sarcoma (12 cases), obstructing esophageal carcinoma (1 case), and stage IV squamous cell carcinoma of the nasopharynx (1 case), and radiation therapy or solar-induced basal cell/squamous cell carcinomas (2 cases). PDT treatment protocols, results, complications, and application as adjunct or primary oncologic therapy for head and neck cancer are reviewed in this article.

  1. Clinical utility of head and neck aspiration cytology.

    PubMed

    Karayianis, S L; Francisco, G J; Schumann, G B

    1988-01-01

    Over the past 3.5 yr, we have examined 195 head and neck fine-needle aspiration (FNA) specimens from three diverse medical settings. Specimens were collected in saline solution or Saccomanno fixative and processed using cytocentrifugation or membrane filtration. This allowed us simultaneously to perform cytologic evaluations, special stains, and immunologic marker studies from a single specimen. Good correlation between clinical experience with FNA and obtaining satisfactory specimens was demonstrated. Our sensitivity (89%) and specificity (94%) reflect problems associated with specimen collection in a training environment where clinician experience with the procedure is low. A definitive diagnosis was possible in most cases, and the treatment plan was often based on the FNA results. In patients without a history of a primary malignancy, a FNA done early in the clinical course helped direct the initial workup of the patient, saving time and expense.

  2. Nontraumatic head and neck injuries: a clinical approach. Part 2.

    PubMed

    Brea Álvarez, B; Esteban García, L; Tuñón Gómez, M; Cepeda Ibarra, Y

    Nontraumatic emergencies of the head and neck represent a challenge in the field of neuroradiology for two reasons. As explained in the first part of this update, these entities affect an area where the thorax joins the cranial cavity and can thus compromise both structures; second, they are uncommon, so they are not well known. Maintaining the same approach as in the first part, focusing on the clinical presentations in the emergency department rather than on the anatomic regions affected, we will study the entities that present with two patterns: those that present with a combination of cervical numbness, dysphagia, and dyspnea and those that present with acute sensory deficits. In the latter group, we will specifically focus on visual deficits, because this is the most common symptom that calls for urgent imaging studies. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Audit of clinical coding of major head and neck operations.

    PubMed

    Mitra, Indu; Malik, Tass; Homer, Jarrod J; Loughran, Sean

    2009-04-01

    Within the NHS, operations are coded using the Office of Population Censuses and Surveys (OPCS) classification system. These codes, together with diagnostic codes, are used to generate Healthcare Resource Group (HRG) codes, which correlate to a payment bracket. The aim of this study was to determine whether allocated procedure codes for major head and neck operations were correct and reflective of the work undertaken. HRG codes generated were assessed to determine accuracy of remuneration. The coding of consecutive major head and neck operations undertaken in a tertiary referral centre over a retrospective 3-month period were assessed. Procedure codes were initially ascribed by professional hospital coders. Operations were then recoded by the surgical trainee in liaison with the head of clinical coding. The initial and revised procedure codes were compared and used to generate HRG codes, to determine whether the payment banding had altered. A total of 34 cases were reviewed. The number of procedure codes generated initially by the clinical coders was 99, whereas the revised codes generated 146. Of the original codes, 47 of 99 (47.4%) were incorrect. In 19 of the 34 cases reviewed (55.9%), the HRG code remained unchanged, thus resulting in the correct payment. Six cases were never coded, equating to pound15,300 loss of payment. These results highlight the inadequacy of this system to reward hospitals for the work carried out within the NHS in a fair and consistent manner. The current coding system was found to be complicated, ambiguous and inaccurate, resulting in loss of remuneration.

  4. Audit of Clinical Coding of Major Head and Neck Operations

    PubMed Central

    Mitra, Indu; Malik, Tass; Homer, Jarrod J; Loughran, Sean

    2009-01-01

    INTRODUCTION Within the NHS, operations are coded using the Office of Population Censuses and Surveys (OPCS) classification system. These codes, together with diagnostic codes, are used to generate Healthcare Resource Group (HRG) codes, which correlate to a payment bracket. The aim of this study was to determine whether allocated procedure codes for major head and neck operations were correct and reflective of the work undertaken. HRG codes generated were assessed to determine accuracy of remuneration. PATIENTS AND METHODS The coding of consecutive major head and neck operations undertaken in a tertiary referral centre over a retrospective 3-month period were assessed. Procedure codes were initially ascribed by professional hospital coders. Operations were then recoded by the surgical trainee in liaison with the head of clinical coding. The initial and revised procedure codes were compared and used to generate HRG codes, to determine whether the payment banding had altered. RESULTS A total of 34 cases were reviewed. The number of procedure codes generated initially by the clinical coders was 99, whereas the revised codes generated 146. Of the original codes, 47 of 99 (47.4%) were incorrect. In 19 of the 34 cases reviewed (55.9%), the HRG code remained unchanged, thus resulting in the correct payment. Six cases were never coded, equating to £15,300 loss of payment. CONCLUSIONS These results highlight the inadequacy of this system to reward hospitals for the work carried out within the NHS in a fair and consistent manner. The current coding system was found to be complicated, ambiguous and inaccurate, resulting in loss of remuneration. PMID:19220944

  5. Neck muscle fatigue alters the cervical flexion relaxation ratio in sub-clinical neck pain patients.

    PubMed

    Zabihhosseinian, Mahboobeh; Holmes, Michael W R; Ferguson, Brad; Murphy, Bernadette

    2015-06-01

    The cervical flexion relaxation ratio is lower in neck pain patients compared to healthy controls. Fatigue modulates the onset and offset angles of the silent period in both the lumbar and cervical spine in healthy individuals; however, this response has not been studied with neck pain patients. The purpose of this study was to determine if cervical extensor fatigue would alter the parameters of the cervical flexion relaxation more in a neck pain group than a healthy control group. Thirteen healthy and twelve neck pain patients participated. Cervical extensor activity was examined bilaterally and kinematics of the neck and head were collected. An isometric, repetitive neck extension task at 70% of maximum elicited fatigue. Participants performed 3 trials of maximal cervical flexion both pre and post fatigue. The healthy controls and neck pain groups fatigued after 56 (41) and 39 (31) repetitions, respectively. There was a significant interaction effect for the flexion relaxation ratio between the control and neck pain groups from pre to post fatigue trials (F1,96=22.67, P=0.0001), but not for onset and offset angles (F1, 96=0.017, P=0.897), although the onset and offset angles did decrease significantly for both groups following fatigue (F1,96=9.26, P=0.002). Individuals with mild to moderate neck pain have significant differences in their neuromuscular control relative to controls, experienced myoelectric fatigue with fewer repetitions in a shorter time, had a lower cervical flexion relaxation ratio at baseline and had an inability to decrease this ratio further in response to fatigue. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Implementing the National Institute of Clinical Excellence improving outcome guidelines for head and neck cancer: developing a business plan with reorganisation of head and neck cancer services.

    PubMed

    Jeannon, J-P; Abbs, I; Calman, F; Gleeson, M; Lyons, A; Hussain, K; McGurk, M; O'Connell, M; Probert, D; Ng, R; Simo, R

    2008-04-01

    The implementation of the National Institute of Clinical Excellence improving outcome guidelines (NICE-IOG) manual for head and neck cancer may have a huge potential cost implication. Head and neck cancer is a rare disease which utilises large quantities of resources which can only be provided in a tertiary centre. Head and neck cancer services should be centralised into a single site for each cancer network. A new higher tariff rate for complex head and neck cancer cases is needed which recognises the true cost of this work. Each network should set its own tariff to make head and neck cancer care financially viable.

  7. [The clinical value of sentinel lymph node detection in laryngeal and hypopharyngeal carcinoma patients with clinically negative neck by methylene blue method and radiolabeled tracer method].

    PubMed

    Zhao, Xin; Xiao, Dajiang; Ni, Jianming; Zhu, Guochen; Yuan, Yuan; Xu, Ting; Zhang, Yongsheng

    2014-11-01

    To investigate the clinical value of sentinel lymph node (SLN) detection in laryngeal and hypopharyngeal carcinoma patients with clinically negative neck (cN0) by methylene blue method, radiolabeled tracer method and combination of these two methods. Thirty-three patients with cN0 laryngeal carcinoma and six patients with cN0 hypopharyngeal carcinoma underwent SLN detection using both of methylene blue and radiolabeled tracer method. All these patients were accepted received the injection of radioactive isotope 99 Tc(m)-sulfur colloid (SC) and methylene blue into the carcinoma before surgery, then all these patients underwent intraopertive lymphatic mapping with a handheld gamma-detecting probe and blue-dyed SLN. After the mapping of SLN, selected neck dissections and tumor resections were peformed. The results of SLN detection by radiolabeled tracer, dye and combination of both methods were compared. The detection rate of SLN by radiolabeled tracer, methylene blue and combined method were 89.7%, 79.5%, 92.3% respectively. The number of detected SLN was significantly different between radiolabeled tracer method and combined method, and also between methylene blue method and combined method. The detection rate of methylene blue and radiolabeled tracer method were significantly different from combined method (P < 0.05). Nine patients were found to have lymph node metastasis by final pathological examination. The accuracy and negative rate of SLN detection of the combined method were 97.2% and 11.1%. The combined method using radiolabeled tracer and methylene blue can improve the detection rate and accuracy of sentinel lymph node detection. Furthermore, sentinel lymph node detection can accurately represent the cervical lymph node status in cN0 laryngeal and hypopharyngeal carcinoma.

  8. Clinical Results of Internal Fixation of Subcapital Femoral Neck Fractures.

    PubMed

    Kang, Joon Soon; Moon, Kyoung Ho; Shin, Joong Sup; Shin, Eun Ho; Ahn, Chi Hoon; Choi, Geon Hong

    2016-06-01

    Subcapital femoral neck is known to cause many complications, such as avascular necrosis (AVN) of the femoral head or nonunion, compared with other femoral neck fractures. The purpose of this study was to analyze the incidence of AVN and fixation failures in patients treated with internal fixation using cannulated screws for the subcapital femoral neck fractures. This study targeted a total of 84 cases of subcapital femoral neck fractures that underwent internal fixation using cannulated screws. The average follow-up time after surgery was 36.8 months (range, 24 to 148 months). Nine hips (10.7%) showing AVN of the femoral head and 6 hips (7.1%) showing fixation failures were observed. The factors affecting the incidence of AVN of the femoral head after sustaining fractures correlated well with fracture types in the Garden classification (p = 0.030). The factors affecting fixation failure were the degree of reduction (p = 0.001) measured by the Garden alignment index and firm fixation (p = 0.009) assessed using the technique of 3-point fixation through the inferomedial cortical bone of the femoral neck. The complication rates for subcapital femoral neck fractures were lower than those previously reported; hence, internal fixation could be a primary treatment option for these fractures.

  9. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain

    PubMed Central

    Kim, Jin Young; Kwag, Kwang Il

    2016-01-01

    [Purpose] The purpose of this study was to investigate clinical effects of deep cervical flexor (DCF) muscles exercise on pain, Neck Disability Index (NDI), and neck and shoulder postures in patients with chronic neck pain. [Subjects and Methods] Twenty-eight patients with chronic neck pain were randomly assigned into either the general strengthening exercise (GSE) group or the DCF activation group as control and experimental groups, respectively. All exercises were performed three times per week over 4 weeks. NDI and numeric rating scale (NRS) score for pain were determined and radiological assessment of neck-shoulder postures (head tilt angle [HTA], neck flexion angle [NFA], and forward shoulder angle [FSA]) was performed before (baseline), 4 weeks after, and 8 weeks after exercise in order to directly compare the exercise effects between the groups. [Results] In the DCF group, the NDI, NRS score, and neck-shoulder postures (analyzed by uisng HTA, NFA, and FSA) were significantly improved. [Conclusion] DCF activation exercise was effective to alleviate pain, recover functions, and correct forward head posture in the patients with neck pain. Hence, it might be recommended in the rehabilitation of patients with chronic neck pain. PMID:26957772

  10. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain.

    PubMed

    Kim, Jin Young; Kwag, Kwang Il

    2016-01-01

    [Purpose] The purpose of this study was to investigate clinical effects of deep cervical flexor (DCF) muscles exercise on pain, Neck Disability Index (NDI), and neck and shoulder postures in patients with chronic neck pain. [Subjects and Methods] Twenty-eight patients with chronic neck pain were randomly assigned into either the general strengthening exercise (GSE) group or the DCF activation group as control and experimental groups, respectively. All exercises were performed three times per week over 4 weeks. NDI and numeric rating scale (NRS) score for pain were determined and radiological assessment of neck-shoulder postures (head tilt angle [HTA], neck flexion angle [NFA], and forward shoulder angle [FSA]) was performed before (baseline), 4 weeks after, and 8 weeks after exercise in order to directly compare the exercise effects between the groups. [Results] In the DCF group, the NDI, NRS score, and neck-shoulder postures (analyzed by uisng HTA, NFA, and FSA) were significantly improved. [Conclusion] DCF activation exercise was effective to alleviate pain, recover functions, and correct forward head posture in the patients with neck pain. Hence, it might be recommended in the rehabilitation of patients with chronic neck pain.

  11. Sentinel node detection in N0 cancer of the pharynx and larynx

    PubMed Central

    Werner, J A; Dünne, A-A; Ramaswamy, A; Folz, B J; Lippert, B M; Moll, R; Behr, Th

    2002-01-01

    Neck lymph node status is the most important factor for prognosis in head and neck squamous cell carcinoma. Sentinel node detection reliably predicts the lymph node status in melanoma and breast cancer patients. This study evaluates the predictive value of sentinel node detection in 50 patients suffering from pharyngeal and laryngeal carcinomas with a N0 neck as assessed by ultrasound imaging. Following 99m-Technetium nanocolloid injection in the perimeter of the tumour intraoperative sentinel node detection was performed during lymph node dissection. Postoperatively the histological results of the sentinel nodes were compared with the excised neck dissection specimen. Identification of sentinel nodes was successful in all 50 patients with a sensitivity of 89%. In eight cases the sentinel node showed nodal disease (pN1). In 41 patients the sentinel node was tumour negative reflecting the correct neck lymph node status (pN0). We observed one false-negative result. In this case the sentinel node was free of tumour, whereas a neighbouring lymph node contained a lymph node metastasis (pN1). Although we have shown, that skipping of nodal basins can occur, this technique still reliably identifies the sentinel nodes of patients with squamous cell carcinoma of the pharynx and larynx. Future studies must show, if sentinel node detection is suitable to limit the extent of lymph node dissection in clinically N0 necks of patients suffering from pharyngeal and laryngeal squamous cell carcinoma. British Journal of Cancer (2002) 87, 711–715. doi:10.1038/sj.bjc.6600445 www.bjcancer.com © 2002 Cancer Research UK PMID:12232751

  12. Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial.

    PubMed

    Cerezo-Téllez, Ester; Torres-Lacomba, María; Fuentes-Gallardo, Isabel; Perez-Muñoz, Milagros; Mayoral-Del-Moral, Orlando; Lluch-Girbés, Enrique; Prieto-Valiente, Luis; Falla, Deborah

    2016-09-01

    Chronic neck pain attributed to a myofascial pain syndrome is characterized by the presence of muscle contractures referred to as myofascial trigger points. In this randomized, parallel-group, blinded, controlled clinical trial, we examined the effectiveness of deep dry needling (DDN) of myofascial trigger points in people with chronic nonspecific neck pain. The study was conducted at a public Primary Health Care Centre in Madrid, Spain, from January 2010 to December 2014. A total of 130 participants with nonspecific neck pain presenting with active myofascial trigger points in their cervical muscles were included. These participants were randomly allocated to receive: DDN plus stretching (n = 65) or stretching only (control group [n = 65]). Four sessions of treatment were applied over 2 weeks with a 6-month follow-up after treatment. Pain intensity, mechanical hyperalgesia, neck active range of motion, neck muscle strength, and perceived neck disability were measured at baseline, after 2 sessions of intervention, after the intervention period, and 15, 30, 90, and 180 days after the intervention. Significant and clinically relevant differences were found in favour of dry needling in all the outcomes (all P < 0.001) at both short and long follow-ups. Deep dry needling and passive stretching is more effective than passive stretching alone in people with nonspecific neck pain. The results support the use of DDN in the management of myofascial pain syndrome in people with chronic nonspecific neck pain.

  13. The Tip of the Iceberg: Clinical Implications of Genomic Sequencing Projects in Head and Neck Cancer

    PubMed Central

    Birkeland, Andrew C.; Ludwig, Megan L.; Meraj, Taha S.; Brenner, J. Chad; Prince, Mark E.

    2015-01-01

    Recent genomic sequencing studies have provided valuable insight into genetic aberrations in head and neck squamous cell carcinoma. Despite these great advances, certain hurdles exist in translating genomic findings to clinical care. Further correlation of genetic findings to clinical outcomes, additional analyses of subgroups of head and neck cancers and follow-up investigation into genetic heterogeneity are needed. While the development of targeted therapy trials is of key importance, numerous challenges exist in establishing and optimizing such programs. This review discusses potential upcoming steps for further genetic evaluation of head and neck cancers and implementation of genetic findings into precision medicine trials. PMID:26506389

  14. Percutaneous Lung Thermal Ablation of Non-surgical Clinical N0 Non-small Cell Lung Cancer: Results of Eight Years’ Experience in 87 Patients from Two Centers

    SciTech Connect

    Palussiere, Jean; Lagarde, Philippe; Aupérin, Anne; Deschamps, Frédéric; Chomy, François; Baere, Thierry de

    2015-02-15

    PurposeTo evaluate the survival outcomes of percutaneous thermal ablation (RFA + microwaves) for patients presenting N0 non-small-cell lung cancer (NSCLC) ineligible for surgery.Materials and MethodsEighty-seven patients from two comprehensive cancer centers were included. Eighty-two patients were treated with RFA electrodes and five with microwave antenna. Overall survival (OS) and disease-free survival (DFS) were estimated and predictive factors of local tumor progression, OS and DFS identified and compared by univariate and multivariate analysesResultsMedian follow-up was 30.5 months (interquartile range 16.7–51) and tumor size was 21 mm (range 10–54 mm). Treatment was incomplete for 14 patients with a local tumor progression of 11.5, 18.3, and 21.1 % at 1, 2, and 3 years, respectively. Two patients presented with neurological (grade III or IV) complications, and one died of respiratory and multivisceral failure as a result of the procedure at 29 days. In univariate analysis, increasing tumor size (P = 0.003) was the only predictive factor related to risk of local tumor progression. 5-year OS and DFS were 58.1 and 27.9 %, respectively. Sex (P = 0.044), pathology (P = 0.032), and tumor size >2 cm (P = 0.046) were prognostic factors for DFS. In multivariate analysis, pathology (P = 0.033) and tumor size >2 cm (P = 0.032) were independent prognostic factors for DFS.ConclusionsOversized and overlapping ablation of N0 NSCLC was well tolerated, effective, with few local tumor progressions, even over long-term follow-up. Increasing tumor size was the main prognostic factor linked to OS, DFS, and local tumor progression.

  15. Development of the clinical use of distant flaps for head and neck reconstruction.

    PubMed

    Thiele, Oliver C; Seeberger, Robin; Engel, Michael; Freier, Kolja; Hoffmann, Jürgen

    2014-01-01

    The reconstruction of hard and soft tissue defects, mainly after ablative oncologic surgery in the head and neck area, is an evolving field. The use of free flaps for reconstruction of the head and neck is considered to be the surgical standard. In our analysis of more than 1000 free flaps we give an overview of the development of the use of different types of free tissue transfer to the head and neck area over the last 25 years. We show that the evolving field of head and neck reconstruction raises new possibilities with new types of flaps, whereas other types of flaps disappear in the everyday clinical use. The spectrum of reconstruction possibilities broadens with the number of different flap types available to the head and neck surgeon. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  16. Adaptive Radiotherapy for Head-and-Neck Cancer: Initial Clinical Outcomes From a Prospective Trial

    SciTech Connect

    Schwartz, David L.; Garden, Adam S.; Thomas, Jimmy; Chen Yipei; Zhang Yongbin; Lewin, Jan; Chambers, Mark S.; Dong, Lei

    2012-07-01

    Purpose: To present pilot toxicity and survival outcomes for a prospective trial investigating adaptive radiotherapy (ART) for oropharyngeal squamous cell carcinoma. Methods and Materials: A total of 24 patients were enrolled in an institutional review board-approved clinical trial; data for 22 of these patients were analyzed. Daily CT-guided setup and deformable image registration permitted serial mapping of clinical target volumes and avoidance structures for ART planning. Primary site was base of tongue in 15 patients, tonsil in 6 patient, and glossopharyngeal sulcus in 1 patient. Twenty patients (91%) had American Joint Committee on Cancer (AJCC) Stage IV disease. T stage distribution was 2 T1, 12 T2, 3 T3, 5 T4. N stage distribution was 1 N0, 2 N1, 5 N2a, 12 N2b, and 2 N2c. Of the patients, 21 (95%) received systemic therapy. Results: With a 31-month median follow-up (range, 13-45 months), there has been no primary site failure and 1 nodal relapse, yielding 100% local and 95% regional disease control at 2 years. Baseline tumor size correlated with absolute volumetric treatment response (p = 0.018). Parotid volumetric change correlated with duration of feeding tube placement (p = 0.025). Acute toxicity was comparable to that observed with conventional intensity-modulated radiotherapy (IMRT). Chronic toxicity and functional outcomes beyond 1 year were tabulated. Conclusion: This is the first prospective evaluation of morbidity and survival outcomes in patients with locally advanced head-and-neck cancer treated with automated adaptive replanning. ART can provide dosimetric benefit with only one or two mid-treatment replanning events. Our preliminary clinical outcomes document functional recovery and preservation of disease control at 1-year follow-up and beyond.

  17. Sublobar Resection Margin Width Does Not Affect Recurrence of Clinical N0 Non-small Cell Lung Cancer Presenting as GGO-Predominant Nodule of 3 cm or Less.

    PubMed

    Moon, Youngkyu; Lee, Kyo Young; Moon, Seok Whan; Park, Jae Kil

    2017-02-01

    Sublobar resection of lung cancer may benefit patients with lung cancer presenting as ground-glass opacity (GGO) nodules. The purpose of this study was to evaluate the effect of margin width on recurrence after sublobar resection in patients with clinical N0 non-small cell lung cancer presenting as GGO-predominant nodule. We conducted a retrospective chart review of 91 patients treated for clinical N0 non-small cell lung cancer ≤3 cm by sublobar resection with clear resection margins. We assigned them to two groups: GGO-predominant tumor and solid-predominant tumor. Each group was subdivided into two groups according to the margin width: resection margin ≤5 mm and resection margin >5 mm. We analyzed the clinicopathological findings and survival among these four groups. There was no recurrence in GGO-predominant tumors after sublobar resection. Margin width did not influence the recurrence in GGO-predominant tumors. In the cases of solid-predominant tumor, 5-year recurrence-free survival after sublobar resection according to margin width ≤5 and >5 mm was 24.2 and 79.6 %, respectively (p < 0.001). Therefore, narrow margin width (resection margin ≤5 mm) was a significant risk factor for recurrence of solid-predominant tumors (hazard ratio 3.868, 95 % confidence interval 1.177-12.714, p = 0.026). The width between the tumor and resection margin does not affect the recurrence after R0 sublobar resection in patients with clinical N0 GGO-predominant lung cancer ≤3 cm. By contrast, margin width is a significant risk factor for recurrence after sublobar resection in patients with clinical N0 solid-predominant lung cancer.

  18. Staging N0 oral cancer: lymphoscintigraphy and conventional imaging.

    PubMed

    Thomsen, J B; Sørensen, J A; Grupe, P; Karstoft, J; Krogdahl, A

    2005-08-01

    To compare sentinel lymph node biopsy, magnetic resonance imaging (MRI), Doppler ultrasonography, and palpation as staging tools in patients with T1/T2 N0 cancer of the oral cavity. Forty consecutive patients were enrolled (17 F and 23 M, aged 32-90 years), 24 T1 and 16 T2 cN0 squamous cell carcinoma of the oral cavity. Palpation was carried out by two observers prior to inclusion. MRI, gray-scale and Doppler ultrasonography were performed. Lymphoscintigraphies were done after peritumoral injections of 99mTc labelled rheniumsulphide nanocolloid, followed by sentinel lymph node biopsy guided by a gamma probe and Patent Blue. Palpation, Doppler ultrasonography, MRI, and sentinel lymph node biopsy were compared to a combination of histopathology and follow-up. Diagnostic testing was performed using the x2 test. Histopathological examination revealed metastatic spread to the neck in 14 of 40 patients. One patient had bilateral neck disease. Sentinel lymph node biopsy and ultrasonography were performed in 80 neck sides of 40 patients and MRI in 70 neck sides (5 patients were claustrophobic). SN revealed suspicious lymph nodes in 12 necks, ultrasonography in 23 necks, and MRI in 9 necks. The positive predictive value of sentinel lymph node biopsy was 100%, ultrasonography 57%, and MRI 56%. The respective negative predictive values were 96%, 96%, and 85%. The sensitivity of sentinel lymph node biopsy 80% was comparable to ultrasonography 87%, but the sensitivity of MRI 36% was low. The specificities were 100%, 85%, and 93%, respectively. By combined sentinel lymph node biopsy and ultrasonography the overall sensitivity could have been 100%. Sentinel lymph node biopsy improved staging of patients with small N0 oral cancers. Combined sentinel lymph node biopsy and Doppler ultrasonography may further improve staging. MRI and simple palpation results were poor.

  19. Clinical Practice in PET/CT for the Management of Head and Neck Squamous Cell Cancer.

    PubMed

    Goel, Reema; Moore, William; Sumer, Baran; Khan, Saad; Sher, David; Subramaniam, Rathan M

    2017-08-01

    The purpose of this article is to summarize the evidence for the value of PET/CT for the management of patients with head and neck squamous cell cancer and suggest best clinical practices. FDG PET/CT is a valuable imaging tool for identifying unknown primary tumors in patients with known cervical node metastases leading to management change and is the standard of care for the initial staging of stage III and IV head and neck squamous cell carcinomas (HNSCCs), for assessing therapy response when performed at least 12 weeks after chemoradiation therapy, and for avoiding unnecessary planned neck dissection. Neck dissection is avoided if PET/CT findings are negative-regardless of the size of the residual neck nodes-because survival outcomes are not compromised. FDG PET/CT is valuable in detecting recurrences and metastases during follow-up when suspected because of clinical symptoms and serves as a prognostic marker for patient survival outcomes, for 5 years. Using FDG PET/CT for routine surveillance of HNSCC after 6 months of treatment without any clinical suspicion should be discouraged.

  20. Isolated perifacial lymph node metastasis in oral squamous cell carcinoma with clinically node-negative neck.

    PubMed

    Agarwal, Sangeet Kumar; Arora, Sowrabh Kumar; Kumar, Gopal; Sarin, Deepak

    2016-10-01

    The incidence of occult perifacial nodal disease in oral cavity squamous cell carcinoma is not well reported. The purpose of this study was to evaluate the incidence of isolated perifacial lymph node metastasis in patients with oral squamous cell carcinoma with a clinically node-negative neck. The study will shed light on current controversies and will provide valuable clinical and pathological information in the practice of routine comprehensive removal of these lymph node pads in selective neck dissection in the node-negative neck. Prospective analysis. This study was started in August 2011 when intraoperatively we routinely separated the lymph node levels from the main specimen for evaluation of the metastatic rate to different lymph node levels in 231 patients of oral squamous cell cancer with a clinically node-negative neck. The current study demonstrated that 19 (8.22%) out of 231 patients showed ipsilateral isolated perifacial lymph node involvement. The incidence of isolated perifacial nodes did not differ significantly between the oral tongue (7.14%) and buccal mucosa (7.75%). Incidence was statistically significant in cases with lower age group (<45 years), advanced T stage, and higher depth of tumor invasion. Isolated perifacial node metastasis is high in oral squamous cell carcinoma with a clinically node-negative neck. The incidence of isolated perifacial involvement is high in cases of buccal mucosal and tongue cancers. A meticulous dissection of the perifacial nodes seems prudent when treating the neck in oral cavity squamous cell carcinoma. 4 Laryngoscope, 126:2252-2256, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  1. The Role of Postmastectomy Radiation Therapy After Neoadjuvant Chemotherapy in Clinical Stage II-III Breast Cancer Patients With pN0: A Multicenter, Retrospective Study (KROG 12-05)

    SciTech Connect

    Shim, Su Jung; Park, Won; Huh, Seung Jae; Choi, Doo Ho; Shin, Kyung Hwan; Lee, Nam Kwon; Suh, Chang-Ok; Keum, Ki Chang; Kim, Yong Bae; Ahn, Seung Do; Kim, Su Ssan; Ha, Sung W.; Chie, Eui Kyu; Kim, Kyubo; Shin, Hyun Soo; Kim, Jin Hee; Lee, Hyung-Sik

    2014-01-01

    Purpose: The purpose of this study was to investigate the role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) in clinical stage II-III breast cancer patients with pN0. Methods and Materials: We retrospectively identified 417 clinical stage II-III breast cancer patients who achieved an ypN0 at surgery after receiving NAC between 1998 and 2009. Of these, 151 patients underwent mastectomy after NAC. The effect of PMRT on disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and overall survival (OS) was evaluated by multivariate analysis including known prognostic factors using the Kaplan-Meier method and compared using the log–rank test and Cox proportional regression analysis. Results: Of the 151 patients who underwent mastectomy, 105 (69.5%) received PMRT and 46 patients (30.5%) did not. At a median follow-up of 59 months, 5 patients (3.3%) developed LRR (8 sites of recurrence) and 14 patients (9.3%) developed distant metastasis. The 5-year DFS, LRRFS, and OS rates were 91.2, 98.1, and 93.3% with PMRT and 83.0%, 92.3%, and 89.9% without PMRT, respectively (all P values not significant). By univariate analysis, only age (≤40 vs >40 years) was significantly associated with decreased DFS (P=.027). By multivariate analysis, age (≤40 vs >40 years) and pathologic T stage (0-is vs 1 vs 2-4) were significant prognostic factors affecting DFS (hazard ratio [HR] 0.353, 95% confidence interval [CI] 0.135-0.928, P=.035; HR 2.223, 95% CI 1.074-4.604, P=.031, respectively). PMRT showed no correlation with a difference in DFS, LRRFS, or OS by multivariate analysis. Conclusions: PMRT might not be necessary for pN0 patients after NAC, regardless of clinical stage. Prospective randomized clinical trial data are needed to assess whether PMRT can be safely omitted in pN0 patients after NAC and mastectomy for clinical stage II-III breast cancer.

  2. A dietitian-led clinic for patients receiving (chemo)radiotherapy for head and neck cancer.

    PubMed

    Kiss, Nicole K; Krishnasamy, Meinir; Loeliger, Jenelle; Granados, Alba; Dutu, Gaelle; Corry, June

    2012-09-01

    Malnutrition is prevalent in head and neck cancer patients and is associated with poorer outcomes and increased health care costs. This study aimed to evaluate the acceptability, organisational efficiency and clinical outcomes of a dietitian-led head and neck cancer clinic. Two consecutive, independent, patient cohorts were studied with a pre-post-test design of 98 patients prior to the introduction of a dietitian-led clinic (DLC) and the subsequent 100 patients who attended the newly formulated DLC. The two groups were compared for frequency of dietitian intervention, weight loss, enteral feeding, hospital admissions and post-treatment medical follow-up requirements. Nutritional management in a DLC was associated with reduced nutrition-related admissions from 12% to 4.5% (p = 0.0029), unplanned nasogastric tube insertions from 75% to 39% (p = 0.02), improved transition to oral diet post-radiotherapy from 68.3% to 76.7% (p = 0.10) and reduced radiation oncologist review at 2 weeks post-radiotherapy from 32% to 15% patients (p = 0.009) compared to the cohort prior to the DLC. A dietitian-led head and neck cancer clinic is associated with improved efficiency and nutritional management of head and neck cancer patients and offers a feasible model of care.

  3. Dorsal midbrain syndrome associated with persistent neck extension: Clinical and diagnostic imaging findings in 2 dogs

    PubMed Central

    Canal, Sara; Baroni, Massimo; Falzone, Cristian; De Benedictis, Giulia M.; Bernardini, Marco

    2015-01-01

    Two young dogs were evaluated for an acute onset of abnormal head posture and eye movement. Neurological examination was characterized mostly by permanent neck extension, abnormalities of pupils, and eye movement. A mesencephalic mass lesion was detected on magnetic resonance imaging in both cases. Neurophysiological pathways likely responsible for this peculiar clinical presentation are discussed. PMID:26663922

  4. Relationships of clinical, psychologic, and individual factors with the functional status of neck pain patients.

    PubMed

    Luo, Xuemei; Edwards, Christopher L; Richardson, William; Hey, Lloyd

    2004-01-01

    The objective of this study was to use both generic and disease-specific functional measures examining relationships of clinical, psychologic, and individual factors with the functional status of neck pain patients. Patients who visited a university-based spine clinic and reported neck pain were included in this study. A comprehensive computerized survey questionnaire was used to collect the information related to this study. The questionnaire also contained a generic measure, short form 12-item survey (SF-12), and a disease-specific measure, neck disability index (NDI). Correlation and multiple regression analysis were conducted to examine the relationships. A range of clinical, psychologic, and individual factors emerged to be significant predictors of the NDI or physical component of the SF-12 (PCS). The predictors of higher NDI included higher levels of neck pain, higher levels of back pain, higher levels of pain in arm or shoulder areas, not working, lower education, higher stress, the presence of depression or anxiety, and smoking. The predictors of lower PCS included not working, higher levels of back pain, higher levels of neck pain, lower education, female sex, the presence of cardiovascular disorders, the absence of cervical disk disorders, and older age. The predictors of the NDI or PCS appear to be multidimensional. Interventions designed to maximally improve the functional status of neck pain patients should be multifaceted and involve multidisciplinary teams. Selection of the most appropriate functional measures for an intervention study should consider differences between the generic and disease-specific measures in terms of their respective relationships with targeted factors. Prospective studies are needed to confirm the relationships observed in this study.

  5. Clinical utility and prospective comparison of ultrasonography and computed tomography imaging in staging of neck metastases in head and neck squamous cell cancer in an Indian setup.

    PubMed

    Ashraf, Mohammad; Biswas, Jaydip; Jha, Jayesh; Nayak, Sandeep; Singh, Vikas; Majumdar, Suparna; Bhowmick, Anup; Dam, Aniruddha

    2011-12-01

    Preoperative lymph node screening of all neck compartments is favored by clinicians for the management of the neck. The presence of a metastatic node on one side of the neck reduces the 5-year survival rate to 50%, and the presence of a metastatic node on both sides of the neck reduces the 5-year survival rate to 25%. This study compared the evaluation of lymph node metastases by ultrasonography (USG) and computed tomography (CT) in patients with squamous cell cancer of the head and neck region. Five hundred and eighty-four patients with squamous cell cancer of the head and neck were prospectively evaluated for the presence of cervical lymph node metastases. All patients underwent clinical examination (palpation), USG and CT imaging. Neck dissection was performed in all the patients, and the results of the preoperative evaluation were correlated with the surgical and histopathological findings. Metastases in neck nodes were identified in 148 patients by histopathological examination. Doppler USG correctly identified 136 node-positive patients (n = 148; sensitivity 91.8%, specificity 97%). CT imaging correctly identified 122 patients with metastatic lymph nodes (n = 148; sensitivity 83%, specificity 93%). Positive predictive values of USG and CT imaging were 95.6% and 91.3%, respectively, whereas the negative predictive values of these two imaging studies were 95.4% and 89.6%, respectively. The accuracy and sensitivity of USG in detection of cervical lymph node metastases make it a potentially promising and cheap preoperative tool for staging neck node metastases and optimizing the treatment plan for surgeons, especially in countries such as India.

  6. Clinical applications of dual-energy CT in head and neck imaging.

    PubMed

    Ginat, Daniel Thomas; Mayich, Michael; Daftari-Besheli, Laleh; Gupta, Rajiv

    2016-03-01

    Dual-energy CT provides insights into the material properties of the tissues and can differentiate between tissues that have similar attenuation on conventional, single energy CT imaging. It has several useful and promising applications in head and neck imaging that an otolaryngologist could use to deliver improved clinical care. These applications include metal artifact reduction, atherosclerotic plaque and tumor characterization, detection of parathyroid lesions, and delineation of paranasal sinus ventilation. Dual-energy CT can potentially improve image quality, reduce radiation dose, and provide specific diagnostic information for certain head and neck lesions. This article reviews some current and potential otolaryngology applications of dual-energy CT.

  7. Clinical analysis of Castleman disease (hyaline vascular type) in parotid and neck region.

    PubMed

    Zhong, Lai-ping; Wang, Li-zhen; Ji, Tong; Hu, Yu-hua; Hu, Yong-jie; Ye, Wei-min; Li, Jun; Sun, Jian; Zhu, Han-guang; Li, Jiang; Zhang, Chen-Ping

    2010-03-01

    The aim of this study was to analyze a single institution's experience in clinical diagnosis, treatment, and prognosis of Castleman disease (hyaline vascular type) in the parotid and neck region. From 2004 to 2008, a total of 10 consecutive patients with Castleman disease (hyaline vascular type) in the parotid and neck region underwent surgery were included in this retrospective study. The preoperative examinations, clinical diagnosis, surgical treatment, and prognosis were recorded and analyzed. Of the 10 patients, 4 were males and 6 female; their age ranged from 13 to 54 years with a mean of 26.6 years. The lesion occurred in the parotid region in 3 patients, in the neck region in 5 patients, and in both the parotid and neck regions in 2 patients. Their course of disease ranged from 3 months to 48 months with a mean of 12.5 months; 70% of the patients (7 out of 10) had a course of disease of <12 months. The patients always had no obvious complaint, and the laboratory examinations were almost within the normal limits. Magnetic resonance imaging/angiography were valuable on clinical diagnosis and differential diagnosis. All patients underwent surgical removal of the masses completely. During the follow-up period, which ranged from 9 months to 60 months with a mean of 38.9 months, no recurrence of the lesion occurred, and the quality of life of each patient was good. Castleman disease (hyaline vascular type) in the parotid and neck region is rare, with clinical manifestation and physical examination the same as benign lesions. There is no specific indication in the laboratory tests and imaging examinations; however, magnetic resonance imaging/angiography has potential value on clinical diagnosis and differential diagnosis. Surgical resection is the choice of treatment with good prognosis. Copyright 2010 Mosby, Inc. All rights reserved.

  8. Congenital midline cervical cleft: clinical approach to a congenital anterior neck defect.

    PubMed

    Crippa, Beatrice Letizia; Bedeschi, Maria Francesca; Cantarella, Giovanna; Colombo, Lorenzo; Agosti, Viola; Amodeo, Ilaria; Fumagalli, Monica; Mazzola, Isabella; Mosca, Fabio

    2015-05-01

    Numerous malformations can affect the anterior part of the neck presenting at birth as a real diagnostic challenge for the pediatrician or the primary care physician who initially evaluate the baby. Congenital midline cervical cleft represents a rare defect of the midline neck, which is sometimes wrongly diagnosed as a thyroglossal duct anomaly, dermoid cyst, branchial cleft anomaly or "birthmark". A prompt clinical diagnosis and surgical treatment during early infancy are essential to ensure both functional and aesthetic outcome. We report a case of a female neonate with a midline cervical cleft diagnosed immediately after birth. The main features of other congenital anomalies of the anterior neck are also discussed referring to their embryologic origin. © 2014 Japanese Teratology Society.

  9. Nontraumatic head and neck emergencies: a clinical approach. Part 1: cervicofacial swelling, dysphagia, and dyspnea.

    PubMed

    Brea Álvarez, B; Tuñón Gómez, M; Esteban García, L; García Hidalgo, C Y; Ruiz Peralbo, R M

    2016-01-01

    Nontraumatic emergencies of the head and neck represent a challenge in the field of neuroradiology for two reasons: first, they affect an area where the thorax joins the cranial cavity and can thus compromise both structures; second, they are uncommon, so they are not well known. Various publications focus on nontraumatic emergencies of the head and neck from the viewpoints of anatomic location or of particular diseases. However, these are not the most helpful viewpoints for dealing with patients in the emergency department, who present with particular signs and symptoms. We propose an analysis starting from the four most common clinical presentations of patients who come to the emergency department for nontraumatic head and neck emergencies: cervical swelling, dysphagia, dyspnea, and loss of vision. Starting from these entities, we develop an approach to the radiologic management and diagnosis of these patients.

  10. Swallowing performance in patients with head and neck cancer: a simple clinical test.

    PubMed

    Patterson, Joanne M; McColl, Elaine; Carding, Paul N; Kelly, Charles; Wilson, Janet A

    2009-10-01

    Few simple clinical measures are available to monitor swallowing performance in head and neck cancer. Water swallow tests (WST) have been used as a part of clinical assessments in neurological dysphagia. The aim of this paper is to evaluate the utility of the 100 mL WST in head and neck cancer patients. The 100 mL WST was performed on 167 head and neck cancer patients. Measures were compared with respect to tumor site/stage, gender and age. The cohort was compared with published healthy controls. The test was quick to administer with excellent compliance. Patients had significantly poorer swallows than the published control group (mean reduction 1.6 mL/s). Function worsened with increased tumor stage and for patients with pharyngeal tumors. The 100 mL WST is an effective swallowing performance measure and is easily incorporated into a clinical examination. This paper provides benchmark data on the 100 mL WST for individuals with head and neck cancer.

  11. Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain

    PubMed Central

    Kovacs, Francisco M; Abraira, Víctor; Royuela, Ana; Corcoll, Josep; Alegre, Luis; Tomás, Miquel; Mir, María Antonia; Cano, Alejandra; Muriel, Alfonso; Zamora, Javier; del Real, María Teresa Gil; Gestoso, Mario; Mufraggi, Nicole

    2008-01-01

    Background The minimal detectable change (MDC) and the minimal clinically important changes (MCIC) have been explored for nonspecific low back pain patients and are similar across different cultural settings. No data on MDC and MCIC for pain severity are available for neck pain patients. The objectives of this study were to estimate MDC and MCIC for pain severity in subacute and chronic neck pain (NP) patients, to assess if MDC and MCIC values are influenced by baseline values and to explore if they are different in the subset of patients reporting referred pain, and in subacute versus chronic patients. Methods Subacute and chronic patients treated in routine clinical practice of the Spanish National Health Service for neck pain, with or without pain referred to the arm, and a pain severity ≥ 3 points on a pain intensity number rating scale (PI-NRS), were included in this study. Patients' own "global perceived effect" over a 3 month period was used as the external criterion. The minimal detectable change (MDC) was estimated by means of the standard error of measurement in patients who self-assess as unchanged. MCIC were estimated by the mean value of change score in patients who self-assess as improved (mean change score, MCS), and by the optimal cutoff point in receiver operating characteristics curves (ROC). The effect on MDC and MCIC of initial scores, duration of pain, and existence of referred pain were assessed. Results 658 patients were included, 487 of them with referred pain. MDC was 4.0 PI-NRS points for neck pain in the entire sample, 4.2 for neck pain in patients who also had referred pain, and 6.2 for referred pain. MCS was 4.1 and ROC was 1.5 for referred and for neck pain, both in the entire sample and in patients who also complained of referred pain. ROC was lower (0.5 PI-NRS points) for subacute than for chronic patients (1.5 points). MCS was higher for patients with more intense baseline pain, ranging from 2.4 to 4.9 PI-NRS for neck pain and

  12. Clinical Pathway Implementation Improves Efficiency of Care in a Maxillofacial Head and Neck Surgery Unit.

    PubMed

    Yetzer, Jacob G; Pirgousis, Phillip; Li, Zhuo; Fernandes, Rui

    2017-01-01

    Clinical pathways have become an important and simple method of improving patient outcomes and decreasing health care resource usage. The purpose of this study was to evaluate early outcomes associated with the implementation of a clinical pathway in a maxillofacial head and neck surgery unit. This investigation is a retrospective cohort study of patients who underwent microvascular reconstruction of the head and neck from January 1, 2014 through December 31, 2014. Continuous variables were compared among 4 groups using analysis of variance or Kruskal-Wallis test, and categorical variables were compared using χ(2) test or Fisher exact test where appropriate. The primary predictor variable was use of the clinical pathway. Groups included patients treated by surgeon A during periods before and after implementation of a postoperative clinical pathway. Two groups treated by surgeon B also were evaluated during the same periods and served as external controls. Each period covered a span of 6 months. Outcome variables across groups were evaluated, including length-of-stay metrics, infection rates, transfers to the intensive care unit, and unplanned return to the operating room. Sixty-six patients who underwent microvascular head and neck reconstruction were included. There was a significant decrease in the average length of stay (P = .0364) and an increase in the rate of discharge within 7 days (P = .0416) in the group treated with the clinical pathway. Other outcomes, including infection rate, transfer to the intensive care unit, and unanticipated return to the operating room, showed no relevant difference among groups. The results of this study suggest that implementation of a clinical pathway can be beneficial for efficient management of postoperative care in the setting of microvascular head and neck reconstruction. More predictable and shorter lengths of stay are achievable and the clinical pathway serves as a valuable means of improving communication of the

  13. Characteristics of NIH- and industry-sponsored head and neck cancer clinical trials.

    PubMed

    Devaiah, Anand; Murchison, Charles

    2016-09-01

    Compare U.S. clinical trials sponsored by the National Institutes of Health (NIH) and industry, especially with regard to trial design, interventions studied, and results reporting rates. U.S. head and neck cancer clinical trials. We used information from ClinicalTrials.gov to compare NIH- and industry-sponsored head and neck cancer clinical trials, specifically analyzing differences in trial design and interventions studied. We examined publication rates and positive results rates using PubMed.gov. About 50% of NIH- and industry-sponsored clinical trials have their results reported in peer-reviewed literature. Industry-sponsored trials had higher rates of positive results than NIH-sponsored trials. NIH- and industry-sponsored clinical trials had similar trial designs, although industry-sponsored trials had significantly lower rates of randomization. Industry trials utilized radiation in 19% of trials and surgery in 2% of trials. NIH trials also had low utilization of both radiation and surgery (27% and 12% of trials, respectively). NIH- and industry-sponsored trials published their results in journals with comparable impact factors. There is significant underreporting of results in U.S. head and neck cancer clinical trials, whether sponsored by NIH or industry. Industry trials have significantly higher rates of positive results, although it is unclear what contributes to this. Both NIH- and industry-sponsored trials underutilize surgery and radiation as treatment modalities, despite the fact that these are standard-of-care therapies for head and neck cancer. We recommend that the NIH and industry report all results from clinical trials and use surgery and radiation as treatment arms in order to arrive at more balanced therapeutic recommendations. N/A. Laryngoscope, 126:E300-E303, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Does continuing education improve physical therapists' effectiveness in treating neck pain? A randomized clinical trial.

    PubMed

    Cleland, Joshua A; Fritz, Julie M; Brennan, Gerard P; Magel, Jake

    2009-01-01

    Physical therapists often attend continuing education (CE) courses to improve their overall clinical performance and patient outcomes. However, evidence suggests that CE courses may not improve the outcomes for patients receiving physical therapy for the management of neck pain. The purpose of this study was to investigate the effectiveness of an ongoing educational intervention for improving the outcomes for patients with neck pain. The study participants were 19 physical therapists who attended a 2-day CE course focusing on the management of neck pain. All patients treated by the therapists in this study completed the Neck Disability Index (NDI) and a pain rating scale at the initial examination and at their final visit. Therapists from 11 clinics were invited to attend a 2-day CE course on the management of neck pain. After the CE course, the therapists were randomly assigned to receive either ongoing education consisting of small group sessions and an educational outreach session or no further education. Clinical outcomes achieved by therapists who received ongoing education and therapists who did not were compared for both pretraining and posttraining periods. The effects of receiving ongoing education were examined by use of linear mixed-model analyses with time period and group as fixed factors; improvements in disability and pain as dependent variables; and age, sex, and the patient's initial NDI and pain rating scores as covariates. Patients treated by therapists who received ongoing education experienced significantly greater reductions in disability during the study period (pretraining to posttraining) than those treated by therapists who did not receive ongoing training (mean difference=4.2 points; 95% confidence interval [CI]=0.69, 7.7). Changes in pain did not differ for patients treated by the 2 groups of therapists during the study period (mean difference=0.47 point; 95% CI=-0.11, 1.0). Therapists in the ongoing education group also used fewer

  15. Therapeutic robot-assisted neck dissection via a retroauricular or modified facelift approach in head and neck cancer: a comparative study with conventional transcervical neck dissection.

    PubMed

    Kim, Won Shik; Byeon, Hyung Kwon; Park, Young Min; Ha, Jong Gyun; Kim, Eun Sung; Koh, Yoon Woo; Choi, Eun Chang

    2015-02-01

    In a previous study of robot-assisted neck dissection (RAND), we limited the indication for neck dissection in clinical N0 head and neck cancer. The purpose of this study was for us to present the comparison of the results of therapeutic RAND via a retroauricular or modified facelift approach with outcomes from conventional neck dissection in clinical node-positive head and neck cancer. This study involved a total of 53 patients who underwent neck dissection for head and neck cancer. Operative and pathologic parameters were assessed. The RAND and the conventional neck dissection group consisted of 20 and 33 patients, respectively. The mean operative time for the RAND group was significantly longer than that of the conventional neck dissection group. The mean number of retrieved lymph nodes in the RAND group was not significantly different from the conventional neck dissection group. Therapeutic RAND via a retroauricular or modified facelift approach was successful with satisfactory esthetic results in patients with node-positive head and neck cancer. © 2014 Wiley Periodicals, Inc.

  16. Guidelines for delineation of lymphatic clinical target volumes for high conformal radiotherapy: head and neck region

    PubMed Central

    2011-01-01

    The success of radiotherapy depends on the accurate delineation of the clinical target volume. The delineation of the lymph node regions has most impact, especially for tumors in the head and neck region. The purpose of this article was the development an atlas for the delineation of the clinical target volume for patients, who should receive radiotherapy for a tumor of the head and neck region. Literature was reviewed for localisations of the adjacent lymph node regions and their lymph drain in dependence of the tumor entity. On this basis the lymph node regions were contoured on transversal CT slices. The probability for involvement was reviewed and a recommendation for the delineation of the CTV was generated. PMID:21854585

  17. Fusion proteins in head and neck neoplasms: Clinical implications, genetics, and future directions for targeting

    PubMed Central

    Escalante, Derek A.; Wang, He; Fundakowski, Christopher E.

    2016-01-01

    ABSTRACT Fusion proteins resulting from chromosomal rearrangements are known to drive the pathogenesis of a variety of hematological and solid neoplasms such as chronic myeloid leukemia and non-small-cell lung cancer. Efforts to elucidate the role they play in these malignancies have led to important diagnostic and therapeutic triumphs, including the famous development of the tyrosine kinase inhibitor dasatinib targeting the BCR-ABL fusion. Until recently, there has been a paucity of research investigating fusion proteins harbored by head and neck neoplasms. The discovery and characterization of novel fusion proteins in neoplasms originating from the thyroid, nasopharynx, salivary glands, and midline head and neck structures offer substantial contributions to our understanding of the pathogenesis and biological behavior of these neoplasms, while raising new therapeutic and diagnostic opportunities. Further characterization of these fusion proteins promises to facilitate advances on par with those already achieved with regard to hematologic malignancies in the precise, molecularly guided diagnosis and treatment of head and neck neoplasms. The following is a subsite specific review of the clinical implications of fusion proteins in head and neck neoplasms and the future potential for diagnostic targeting. PMID:27636353

  18. Tuberculosis of the head and neck – epidemiological and clinical presentation

    PubMed Central

    Bruzgielewicz, Antoni; Osuch-Wójcikewicz, Ewa; Niemczyk, Kazimierz; Chmielewski, Rafał

    2013-01-01

    Introduction The aim of our retrospective study was to review the clinical and epidemiological presentation of head and neck tuberculosis. Material and methods We analyzed the history of 73 patients with head and neck tuberculosis hospitalized in the Department of Otolaryngology, Medical University of Warsaw, between 1983 and 2009. Results We found that 26 (35.6%) patients presented with lymph node tuberculosis, 20 (27.4%) with laryngeal tuberculosis, 10 (13.7%) with oropharyngeal tuberculosis, 9 (12.3%) with salivary gland tuberculosis, 3 (4.1%) with tuberculosis of paranasal sinuses, 3 (4.1%) with aural tuberculosis, and 2 (2.7%) with skin tuberculosis in the head and neck region. Within the group of patients with lymph node tuberculosis in 15 cases there were infected lymph nodes of the 2nd and 3rd cervical region and in 11 infected lymph nodes of the 1st cervical region. In 5 cases of laryngeal tuberculosis there was detected coexistence of cancer. Oropharyngeal tuberculosis in 7 cases was localized in tonsils, where in 1 case coexisting cancer was diagnosed. Chest X-ray was performed in all cases and pulmonary tuberculosis was identified in 26 (35.6%) cases. Conclusions We conclude that tuberculosis still remains a problem and must be taken into consideration in the diagnostic process. The coincidence of tuberculosis and cancer is remarkable in the head and neck region. PMID:25624854

  19. Clinical impact of cervical lymph node involvement and central neck dissection in patients with papillary thyroid carcinoma: a retrospective analysis of 368 cases.

    PubMed

    Bozec, Alexandre; Dassonville, Olivier; Chamorey, Emmanuel; Poissonnet, Gilles; Sudaka, Anne; Peyrottes, Isabelle; Ettore, Francette; Haudebourg, Juliette; Bussière, Françoise; Benisvy, Danielle; Marcy, Pierre-Yves; Sadoul, Jean Louis; Hofman, Paul; Lassale, Sandra; Vallicioni, Jacques; Demard, François; Santini, José

    2011-08-01

    The impact of cervical lymph node metastases and the optimal surgical management of the neck in patients with papillary thyroid carcinoma (PTC) remain controversial. The objectives of this retrospective study were to determine, in patients with PTC, the predictive factors and the impact on tumor recurrence rate of cervical lymph node involvement, and to evaluate the oncologic results and the morbidity of central neck dissection (CND). We reviewed the records of patients who had undergone surgical treatment for PTC at our institution between 1990 and 2000. A total of 368 patients (86 men and 282 women) were included in this study. Young age (p = 0.02), tumor size (p = 0.001) and extrathyroidal tumor extension (p = 0.003) were significant predictive factors of cervical lymph node metastatic involvement (multivariate analysis). Initial metastatic cervical lymph node involvement was identified as an independent risk factor of tumor recurrence (multivariate analysis, p = 0.01). Metastatic lymph node(s) were found in prophylactic CND specimens in 31% of the patients. CND increased the risk of postoperative hypocalcemia (p = 0.008) and of permanent hypoparathyroidism (p = 0.002). In conclusion, cervical lymph node metastatic involvement at the time of initial surgery is an independent risk factor of tumor recurrence. CND provided an up-staging of more than 30% of patients with a clinically N0 neck, but was associated with significant morbidity regarding parathyroid function.

  20. Analysis of time-dose factors in clinically positive neck nodes treated with irradiation alone in squamous cell carcinoma of the head and neck

    SciTech Connect

    Mendenhall, W.M.; Million, R.R.; Bova, F.J.

    1984-05-01

    This is a retrospective analysis of time-dose factors in 139 patients with 238 evaluable clinically positive lymph nodes treated with external beam radiation therapy alone to the primary lesion and neck for squamous cell carcinoma of the head and neck at the University of Florida from October 1964 through April 1980. Lymph node control was also influenced by dose, overall treament time, and fractionation schedule; these factors were interrelated and appeared to increase in importance as the size of the lymph node increased.

  1. Head and neck neurovascular trauma: Clinical and angiographic correlation

    PubMed Central

    Ssenyonga, Peter Kato; Le Feuvre, David

    2015-01-01

    A retrospective review of all angiograms done for craniocervical trauma, over an eight-year period at Groote Schuur Hospital identified 61 patients out of 823 angiographically studied who had extradural vascular injury and required endovascular treatment. Multiple lesions were identified in nine (14,8%) patients and associated injuries were found in 23 patients (37%). The mechanism of injury was blunt in nine (14.8%) patients and penetrating in 52 (85.2%). There was a statistically significant correlation between the presenting clinical feature and the underlying angiographic lesion. Patients with active bleeding were more likely to have a vessel laceration, an expanding hematoma was associated with false aneurysm and a pulsatile mass with arteriovenous fistula. Endovascular treatment with emphasis on vessel occlusion rather than preservation was successful in all cases except one which required surgical vessel ligation. PMID:25934784

  2. Experiences and preferences of patients visiting a head and neck oncology outpatient clinic: a qualitative study.

    PubMed

    Bisschop, Jeroen A S; Kloosterman, Fabienne R; van Leijen-Zeelenberg, Janneke E; Huismans, Geert Willem; Kremer, Bernd; Kross, Kenneth W

    2017-05-01

    The objective of this study is to report on an in-depth evaluation of patient experiences and preferences at a Head and Neck Oncology outpatient clinic. A qualitative research design was used to determine the experiences and preferences of Head and Neck Cancer patients in an Oncology Outpatient Clinic, Maastricht University Medical Center, The Netherlands. Head and Neck Cancer Patients, treated for at least 6 months at the Oncology Clinic, were included. A qualitative research design with patient interviews was used. All interviews were recorded and transcribed verbatim to increase validity. Analysis was done with use of the template approach and qualitative data analysis software. Three of the six dimensions predominated in the interview: (1) respect for patients' values, preferences and expressed need, (2) information, communication and education and (3) involvement of family and friends. The dimensions physical comfort; emotional support; coordination and integration of care were considered to be of less significance. The findings from this study resulted in a deeper understanding of patients' experiences and preferences and can be useful in the transition towards a more patient-centered approach of health care.

  3. A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211).

    PubMed

    Aokage, Keiju; Saji, Hisashi; Suzuki, Kenji; Mizutani, Tomonori; Katayama, Hiroshi; Shibata, Taro; Watanabe, Syunichi; Asamura, Hisao

    2017-05-01

    Lobectomy has been the standard surgery for even stage I lung cancer since the validity of limited resection for stage I lung cancer was denied by the randomized study reported in 1995. The aim of this non-randomized confirmatory going on since September 2013 is to confirm the efficacy of a segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-slice computed tomography. A total of 390 patients from 42 Japanese institutions are recruited within 4 years. The primary endpoint of this study is a 5-year relapse-free survival in all of the patients who undergo a segmentectomy for a lung nodule. The secondary endpoints are overall survival, annual relapse-free survival, disease-free survival, proportion of local relapse, postoperative pulmonary function, proportion of segmentectomy completion, proportion of R0 resection completion by segmentectomy, adverse events, and serious adverse events. This trial has been registered at the UMIN Clinical Trials Registry as UMIN000011819 ( http://www.umin.ac.jp/ctr/ ). Patient's accrual has been already finished in November, 2015 and the primary analysis will be performed in 2021. This study is one of the pivotal trial of lung segmentectomy for early lung cancer. The result will provide a clear evidence for our daily clinics and will be possible contribution to preserving pulmonary function for lung cancer patients.

  4. Rapidly enlarging neck masses of the thyroid with Horner's syndrome: a concise clinical review.

    PubMed

    Donaldson, J F; Rodriguez-Gomez, I A; Parameswaran, Rajeev

    2015-04-01

    Horner's syndrome (HS) presenting with a neck mass is a rare but challenging clinical scenario which may be caused by malignant thyroid disease. A concise review of the literature (PubMED database; 1990-2013) on the clinical management of neck masses with HS. An example case is also discussed. 1.3% of HS is caused by thyroid pathology. Thyroid pathology is the commonest cause of a neck mass associated with HS: the majority are caused by benign pathology; with carcinoma and lymphoma accounting for the remainder. Anaplastic thyroid carcinoma (ATC), thyroid lymphoma (TL) and thyroid sarcoma (TS) typically present with rapidly enlarging anterior neck masses in the elderly and are difficult to distinguish clinically. Although fine needle aspirate cytology (FNAC) is the diagnostic tool of choice for thyroid masses, core or incisional biopsy may be necessary when FNAC is inconclusive. Differentiation between ATC, TL and TS is imperative as their treatment and prognoses differ greatly. Where feasible a combination of surgical debulking, radiotherapy and chemotherapy is the treatment of choice in ATC. Advanced cases benefit from 2 monthly endoscopic surveillance ± tracheostomy, stenting or Nd-YAG laser therapy. Aggressive oncological resection alone is recommended in TS. Treatment regimes in thyroid lymphoma (typically chemotherapy ± radiotherapy) differ for histological sub-types. 5-year failure-free survival is 90% in TL compared with a mean survival of 6-8 months in ATC and 10 months in TS. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  5. [Extracranial schwannomas of the Head and Neck: Clinical -approach based on 20 cases].

    PubMed

    Höing, Benedikt; Stuck, Boris A; Kansy, Benjamin; Hussain, Timon; Schlüter, Anke; Holtmann, Laura; Ringelstein, Adrian; Mattheis, Stefan; Lang, Stephan; Dominas, Nina

    2017-09-01

    Background Schwannomas are rare benign tumors originating from the perineural cells forming the myelin layer in the peripheral nervous system (PNS). While well established therapeutic concepts exist for intracranial schwannomas, there is a lack of consistent clinical standards for extracranial schwannomas. Method This retrospective study describes the clinical pathway of 20 patients with histologically proven extracranial schwannomas of the head and neck. The diagnostic and therapeutic strategies for schwannomas are discussed with special emphasis on localization and functional outcome. Results Extracranial schwannomas of the head and neck region mostly originated from the facial nerve (n = 4), vagal nerve (n = 4) or sympathetic chain (n = 3). Most common symptoms were swelling (n = 12) and pain (n = 3). Preoperative imaging included MRI (n = 13), ultrasound (n = 12) and CT (n = 3). Surgical intervention was performed in 18 cases (n = 14 complete extirpation, n = 3 partial extirpation, n = 1 unknown). Regarding completely extirpated schwannomas of motor nerves (n = 10) severing the nerve of origin was more often required in patients with a preexisting functional deficit (3 out of 4 = 75 %) than in patients without preexisting deficits (2 out of 6 = 33 %). Conclusion Representing rare tumors of the head and neck region mostly originating from the facial nerve, sympathetic chain or caudal cranial nerves extracranial schwannomas require a systematic diagnostic and therapeutic approach. Postoperative functional deficits after complete extirpation must especially be anticipated in patients with a preexisting functional deficit. Georg Thieme Verlag KG Stuttgart · New York.

  6. T1N0 to T2N0 Squamous Cell Carcinoma of the Glottic Larynx Treated With Definitive Radiotherapy

    SciTech Connect

    Chera, Bhishamjit S.; Amdur, Robert J.; Morris, Christopher G.; Kirwan, Jessica M.; Mendenhall, William M.

    2010-10-01

    Purpose: To report the treatment outcomes of definitive radiotherapy (RT) for early-stage squamous cell carcinoma (SCCA) of the glottic larynx. Methods and Materials: We retrospectively reviewed the medical records of 585 patients with T1N0 to T2N0 invasive SCCA of the glottic larynx treated between 1964 and 2006 with RT alone. All patients had at least 2 years of follow-up, had histologic diagnosis of invasive SCCA, and received continuous-course RT. None of these patients received chemotherapy or had elective nodal RT. The probabilities of local control (LC), ultimate LC, ultimate LC with larynx preservation, neck control, cause-specific survival (CSS), and overall survival (OS) were calculated by the Kaplan-Meier product-limit method. Results: The median follow-up for survivors was 12 years. Five-year LC rates were as follows: T1A, 94%; T1B, 93%; T2A, 80%; and T2B, 70%. Multivariate analysis revealed that overall treatment time greater than 41 days (p = 0.001) and poorly differentiated histology (p = 0.016) adversely affected LC. Five-year rates of ultimate LC with laryngeal preservation were: T1A, 95%; T1B, 94%, T2A, 81%; and T2B, 74%. Twenty-four (4%) of 585 patients failed in the neck; only 7 neck failures (1%) were isolated. Five-year CSS and OS rates were as follows: T1A, 97% and 82%; T1B, 99% and 83%; T2A, 94% and 76%; and T2B, 90% and 78%, respectively. Ten (1.7%) patients had severe and/or fatal complications. One patient died of a radiation-induced carotid artery angiosarcoma. Conclusion: Based on our study results, RT cures a high proportion of patients with T1N0 to T2N0 glottic SCCAs and has a low rate of severe complications.

  7. HPV-Associated Head and Neck Cancer: Unique Features of Epidemiology and Clinical Management.

    PubMed

    Maxwell, Jessica H; Grandis, Jennifer R; Ferris, Robert L

    2016-01-01

    Human papillomavirus (HPV) is a recently identified causative agent for a subset of head and neck cancers, primarily in the oropharynx, and is largely responsible for the rising worldwide incidence of oropharyngeal cancer (OPC). Patients with HPV-positive OPC have distinct risk factor profiles and generally have a better prognosis than patients with traditional, HPV-negative, head and neck cancer. Concurrent chemotherapy and radiation is a widely accepted primary treatment modality for many patients with HPV-positive OPC. However, recent advances in surgical modalities, including transoral laser and robotic surgery, have led to the reemergence of primary surgical treatment for HPV-positive patients. Clinical trials are under way to determine optimal treatment strategies for the growing subset of patients with HPV-positive OPC. Similarly, identifying those patients with HPV-positive cancer who are at risk for recurrence and poor survival is critical in order to tailor individual treatment regimens and avoid potential undertreatment.

  8. HPV-Associated Head and Neck Cancer: Unique Features of Epidemiology and Clinical Management

    PubMed Central

    Maxwell, Jessica H.; Grandis, Jennifer R.; Ferris, Robert L.

    2017-01-01

    Human papillomavirus (HPV) is a recently identified causative agent for a subset of head and neck cancers, primarily in the oropharynx, and is largely responsible for the rising worldwide incidence of oropharyngeal cancer (OPC). Patients with HPV-positive OPC have distinct risk factor profiles and generally have a better prognosis than patients with traditional, HPV-negative, head and neck cancer. Concurrent chemotherapy and radiation is a widely accepted primary treatment modality for many patients with HPV-positive OPC. However, recent advances in surgical modalities, including transoral laser and robotic surgery, have led to the reemergence of primary surgical treatment for HPV-positive patients. Clinical trials are under way to determine optimal treatment strategies for the growing subset of patients with HPV-positive OPC. Similarly, identifying those patients with HPV-positive cancer who are at risk for recurrence and poor survival is critical in order to tailor individual treatment regimens and avoid potential undertreatment. PMID:26332002

  9. The role of neuroplasticity in experimental neck pain: a study of potential mechanisms impeding clinical outcomes of training.

    PubMed

    Rittig-Rasmussen, Bjarne; Kasch, Helge; Fuglsang-Frederiksen, Anders; Svensson, Peter; Jensen, Troels Staehelin

    2014-08-01

    Training is a mainstay in the clinical management of neck pain, yet, effects of various training protocols are only small to moderate and improvements are required. Previous investigations of the nervous system indicate a correlation between neuroplastic adaptation to training and functional recovery. The interaction between neck pain and training thus needs further exploration. This was a randomized experimental study of the effects of experimental neck pain and training on corticomotor excitability. Healthy volunteers were randomized to training and experimental neck pain, training and no pain, and pain and no training. Primary endpoints were corticomotor excitability assessed by transcranial magnetic stimulation and electromyography measured as changes in amplitudes and latencies of motor evoked potentials (MEPs), recorded at baseline and after 30 min, 1 h, and 1 week. Additionally, correlations between changes in MEPs and motor learning, effects of pain and concomitant neck training on pain, muscle strength, and fatigue were investigated. Data were analyzed by repeated measurement ANOVA, paired t tests, Grubbs' outlier test and correlation coefficients. Results indicated that neck pain and training significantly enhanced the inhibition of the amplitudes of the MEPs for 1 week. The results indicate that moderate neck pain and training induce long-lasting inhibition of the corticomotor pathways. This inhibition may limit the outcome of neck training in painful conditions in contrast to pain-free training conditions.

  10. Proton Radiation Therapy for Head and Neck Cancer: A Review of the Clinical Experience to Date

    SciTech Connect

    Holliday, Emma B.; Frank, Steven J.

    2014-06-01

    Proton beam radiation has been used for cancer treatment since the 1950s, but recent increasing interest in this form of therapy and the construction of hospital-based and clinic-based facilities for its delivery have greatly increased both the number of patients and the variety of tumors being treated with proton therapy. The mass of proton particles and their unique physical properties (ie, the Bragg peak) allow proton therapy to spare normal tissues distal to the tumor target from incidental irradiation. Initial observations show that proton therapy is particularly useful for treating tumors in challenging locations close to nontarget critical structures. Specifically, improvements in local control outcomes for patients with chordoma, chonodrosarcoma, and tumors in the sinonasal regions have been reported in series using proton. Improved local control and survival outcomes for patients with cancer of the head and neck region have also been seen with the advent of improvements in better imaging and multimodality therapy comprising surgery, radiation therapy, and chemotherapy. However, aggressive local therapy in the proximity of critical normal structures to tumors in the head and neck region may produce debilitating early and late toxic effects. Great interest has been expressed in evaluating whether proton therapy can improve outcomes, especially early and late toxicity, when used in the treatment of head and neck malignancies. This review summarizes the progress made to date in addressing this question.

  11. p16 status and interval neck dissection findings after a 'clinically complete response' to chemoradiotherapy in oropharyngeal squamous cell carcinoma.

    PubMed

    Miah, M S; Spielmann, P; White, S J; Kennedy, C; Kernohan, N; Mountain, R E; Cassasola, R; Mahendran, S

    2015-08-01

    To evaluate the histopathological findings from post-treatment neck dissection of p16 positive and negative oropharyngeal carcinoma cases, after completion of chemoradiotherapy, and to question the role of neck dissection after a 'clinically complete response' to chemoradiotherapy. Data were collected retrospectively from a cohort of patients treated with curative intent using chemoradiotherapy and post-treatment neck dissection. Primary tumours underwent p16 immunohistochemistry. Neck dissection specimens were examined for viable cancer cells. A total of 76 cases were assessed. Viable cancer cells were detected from neck dissection in 29 per cent of p16 negative cases. Locoregional recurrence occurred in 12.9 per cent of p16 negative cases. The association between p16 positivity in the primary tumour and histopathologically negative neck dissection was significant (p < 0.05). p16 status appeared to be an independent marker of disease control for the cohort in this study. The data raise questions about the role of post-treatment neck dissection in p16 positive cases with a 'clinically complete response' to chemoradiotherapy.

  12. MRI of the brain, head, neck and spine. A teaching atlas of clinical applications

    SciTech Connect

    Valk, J.

    1988-01-01

    This book is a teaching atlas of the clinical applications of magnetic resonance imaging of the brain, head, neck and spine. It demonstrates how choices of MRI parameters are reflected in the images and which selection can best be made to achieve optimal results. It supplies an extensive collection of images of pathological conditions based on the author's experience and a collection of over 5000 documented MRI studies of both adults and children. In the introduction to each chapter an overview is given of the specific diagnostic problem and the potential MRI solution. In the case studies the application of these MRI techniques are carefully explained.

  13. Spine and Pain Clinics Serving North Carolina Patients With Back and Neck Pain

    PubMed Central

    Castel, Liana D.; Freburger, Janet K.; Holmes, George M.; Scheinman, Rachael P.; Jackman, Anne M.; Carey, Timothy S.

    2009-01-01

    Study Design Cross-sectional survey. Objective Our primary objective was to describe spine and pain clinics serving North Carolina residents with respect to organizational characteristics. Our secondary objective was to assess the multidisciplinary nature of the clinics surveyed. Summary of Background Data Pain clinics have become common in the United States, and patients with chronic back pain have increasingly been seeking services at these clinics. Little is known about the organizational characteristics of spine and pain clinics. Methods We identified and surveyed spine and pain clinics serving North Carolina residents with chronic back and neck pain. Practice managers at 46 clinics completed a 20-minute questionnaire about the characteristics of their clinic, including providers on staff and services offered. Descriptive and exploratory analyses were conducted to summarize the data. Several variables were constructed to assess the multidisciplinary nature of the clinics. Results The response rate was 75%. There was marked heterogeneity among the clinics surveyed. Fifty-nine percent of practices were free-standing (n = 27) and 61% were physician-owned (n = 28). Twenty-five clinics (54%) had an anesthesiologist. Other common physician providers were physiatrists and surgeons. Less than one third of sites had mental health providers (n = 12; 26%); only 26% employed physical therapists. Seventy-six percent of sites offered epidural injections, 74% long-term narcotic prescriptions, and 67% antidepressants. The majority of clinics (30 of 33) prescribing narcotics provided monitoring of therapy using periodic urine toxicology testing. Forty-eight percent of sites (n = 22) offered exercise instruction. Few clinics were multidisciplinary in nature. Only 3 (7%) met the criteria of having a medical physician, registered nurse, physical therapist, and mental health specialist. Conclusion Clinics varied widely in their organizational characteristics, including providers

  14. Freedom from local and regional failure of contralateral neck with ipsilateral neck radiotherapy for node-positive tonsil cancer: updated results of an institutional clinical management approach.

    PubMed

    Dan, Tu D; Raben, David; Schneider, Charles J; Hockstein, Neil G; Witt, Robert L; Dzeda, Michael; Cormier, Jennifer F; Raben, Adam

    2015-06-01

    To update the outcomes of an institutional clinical management approach using ipsilateral neck radiotherapy in the treatment of node-positive squamous cell carcinoma of the tonsil with a well-lateralized primary lesion. Between August 2003 and April 2014, 61 consecutive patients with ipsilateral node-positive squamous cell carcinoma of the tonsil without involvement of the base of the tongue or midline soft palate were treated at a community hospital-based cancer center with radiotherapy to the primary site and ipsilateral neck. Overall survival, disease-free survival and freedom from contralateral failure were calculated. Median follow up was 37.2months (range 4-121months). Freedom from contralateral nodal failure at 5years was 98% with one contralateral nodal failure noted. The patient underwent a salvage neck dissection and was treated with post-operative radiotherapy with no evidence of disease to date. 5-year overall survival (OS) was 92.4% and 5year disease-free survival (DFS) was 86.7%. This represents the single largest series reported from a community hospital-based cancer center in which lateralized tonsil cancers with N+ disease were treated with ipsilateral neck radiotherapy. In this carefully selected cohort of patients with well-lateralized tonsil cancers, the risk of contralateral nodal failure appears to be <5%, suggesting that prophylactic radiation of the contralateral neck may not be necessary. Future planned studies will focus on prospectively selecting subgroups of patients eligible for treatment de-intensification as survivorship issues in excellent prognosis HPV positive patients are increasingly becoming relevant. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Clinical Validation of Atlas-Based Auto-Segmentation of Multiple Target Volumes and Normal Tissue (Swallowing/Mastication) Structures in the Head and Neck

    SciTech Connect

    Teguh, David N.; Levendag, Peter C.; Voet, Peter W.J.; Al-Mamgani, Abrahim; Han Xiao; Wolf, Theresa K.; Hibbard, Lyndon S.; Nowak, Peter; Akhiat, Hafid; Dirkx, Maarten L.P.; Heijmen, Ben J.M.; Hoogeman, Mischa S.

    2011-11-15

    Purpose: To validate and clinically evaluate autocontouring using atlas-based autosegmentation (ABAS) of computed tomography images. Methods and Materials: The data from 10 head-and-neck patients were selected as input for ABAS, and neck levels I-V and 20 organs at risk were manually contoured according to published guidelines. The total contouring times were recorded. Two different ABAS strategies, multiple and single subject, were evaluated, and the similarity of the autocontours with the atlas contours was assessed using Dice coefficients and the mean distances, using the leave-one-out method. For 12 clinically treated patients, 5 experienced observers edited the autosegmented contours. The editing times were recorded. The Dice coefficients and mean distances were calculated among the clinically used contours, autocontours, and edited autocontours. Finally, an expert panel scored all autocontours and the edited autocontours regarding their adequacy relative to the published atlas. Results: The time to autosegment all the structures using ABAS was 7 min/patient. No significant differences were observed in the autosegmentation accuracy for stage N0 and N+ patients. The multisubject atlas performed best, with a Dice coefficient and mean distance of 0.74 and 2 mm, 0.67 and 3 mm, 0.71 and 2 mm, 0.50 and 2 mm, and 0.78 and 2 mm for the salivary glands, neck levels, chewing muscles, swallowing muscles, and spinal cord-brainstem, respectively. The mean Dice coefficient and mean distance of the autocontours vs. the clinical contours was 0.8 and 2.4 mm for the neck levels and salivary glands, respectively. For the autocontours vs. the edited autocontours, the mean Dice coefficient and mean distance was 0.9 and 1.6 mm, respectively. The expert panel scored 100% of the autocontours as a 'minor deviation, editable' or better. The expert panel scored 88% of the edited contours as good compared with 83% of the clinical contours. The total editing time was 66 min. Conclusion

  16. A head and neck lymph node classification using an anatomical grid system while maintaining clinical relevance.

    PubMed

    Benninger, Brion; Barrett, Richard

    2011-10-01

    The current classification of head and neck lymph nodes lacks a standardized system that integrates basic anatomy and clinical relevance. Currently, anatomy texts, atlases, and journals used to educate future health care professionals use a classification system that differs from the commonly used clinical nomenclature. As a result, student trainees entering the professional world are confused by lymph node terminology. The purpose of this study was to suggest a lymph node classification system that accurately reflected anatomy and clinical applications. A literature search was conducted on anatomic and clinical texts, atlases, journals, and Web sites. Two recurring classification themes were found from anatomic texts and atlases: superficial and deep chains, and local anatomic structures. Since 1988 the clinical specialties have used a Roman numeral "level" system. The differences between anatomic and clinical classification systems have led to academic frustration. After analysis, a functional classification system was developed that integrated anatomic and clinical terminology from the current classification systems. This suggested system revised the clinically accepted level system approved in 1988 and replaced the terminology with an anatomically derived naming system. This system satisfies the need for a classification that unifies anatomic and clinical applications. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  17. The effect of head and neck positions on oropharyngeal swallowing: a clinical and electrophysiologic study.

    PubMed

    Ertekin, C; Keskin, A; Kiylioglu, N; Kirazli, Y; On, A Y; Tarlaci, S; Aydoğdu, I

    2001-09-01

    To determine the clinical usefulness of an electrophysiologic method for evaluating dysphagia and to identify the effects of various head and neck positions on oropharyngeal swallowing. Experimental, with control group. An electromyography laboratory. Patients with neurogenic dysphagia (n = 51) and healthy controls (n = 24). Patients were divided into 2 groups: those patients with unilateral lower cranial lesions (n = 9) and those without laterality in the function of the oropharyngeal muscles (n = 42). Subjects were instructed to swallow doses of water, gradually increasing in quantity from 1 to 25 mL under 5 conditions: neutral, chin up, chin tucked, head rotated right, and head rotated left. Change in dysphagia limit through specified head and neck postures. Oropharyngeal swallowing was evaluated by laryngeal movements that were detected by a piezoelectric sensor and electromyography of the submental muscle complex. Laryngeal sensor signals occurring within 8 seconds of a swallow were accepted as a sign of the dysphagia limit. In the control group, dysphagia limit did not change significantly with changes in head and neck postures, except for the chin-up posture (p <.05) in which piecemeal deglutition occurred when subjects swallowed volumes less than 20 mL. Dysphagia limit improved significantly (p <.05) in 67% of the patients with unilateral lower cranial lesions when the head was rotated toward the paretic side. In dysphagic patients with bilateral symptoms, a significant (p <.01) improvement in dysphagia limit occurred in 50% of patients in chin-tuck position, but in the chin-up position, 55% of the patients experienced a significant (p <.01) decrease in dysphagia limit. The electrophysiologic method of measuring dysphagia limit confirms neurogenic dysphagia and its severity in the neutral head position. Changes in head and neck positions do not significantly alter dysphagia limit in unimpaired subjects except for the chin-up position. Although the results

  18. Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients.

    PubMed

    Gambardella, Claudio; Tartaglia, Ernesto; Nunziata, Anna; Izzo, Graziella; Siciliano, Giuseppe; Cavallo, Fabio; Mauriello, Claudio; Napolitano, Salvatore; Thomas, Guglielmo; Testa, Domenico; Rossetti, Gianluca; Sanguinetti, Alessandro; Avenia, Nicola; Conzo, Giovanni

    2016-09-19

    Lymph nodal involvement is very common in differentiated thyroid cancer, and in addition, cervical lymph node micrometastases are observed in up to 80 % of papillary thyroid cancers. During the last decades, the role of routine central lymph node dissection (RCLD) in the treatment of papillary thyroid cancer (PTC) has been an object of research, and it is now still controversial. Nevertheless, many scientific societies and referral authors have definitely stated that even if in expert hands, RCLD is not associated to higher morbidity; it should be indicated only in selected cases. In order to better analyze the current role of prophylactic neck dissection in the surgical treatment of papillary thyroid cancers, an analysis of the most recent literature data was performed. Prophylactic or therapeutic lymph node dissection, selective, lateral or central lymph node dissection, modified radical neck dissection, and papillary thyroid cancer were used by the authors as keywords performing a PubMed database research. Literature reviews, PTCs large clinical series and the most recent guidelines of different referral endocrine societies, inhering neck dissection for papillary thyroid cancers, were also specifically evaluated. A higher PTC incidence was nowadays reported in differentiated thyroid cancer (DTC) clinical series. In addition, ultrasound guided fine-needle aspiration citology allowed a more precocious diagnosis in the early phases of disease. The role of prophylactic neck dissection in papillary thyroid cancer management remains controversial especially regarding indications, approach, and surgical extension. Even if morbidity rates seem to be similar to those reported after total thyroidectomy alone, RCLD impact on local recurrence and long-term survival is still a matter of research. Nevertheless, only a selective use in high-risk cases is supported by more and more scientific data. In the last years, higher papillary thyroid cancer incidence and more

  19. Cost-Effectiveness Analysis of Elective Neck Dissection in Patients With Clinically Node-Negative Oral Cavity Cancer

    PubMed Central

    Acevedo, Joseph R.; Fero, Katherine E.; Wilson, Bayard; Sacco, Assuntina G.; Mell, Loren K.; Coffey, Charles S.

    2016-01-01

    Purpose Recently, a large randomized trial found a survival advantage among patients who received elective neck dissection in conjunction with primary surgery for clinically node-negative oral cavity cancer compared with those receiving primary surgery alone. However, elective neck dissection comes with greater upfront cost and patient morbidity. We present a cost-effectiveness analysis of elective neck dissection for the initial surgical management of early-stage oral cavity cancer. Methods We constructed a Markov model to simulate primary, adjuvant, and salvage therapy; disease recurrence; and survival in patients with T1/T2 clinically node-negative oral cavity squamous cell carcinoma. Transition probabilities were derived from clinical trial data; costs (in 2015 US dollars) and health utilities were estimated from the literature. Incremental cost-effectiveness ratios, expressed as dollar per quality-adjusted life-year (QALY), were calculated with incremental cost-effectiveness ratios less than $100,000/QALY considered cost effective. We conducted one-way and probabilistic sensitivity analyses to examine model uncertainty. Results Our base-case model found that over a lifetime the addition of elective neck dissection to primary surgery reduced overall costs by $6,000 and improved effectiveness by 0.42 QALYs compared with primary surgery alone. The decrease in overall cost despite the added neck dissection was a result of less use of salvage therapy. On one-way sensitivity analysis, the model was most sensitive to assumptions about disease recurrence, survival, and the health utility reduction from a neck dissection. Probabilistic sensitivity analysis found that treatment with elective neck dissection was cost effective 76% of the time at a willingness-to-pay threshold of $100,000/QALY. Conclusion Our study found that the addition of elective neck dissection reduces costs and improves health outcomes, making this a cost-effective treatment strategy for patients

  20. The clinical course and prognostic factors of non-specific neck pain: a systematic review.

    PubMed

    Borghouts, J A; Koes, B W; Bouter, L M

    1998-07-01

    Neck pain occurs frequently in western societies. In the majority of cases, no specific cause can be identified. In order to gain insight into the clinical course and prognostic factors of non-specific neck pain, a systematic review was conducted. A computerized literature search was carried out to identify observational studies on non-specific neck pain and randomized clinical trials (RCTs) on conservative treatment of non-specific neck pain. Two reviewers scored independently, the methodological quality of all identified publications, using a standardized set of 13 criteria which were divided into five categories according to: study population, study design, follow-up, outcome measures and analysis/data presentation. To determine prognosis per study, an overall percentage of recovery for the most important outcome measures (pain, general improvement, functional status, health care utilization and lost days of work) was calculated. In total 23 eligible publications were identified (six observational studies and 17 RCTs). Only seven of 23 studies scored 50% or more of the 13 items, indicating a generally poor quality of methods. The most prevalent methodological shortcomings appeared to be selection of the study population, the sample size and analysis techniques. Most information regarding the clinical course is available for the group of patients with complaints for more than 6 months, who are treated in a secondary care or an occupational setting. In this group of patients, 46% (median) had less pain, with a range of 22-79% and a general improvement that ranged between 37 and 95% (47% median). The reduction in the use of analgesics ranged between 32 and 80% (37% median). Six studies reported on prognostic factors. Bearing in mind the limited number of studies and the low methodological quality, there are some indications that the localization (radiation to the arms/neurologic signs) and radiologic findings (degenerative changes in the discs and joints) are not

  1. [Throat infection, neck spinal disease, chest pain and cardiac response: a new clinical syndrome?].

    PubMed

    Zhou, Chang-Qing; Yan, Jiang-Tao; Fan, Qiao; Li, Zhou-Ya; Cianflone, Katherine; Wang, Dao-Wen

    2010-02-01

    To analyze the characteristics of a new clinical syndrome, including throat infection, neck spinal disease, chest pain and cardiac response. A total of 165 patients with above mentioned symptoms admitted to Tongji hospital from 2003 to 2005 were included in this study and underwent further medical history inquiry, physical examination and laboratory tests. Eighty-five healthy subjects served as controls. Serum myocardial auto-antibodies against beta(1)-adrenoceptor, alpha-myosin heavy chain, M(2)-muscarinic receptor and adenine-nucleotide translocator were detected, inflammatory cytokines, high sensitivity C-reaction protein, serum antibodies against Coxsackie virus-B, cytomegalovirus, Mycoplasma pneumoniae and Chlamydia pneumoniae were determined and lymphocyte subclasses were assayed by flow cytometry. All patients had a complex of four symptoms or tetralogy: (1) persistent throat or upper respiratory tract infection; (2) neck pain; (3) chest pain; (4) chest depression or dyspnea, some of them with anxiety. Anti-myocardial auto-antibodies (AMCA) were present in all patients vs. 8% in controls. TNF-alpha, IL-1 and IL-6 were significantly higher in patients than controls (P < 0.01). CD3(+) and CD4(-)CD8(+) lymphocytes were significantly higher and CD56(+) lymphocytes lower in patients than those in controls (P < 0.01). The ratios of serum pathogen antibodies positive against Coxsackie virus-B, cytomegalovirus, Mycoplasma pneumoniae and Chlamydia pneumoniae were all significantly higher in patients than in controls. These data led to identification of a persistent respiratory infection-related clinical syndrome, including persistent throat infection, neck spinal lesion, rib cartilage inflammation, symptoms of cardiac depression and dyspnea with or without anxiety.

  2. Clinical implementation of intraoperative cone-beam CT in head and neck surgery

    NASA Astrophysics Data System (ADS)

    Daly, M. J.; Chan, H.; Nithiananthan, S.; Qiu, J.; Barker, E.; Bachar, G.; Dixon, B. J.; Irish, J. C.; Siewerdsen, J. H.

    2011-03-01

    A prototype mobile C-arm for cone-beam CT (CBCT) has been translated to a prospective clinical trial in head and neck surgery. The flat-panel CBCT C-arm was developed in collaboration with Siemens Healthcare, and demonstrates both sub-mm spatial resolution and soft-tissue visibility at low radiation dose (e.g., <1/5th of a typical diagnostic head CT). CBCT images are available ~15 seconds after scan completion (~1 min acquisition) and reviewed at bedside using custom 3D visualization software based on the open-source Image-Guided Surgery Toolkit (IGSTK). The CBCT C-arm has been successfully deployed in 15 head and neck cases and streamlined into the surgical environment using human factors engineering methods and expert feedback from surgeons, nurses, and anesthetists. Intraoperative imaging is implemented in a manner that maintains operating field sterility, reduces image artifacts (e.g., carbon fiber OR table) and minimizes radiation exposure. Image reviews conducted with surgical staff indicate bony detail and soft-tissue visualization sufficient for intraoperative guidance, with additional artifact management (e.g., metal, scatter) promising further improvements. Clinical trial deployment suggests a role for intraoperative CBCT in guiding complex head and neck surgical tasks, including planning mandible and maxilla resection margins, guiding subcranial and endonasal approaches to skull base tumours, and verifying maxillofacial reconstruction alignment. Ongoing translational research into complimentary image-guidance subsystems include novel methods for real-time tool tracking, fusion of endoscopic video and CBCT, and deformable registration of preoperative volumes and planning contours with intraoperative CBCT.

  3. Determining optimal clinical target volume margins in head-and-neck cancer based on microscopic extracapsular extension of metastatic neck nodes

    SciTech Connect

    Apisarnthanarax, Smith; Elliott, Danielle D.; El-Naggar, Adel K.; Asper, Joshua A. P.A.; Blanco, Angel; Ang, K. Kian; Garden, Adam S.; Morrison, William H.; Rosenthal, David; Weber, Randal S.; Chao, K.S. Clifford . E-mail: cchao@mdanderson.org

    2006-03-01

    Purpose: To determine the optimal clinical target volume margins around the gross nodal tumor volume in head-and-neck cancer by assessing microscopic tumor extension beyond cervical lymph node capsules. Methods and Materials: Histologic sections of 96 dissected cervical lymph nodes with extracapsular extension (ECE) from 48 patients with head-and-neck squamous cell carcinoma were examined. The maximum linear distance from the external capsule border to the farthest extent of the tumor or tumoral reaction was measured. The trends of ECE as a function of the distance from the capsule and lymph node size were analyzed. Results: The median diameter of all lymph nodes was 11.0 mm (range: 3.0-30.0 mm). The mean and median ECE extent was 2.2 mm and 1.6 mm, respectively (range: 0.4-9.0 mm). The ECE was <5 mm from the capsule in 96% of the nodes. As the distance from the capsule increased, the probability of tumor extension declined. No significant difference between the extent of ECE and lymph node size was observed. Conclusion: For N1 nodes that are at high risk for ECE but not grossly infiltrating musculature, 1 cm clinical target volume margins around the nodal gross tumor volume are recommended to cover microscopic nodal extension in head-and-neck cancer.

  4. ANALYSIS OF CLINICAL AND FUNCTIONAL OUTCOME AND COMPLICATIONS OF TALAR NECK FRACTURES

    PubMed Central

    Bastos, Leonardo Ribeiro; Ferreira, Ricardo Cardenuto; Mercadante, Marcelo Tomanik

    2015-01-01

    Objective: To evaluate the clinical, functional and radiographic results from talar neck fractures in patients treated at the Foot and Ankle Surgery Group of Santa Casa de Sao Paulo. Method: We evaluated 20 patients. The mean follow-up time was 71 months. One fracture was classified as Hawkins Type I, 12 as Hawkins type II, five as Hawkins type III, two as Hawkins type IV and four fractures were open. Results: One patient was treated conservatively, 16 were treated with open reduction and internal fixation (three with primary subtalar arthrodesis), one was treated with talectomy and two with tibiotalocalcaneal arthrodesis. The reduction obtained was anatomical in seven feet, acceptable in six feet and poor in four. Seven patients had early complications. There was one case of delayed consolidation and four of talar body osteonecrosis. Four patients required secondary reconstruction procedures. No significant radiographic impairment of the ankle joint was found in 62% of the patients and of the subtalar joint in 25%. Of the patients who did not undergo secondary procedures, 81% complained about the treated foot, 37.5% showed some deformity, 44% presented diminished sensitivity and 50% had to retire from work. The mean loss of motion in the ankle was 49%, and in the subtalar joint, 80%. The average AOFAS score was 73 points. Conclusion: Talar neck fractures are associated with high rates of clinical, functional and radiographic complications. PMID:27022565

  5. Early clinical experience with volumetric modulated arc therapy in head and neck cancer patients

    PubMed Central

    2010-01-01

    Background To report about early clinical experience in radiation treatment of head and neck cancer of different sites and histology by volumetric modulated arcs with the RapidArc technology. Methods During 2009, 45 patients were treated at Istituto Clinico Humanitas with RapidArc (28 males and 17 females, median age 65 years). Of these, 78% received concomitant chemotherapy. Thirty-six patients were treated as exclusive curative intent (group A), three as postoperative curative intent (group B) and six with sinonasal tumours (group C). Dose prescription was at Planning Target Volumes (PTV) with simultaneous integrated boost: 54.45Gy and 69.96Gy in 33 fractions (group A); 54.45Gy and 66Gy in 33 fractions (group B) and 55Gy in 25 fractions (group C). Results Concerning planning optimization strategies and constraints, as per PTV coverage, for all groups, D98% > 95% and V95% > 99%. As regards organs at risk, all planning objectives were respected, and this was correlated with observed acute toxicity rates. Only 28% of patients experienced G3 mucositis, 14% G3 dermitis 44% had G2 dysphagia. Nobody required feeding tubes to be placed during treatment. Acute toxicity is also related to chemotherapy. Two patients interrupted the course of radiotherapy because of a quick worsening of general clinical condition. Conclusions These preliminary results stated that volumetric modulated arc therapy in locally advanced head and neck cancers is feasible and effective, with acceptable toxicities. PMID:20950429

  6. The intra- and inter-rater reliability of five clinical muscle performance tests in patients with and without neck pain

    PubMed Central

    2013-01-01

    Background This study investigates the reliability of muscle performance tests using cost- and time-effective methods similar to those used in clinical practice. When conducting reliability studies, great effort goes into standardising test procedures to facilitate a stable outcome. Therefore, several test trials are often performed. However, when muscle performance tests are applied in the clinical setting, clinicians often only conduct a muscle performance test once as repeated testing may produce fatigue and pain, thus variation in test results. We aimed to investigate whether cervical muscle performance tests, which have shown promising psychometric properties, would remain reliable when examined under conditions similar to those of daily clinical practice. Methods The intra-rater (between-day) and inter-rater (within-day) reliability was assessed for five cervical muscle performance tests in patients with (n = 33) and without neck pain (n = 30). The five tests were joint position error, the cranio-cervical flexion test, the neck flexor muscle endurance test performed in supine and in a 45°-upright position and a new neck extensor test. Results Intra-rater reliability ranged from moderate to almost perfect agreement for joint position error (ICC ≥ 0.48-0.82), the cranio-cervical flexion test (ICC ≥ 0.69), the neck flexor muscle endurance test performed in supine (ICC ≥ 0.68) and in a 45°-upright position (ICC ≥ 0.41) with the exception of a new test (neck extensor test), which ranged from slight to moderate agreement (ICC = 0.14-0.41). Likewise, inter-rater reliability ranged from moderate to almost perfect agreement for joint position error (ICC ≥ 0.51-0.75), the cranio-cervical flexion test (ICC ≥ 0.85), the neck flexor muscle endurance test performed in supine (ICC ≥ 0.70) and in a 45°-upright position (ICC ≥ 0.56). However, only slight to fair agreement was found for the neck extensor test (ICC

  7. Surgical anatomy of the external branch of the superior laryngeal nerve and its clinical significance in head and neck surgery.

    PubMed

    Kochilas, Xenophon; Bibas, Athanasios; Xenellis, John; Anagnostopoulou, Sofia

    2008-03-01

    Injury of the external branch of the superior laryngeal nerve (EBSLN) increases the morbidity following a variety of neck procedures and can have catastrophic consequences in people who use their voice professionally. Identification and preservation of the EBSLN are thus important in thyroidectomy, parathyroidectomy, carotid endarterectomy, and anterior cervical spine procedures, where the nerve is at risk. There are large variations in the anatomical course of the EBSLN, which makes the intraoperative identification of the nerve challenging. The topographic relationship of the EBSLN to the superior thyroid artery and the upper pole of the thyroid gland are considered by many authors to be the key point for identifying the nerve during surgery of the neck. The classifications by Cernea et al. ([1992a] Head Neck 14:380-383; [1992b] Am. J. Surg. 164:634-639) and by Kierner et al. ([1998] Arch. Otolaryngol. Head Neck Surg. 124:301-303), as well as clinically important connections are discussed in detail. Along with sound anatomical knowledge, neuromonitoring is helpful in identifying the EBSLN during neck procedures. The clinical signs of EBSLN injury include hoarseness, decreased voice projection, decreased pitch range, and fatigue after extensive voice use. Videostroboscopy, electromyography, voice analysis, and electroglottography can provide crucial information on the function of the EBSLN following neck surgery.

  8. Exploring integrative medicine for back and neck pain - a pragmatic randomised clinical pilot trial

    PubMed Central

    Sundberg, Tobias; Petzold, Max; Wändell, Per; Rydén, Anna; Falkenberg, Torkel

    2009-01-01

    Background A model for integrative medicine (IM) adapted to Swedish primary care was previously developed. The aim of this study was to explore the feasibility of a pragmatic randomised clinical trial to investigate the effectiveness of the IM model versus conventional primary care in the management of patients with non-specific back/neck pain. Specific objectives included the exploration of recruitment and retention rates, patient and care characteristics, clinical differences and effect sizes between groups, selected outcome measures and power calculations to inform the basis of a full-scale trial. Methods Eighty patients with back/neck pain of at least two weeks duration were randomised to the two types of care. Outcome measures were standardised health related quality of life (the eight domains of SF-36) complemented by a set of exploratory "IM tailored" outcomes targeting self-rated disability, stress and well-being (0-10 scales); days in pain (0-14); and the use of analgesics and health care over the last two weeks (yes/no). Data on clinical management were derived from medical records. Outcome changes from baseline to follow-up after 16 weeks were used to explore the differences between the groups. Results Seventy-five percent (80/107) of screened patients in general practice were eligible and feasible to enrol into the trial. Eighty-two percent (36/44) of the integrative and 75% (27/36) of the conventional care group completed follow-up after 16 weeks. Most patients had back/neck pain of at least three months duration. Conventional care typically comprised advice and prescription of analgesics, occasionally complemented with sick leave or a written referral to physiotherapy. IM care generally integrated seven treatment sessions from two different types of complementary therapies with conventional care over ten weeks. The study was underpowered to detect any statistically significant differences between the groups. One SF-36 domain showed a clinically

  9. The clinical impact of HPV tumor status upon head and neck squamous cell carcinomas

    PubMed Central

    Benson, Eleni; Li, Ryan; Eisele, David; Fakhry, Carole

    2015-01-01

    SUMMARY Human papillomavirus (HPV) is etiologically responsible for a distinct subset of head and neck squamous cell cancers (HNSCCs). HPV-positive HNSCCs (HPV-HNSCCs) most commonly arise from the oropharynx and are responsible for the increasing incidence of oropharyngeal SCC (OSCC) in the United States (US) and abroad. HPV-positive OSCC (HPV-OSCC) has a unique demographic and risk factor profile and tumor biology. HPV-OSCC patients tend to be white, younger, and have a higher cumulative exposure to sexual behaviors as compared with HPV-negative OSCC patients. HPV-positive tumor status also significantly improves survival, and is indeed the single strongest prognostic factor for OSCC. The mechanisms that underlie the improved prognosis conferred by HPV-positive disease are unknown. The purpose of this review is to describe the clinical impact of HPV status in HNSCC, particularly in OSCC, both in terms of the unique clinic-demographic profile and prognostic implications. PMID:24134947

  10. Dry needling of the trapezius muscle in office workers with neck pain: a randomized clinical trial.

    PubMed

    Cerezo-Téllez, Ester; Lacomba, María Torres; Fuentes-Gallardo, Isabel; Mayoral Del Moral, Orlando; Rodrigo-Medina, Beatriz; Gutiérrez Ortega, Carlos

    2016-09-01

    Neck pain is a frequent complaint in office workers. This pain can be caused by myofascial trigger points (MTrPs) in the trapezius muscle. This study aimed to determine the effectiveness of deep dry needling (DDN) of active MTrPs in the trapezius muscle. A randomized, single blinded clinical trial was carried out at the Physical Therapy Department at Physiotherapy in Women's Health Research Group at Physical Therapy Department of University of Alcalá, in Alcalá de Henares, Madrid, Spain. Forty-four office workers with neck pain and active MTrPs in the trapezius muscle were randomly allocated to either the DDN or the control group (CG). The participants in the DDN group were treated with DDN of all MTrPs found in the trapezius muscle. They also received passive stretch of the trapezius muscle. The CG received the same passive stretch of the trapezius muscle only. The primary outcome measure was subjective pain intensity, measured using a visual analogue scale (VAS). Secondary outcomes were pressure pain threshold (PPT), cervical range of motion (CROM) and muscle strength. Data were collected at baseline, after interventions and 15 days after the last treatment. Differences were found between the DDN group and the CG for the VAS (P < 0.001), PPT (P < 0.001), range of motion (AROM) (P < 0.05) and strength (P < 0.05) after intervention and at the 15-day follow-up. Deep dry needling and passive stretch seems to be more effective than passive stretch only. The effects are maintained in the short term. The results support the use of DDN in the management of trapezius muscle myofascial pain syndrome in neck pain.

  11. Dry needling of the trapezius muscle in office workers with neck pain: a randomized clinical trial

    PubMed Central

    Cerezo-Téllez, Ester; Lacomba, María Torres; Fuentes-Gallardo, Isabel; Mayoral del Moral, Orlando; Rodrigo-Medina, Beatriz; Gutiérrez Ortega, Carlos

    2016-01-01

    Background Neck pain is a frequent complaint in office workers. This pain can be caused by myofascial trigger points (MTrPs) in the trapezius muscle. This study aimed to determine the effectiveness of deep dry needling (DDN) of active MTrPs in the trapezius muscle. Methods A randomized, single blinded clinical trial was carried out at the Physical Therapy Department at Physiotherapy in Women's Health Research Group at Physical Therapy Department of University of Alcalá, in Alcalá de Henares, Madrid, Spain. Forty-four office workers with neck pain and active MTrPs in the trapezius muscle were randomly allocated to either the DDN or the control group (CG). The participants in the DDN group were treated with DDN of all MTrPs found in the trapezius muscle. They also received passive stretch of the trapezius muscle. The CG received the same passive stretch of the trapezius muscle only. The primary outcome measure was subjective pain intensity, measured using a visual analogue scale (VAS). Secondary outcomes were pressure pain threshold (PPT), cervical range of motion (CROM) and muscle strength. Data were collected at baseline, after interventions and 15 days after the last treatment. Results Differences were found between the DDN group and the CG for the VAS (P < 0.001), PPT (P < 0.001), range of motion (AROM) (P < 0.05) and strength (P < 0.05) after intervention and at the 15-day follow-up. Discussion Deep dry needling and passive stretch seems to be more effective than passive stretch only. The effects are maintained in the short term. The results support the use of DDN in the management of trapezius muscle myofascial pain syndrome in neck pain. PMID:27582622

  12. Femoral Neck Anteversion and Neck Shaft Angles: Determination and their Clinical Implications in Fetuses of Different Gestational Ages.

    PubMed

    Souza, A D; Ankolekar, V H; Padmashali, S; Das, A; Souza, Asd; Hosapatna, M

    2015-07-01

    Precise anatomical assessment of femoral neck anteversion (FNA) and the neck shaft angles (NSA) would be essential in diagnosing the pathological conditions involving hip joint and its ligaments. The present study was undertaken on 48 fetal femurs to calculate the NSA and FNA in fetuses digitally. End on images of upper end of the femurs were taken for the estimation of FNA and a photograph in a perpendicular plane was taken to calculate the NSA. Microsoft Paint software was used to mark the points and Image J software was used to calculate the angles digitally. The FNA ranged from 17.08º to 33.97 º on right and 17.32 º to 45.08 º on left. The NSA ranged from 139.33 º to 124.91 º on right and 143.98 º to 123.8 º on left. Unpaired t test showed the FNA and NSA of femur did not vary significantly during the third trimester.

  13. Association between injury to the retinacula of Weitbrecht and femoral neck fractures: anatomical and clinical observations

    PubMed Central

    Mei, Jiong; Ni, Ming; Wang, Guoliang; Jia, Guangyao; Liu, Shiwei; Cui, Xueliang; Jiang, Chao; Wang, Hua; Dai, Yahui; Quan, Kun; Chen, Rui

    2015-01-01

    Currently, there is no objective indicator for surgical procedures in elderly patients with femoral neck fractures. The purpose of this study was to determine the severity of damage to the retinacula of Weitbrecht based on the type of femoral neck fracture, anatomical and clinical observations. Data from 44 patients treated with artificial femoral head replacement were analyzed for the association between Garden type fracture and severity of injury to Weitbrecht’s retinacula. Additionally, 18 cases (Pauwels type III fracture) after Watson-Jones surgical approach and internal fixations were used to investigate the bone healing and femoral head necrosis. Among 44 patients (Garden type was III-IV, 79.6%), significant associations were found between Garden type fracture and lateral (P < 0.001), anterior (P = 0.045), and medial (P = 0.004) retinacular injury. Significant positive Spearman correlation coefficients between Garden type and the severity of injury to Weitbrecht’s retinacula were Ρ = 0.561 with P < 0.001 for lateral, Ρ = 0.338 with P = 0.025 for anterior, and Ρ = 0.469 with P = 0.001 for medial retinacula. Additionally, 4 out of 18 Pauwels type III fracture cases were observed severe damages on Weitbrecht’s retinacula and resulting bone necrosis. In conclusion, this study provided the anatomical and histological correlations between fracture displacement and degree of retinacula injury. PMID:26770357

  14. Clinical use of a neck brace to improve hands-free speech in laryngectomized patients.

    PubMed

    Dirven, Richard; Kooijman, Piet G C; Wouters, Yannick; Marres, Henri A M

    2012-06-01

    Time of adherence of adhesive baseplate housings to the neck of a laryngectomized patient is one of the main problems that account for the low number of laryngectomy patients who benefit from hands-free speech. An external neck brace (ENB 1.0) was introduced to support peristomal fixation of adhesive baseplates. A prospective randomized controlled clinical cross-over trial. A total of 28 laryngectomy patients participated in this randomized, prospective, crossover trial. All used the Provox hands-free heat and moisture exchanger (HME) valve for 1 month: 2 weeks with an ENB and 2 weeks without. The median lifetime of an adhesive baseplate without a brace was 52.5 minutes versus 210 minutes with a brace (P = .03). Four participants considered the ENB as "a little" bit of a welcome addition, nine as "quite a bit," and six as "very much" (79%) to improve hands-free speech. The ENB significantly increases the lifetime of an adhesive baseplate and therefore contributes to achieving hands-free speech for a greater number of patients with laryngectomy. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  15. Clinical experience transitioning from IMRT to VMAT for head and neck cancer

    SciTech Connect

    Studenski, Matthew T.; Bar-Ad, Voichita; Siglin, Joshua; Cognetti, David; Curry, Joseph; Tuluc, Madalina; Harrison, Amy S.

    2013-07-01

    To quantify clinical differences for volumetric modulated arc therapy (VMAT) versus intensity modulated radiation therapy (IMRT) in terms of dosimetric endpoints and planning and delivery time, twenty head and neck cancer patients have been considered for VMAT using Nucletron Oncentra MasterPlan delivered via an Elekta linear accelerator. Differences in planning time between IMRT and VMAT were estimated accounting for both optimization and calculation. The average delivery time per patient was obtained retrospectively using the record and verify software. For the dosimetric comparison, all contoured organs at risk (OARs) and planning target volumes (PTVs) were evaluated. Of the 20 cases considered, 14 had VMAT plans approved. Six VMAT plans were rejected due to unacceptable dose to OARs. In terms of optimization time, there was minimal difference between the two modalities. The dose calculation time was significantly longer for VMAT, 4 minutes per 358 degree arc versus 2 minutes for an entire IMRT plan. The overall delivery time was reduced by 9.2 ± 3.9 minutes for VMAT (51.4 ± 15.6%). For the dosimetric comparison of the 14 clinically acceptable plans, there was almost no statistical difference between the VMAT and IMRT. There was also a reduction in monitor units of approximately 32% from IMRT to VMAT with both modalities demonstrating comparable quality assurance results. VMAT provides comparable coverage of target volumes while sparing OARs for the majority of head and neck cases. In cases where high dose modulation was required for OARs, a clinically acceptable plan was only achievable with IMRT. Due to the long calculation times, VMAT plans can cause delays during planning but marked improvements in delivery time reduce patient treatment times and the risk of intra-fraction motion.

  16. Clinical experience transitioning from IMRT to VMAT for head and neck cancer.

    PubMed

    Studenski, Matthew T; Bar-Ad, Voichita; Siglin, Joshua; Cognetti, David; Curry, Joseph; Tuluc, Madalina; Harrison, Amy S

    2013-01-01

    To quantify clinical differences for volumetric modulated arc therapy (VMAT) versus intensity modulated radiation therapy (IMRT) in terms of dosimetric endpoints and planning and delivery time, twenty head and neck cancer patients have been considered for VMAT using Nucletron Oncentra MasterPlan delivered via an Elekta linear accelerator. Differences in planning time between IMRT and VMAT were estimated accounting for both optimization and calculation. The average delivery time per patient was obtained retrospectively using the record and verify software. For the dosimetric comparison, all contoured organs at risk (OARs) and planning target volumes (PTVs) were evaluated. Of the 20 cases considered, 14 had VMAT plans approved. Six VMAT plans were rejected due to unacceptable dose to OARs. In terms of optimization time, there was minimal difference between the two modalities. The dose calculation time was significantly longer for VMAT, 4 minutes per 358 degree arc versus 2 minutes for an entire IMRT plan. The overall delivery time was reduced by 9.2 ± 3.9 minutes for VMAT (51.4 ± 15.6%). For the dosimetric comparison of the 14 clinically acceptable plans, there was almost no statistical difference between the VMAT and IMRT. There was also a reduction in monitor units of approximately 32% from IMRT to VMAT with both modalities demonstrating comparable quality assurance results. VMAT provides comparable coverage of target volumes while sparing OARs for the majority of head and neck cases. In cases where high dose modulation was required for OARs, a clinically acceptable plan was only achievable with IMRT. Due to the long calculation times, VMAT plans can cause delays during planning but marked improvements in delivery time reduce patient treatment times and the risk of intra-fraction motion. Copyright © 2013 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  17. A Clinical Concept for Interfractional Adaptive Radiation Therapy in the Treatment of Head and Neck Cancer

    SciTech Connect

    Jensen, Alexandra D.; Nill, Simeon; Huber, Peter E.; Bendl, Rolf; Debus, Juergen; Muenter, Marc W.

    2012-02-01

    Purpose: To present an approach to fast, interfractional adaptive RT in intensity-modulated radiation therapy (IMRT) of head and neck tumors in clinical routine. Ensuring adequate patient position throughout treatment proves challenging in high-precision RT despite elaborate immobilization. Because of weight loss, treatment plans must be adapted to account for requiring supportive therapy incl. feeding tube or parenteral nutrition without treatment breaks. Methods and Materials: In-room CT position checks are used to create adapted IMRT treatment plans by stereotactic correlation to the initial setup, and volumes are adapted to the new geometry. New IMRT treatment plans are prospectively created on the basis of position control scans using the initial optimization parameters in KonRad without requiring complete reoptimization and thus facilitating quick replanning in daily routine. Patients treated for squamous cell head and neck cancer (SCCHN) in 2006-2007 were evaluated as to necessity/number of replannings, weight loss, dose, and plan parameters. Results: Seventy-two patients with SCCHN received IMRT to the primary site and lymph nodes (median dose 70.4 Gy). All patients received concomitant chemotherapy requiring supportive therapy by feeding tube or parenteral nutrition. Median weight loss was 7.8 kg, median volume loss was approximately 7%. Fifteen of 72 patients required adaptation of their treatment plans at least once. Target coverage was improved by up to 10.7% (median dose). The increase of dose to spared parotid without replanning was 11.7%. Replanning including outlining and optimization was feasible within 2 hours for each patient, and treatment could be continued without any interruptions. Conclusion: To preserve high-quality dose application, treatment plans must be adapted to anatomical changes. Replanning based on position control scans therefore presents a practical approach in clinical routine. In the absence of clinically usable online

  18. [Good clinical practice in nutritional management of head and neck cancer patients].

    PubMed

    Meuric, J; Garabige, V; Blanc-Vincent, M P; Lallemand, Y; Bachmann, P

    1999-10-01

    The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. To develop clinical practice guidelines according to the definitions of Standards, Options and Recommandations for the nutritional management of the head and neck cancer patients. Data have been identified by literature search using Medline and the expert groups personal reference lists. Once the guidelines were defined, the document was submitted for review to 121 independent reviewers, and to the medical committees of the 20 French Cancer Centres. The main recommendations for the nutritional management of head and neck cancer patients are that: 1) Nutritional management prevents undernutrition, improves quality of life, reduces adverse effects of the treatment and prevents treatment delay; 2) The nutritional management of the head and neck cancer patient must be done before, during and after cancer treatment; 3) Before treatment, the weight of the patient must be assessed: 10% of weight loss in 6 months requires to an urgent nutritional intervention; 4) During radiation therapy, feeding should be adapted to various characteristics such as swallowing mechanism, side effects of the treatment, age; 5) During chemotherapy, nutrition must be checked and assessed at each cycle; 6) During surgery, enteral feeding must be stopped and nasogastric feeding progressively introduced starting on day 1 post-operatively. The quality of feed must be adequate during all the healing period. Close surveillance

  19. Midterm results of a femoral stem with a modular neck design: clinical outcomes and metal ion analysis.

    PubMed

    Silverton, Craig D; Jacobs, Joshua J; Devitt, Jeffrey W; Cooper, H John

    2014-09-01

    Modular neck femoral stems have a higher-than-anticipated rate of failure in registry results, but large single-center cohort studies are lacking. This is a retrospective cohort of 152 hips implanted with a single titanium stem with a modular titanium neck, presenting clinical, radiographic, and metal ion results at a mean 4.5-year follow-up. Five hips were revised during the study period, for an overall Kaplan-Meier survival of 0.894 at 8 years. There was one modular neck fracture (0.66%), but others demonstrated corrosion or adverse tissue reaction. Serum metal levels demonstrated wide variability. Despite good clinical results in the majority of patients, we confirmed an increased rate of femoral revision at mid-term follow-up, and therefore urge caution in the use of this particular stem design. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Interactive cervical motion kinematics: sensitivity, specificity and clinically significant values for identifying kinematic impairments in patients with chronic neck pain.

    PubMed

    Sarig Bahat, Hilla; Chen, Xiaoqi; Reznik, David; Kodesh, Einat; Treleaven, Julia

    2015-04-01

    Chronic neck pain has been consistently shown to be associated with impaired kinematic control including reduced range, velocity and smoothness of cervical motion, that seem relevant to daily function as in quick neck motion in response to surrounding stimuli. The objectives of this study were: to compare interactive cervical kinematics in patients with neck pain and controls; to explore the new measures of cervical motion accuracy; and to find the sensitivity, specificity, and optimal cutoff values for defining impaired kinematics in those with neck pain. In this cross-section study, 33 patients with chronic neck pain and 22 asymptomatic controls were assessed for their cervical kinematic control using interactive virtual reality hardware and customized software utilizing a head mounted display with built-in head tracking. Outcome measures included peak and mean velocity, smoothness (represented by number of velocity peaks (NVP)), symmetry (represented by time to peak velocity percentage (TTPP)), and accuracy of cervical motion. Results demonstrated significant and strong effect-size differences in peak and mean velocities, NVP and TTPP in all directions excluding TTPP in left rotation, and good effect-size group differences in 5/8 accuracy measures. Regression results emphasized the high clinical value of neck motion velocity, with very high sensitivity and specificity (85%-100%), followed by motion smoothness, symmetry and accuracy. These finding suggest cervical kinematics should be evaluated clinically, and screened by the provided cut off values for identification of relevant impairments in those with neck pain. Such identification of presence or absence of kinematic impairments may direct treatment strategies and additional evaluation when needed.

  1. [Clinical research on immune checkpoint and head and neck squamous cell carcinoma].

    PubMed

    Yu, D; Qi, X M; Zhao, X; Liu, Y; Xue, K; Jin, C S; Wen, L J

    2017-09-07

    T cell immune checkpoint pathways contribute to tumor immune escape. Many studies have shown that immune checkpoint is demonstrably correlated with tumor grade or prognosis in several types of malignancies and immune checkpoint has become a new biological index for tumor detection and prognosis. Immune checkpoint inhibitors have shown promising tumor outcomes in clinical trials for some advanced solid tumors and it will become a new target for cancer immunotherapy. In this review we will explore the correlation between expressions of immune checkpoint-associated genes and proteins in immune microenviroment and prognosis of head and neck squamous cell carcinoma, and specifically will discuss how this pathway can be manipulated with immune therapeutic drugs.

  2. Throat infection, neck and chest pain and cardiac response: a persistent infection-related clinical syndrome.

    PubMed

    Zhou, Changqing; Fu, Xiangning; Yan, Jiangtao; Fan, Qiao; Li, Zhuoya; Cianflone, Katherine; Wang, Daowen

    2009-02-01

    Dizziness, chest discomfort, chest depression and dyspnea are a group of symptoms that are common complaints in clinical practice. Patients with these symptoms are usually informed that while neurosis consequent to coronary heart disease is excluded nonetheless they remain unhealthy with no rational explanation or treatment. 165 cases of these symptoms and 85 control subjects were reviewed and underwent further medical history inquiry, routine EKG test and cardiac ultrasound examination. Thirty-five patients received coronary artery angiography to exclude coronary heart disease. Serum myocardial autoantibodies against beta(1)-adrenoceptor, alpha-myosin heavy chain, M(2)-muscarinic receptor and adenine-nucleotide translocator were tested, and inflammatory cytokines and high sensitivity C-reaction protein were measured and lymphocyte subclass was assayed by flow cytometry. All patients had a complex of four symptoms or tetralogy: (1) persistent throat or upper respiratory tract infection, (2) neck pain, (3) chest pain and (4) chest depression or dyspnea, some of them with anxiety. Anti-myocardial autoantibodies (AMCAs) were present in all patients vs. 8% in controls. TNF-alpha, IL-1 and IL-6 were significantly higher in patients than in controls (P<0.01). CD3(+) and CD4-CD8(+) lymphocytes were significantly higher and CD56(+) lymphocytes lower in patients than those in controls (P<0.01). The ratio of serum pathogen antibodies positive against Coxsackie virus-B, cytomegalovirus, Mycoplasma pneumoniae and Chlamydia pneumoniae were all markedly higher in patients. These data led to identification of a persistent respiratory infection-related clinical syndrome, including persistent throat infection, neck spinal lesion, rib cartilage inflammation, symptoms of cardiac depression and dyspnea with or without anxiety.

  3. Clinical significance of poor CD3 response in head and neck cancer.

    PubMed

    Shibuya, Terry Y; Nugyen, Nghia; McLaren, Christine E; Li, Kuo-Tung; Wei, Wei-Zen; Kim, Sanghun; Yoo, George H; Rogowski, Amy; Ensley, John; Sakr, Wael

    2002-03-01

    The objective of our investigation was to prospectively study what the implications of an unresponsive CD3 receptor are on clinical outcome in advanced-stage head and neck cancer patients. Lymph node mononuclear cells were purified from cancer patients and stimulated with immobilized anti-CD3 in vitro for 8 days. Two populations were identified, nonresponders (NRs) with [(3)H]thymidine-counts per min (cpm) <3500 and responders (Rs) with cpm >or=3500. NRs and Rs were prospectively followed for a minimum of 24 months, and clinical outcomes were compared. Postoperative complications, length of hospitalization, toxicities associated with chemotherapy or radiation therapy, survival, and disease-free status were measured. Twenty-six patients were followed, of which 19 Rs [[(3)H](X) = 37,819 +/- 24,979 cpm (mean proliferative count +/- SD)] and 7 NRs ([(3)H](X) = 1,375 +/- 1,102 cpm) were identified. There were no phenotypic differences in lymph node T-cell subpopulations (CD3, CD4, CD8, CD28, CD45RO) between groups. There was a 71% (5/7) incidence of recurrent cancer in NRs compared with 16% (3/19) in Rs; the median disease-free interval was significantly less in NRs (P = 0.03). The risk ratio of Rs to develop a recurrent cancer was 0.237 (95% confidence interval, 0.057-0.994), much less than for NRs. Patients with an unresponsive CD3 receptor as measured by in vitro response to anti-CD3 monoclonal antibodies had a significantly higher incidence of recurrent cancer. Analyses using Cox proportion hazards models demonstrated that CD3 response was the single greatest predictor of reduced disease-free interval. This is the first prospective study to confirm the importance of regional lymph node mononuclear cell CD3 receptor function in head and neck squamous cell carcinoma patients for tumor control.

  4. Immunotherapy of head and neck cancer: Emerging clinical trials from a National Cancer Institute Head and Neck Cancer Steering Committee Planning Meeting.

    PubMed

    Bauman, Julie E; Cohen, Ezra; Ferris, Robert L; Adelstein, David J; Brizel, David M; Ridge, John A; O'Sullivan, Brian; Burtness, Barbara A; Butterfield, Lisa H; Carson, William E; Disis, Mary L; Fox, Bernard A; Gajewski, Thomas F; Gillison, Maura L; Hodge, James W; Le, Quynh-Thu; Raben, David; Strome, Scott E; Lynn, Jean; Malik, Shakun

    2017-04-01

    Recent advances have permitted successful therapeutic targeting of the immune system in head and neck squamous cell carcinoma (HNSCC). These new immunotherapeutic targets and agents are being rapidly adopted by the oncologic community and hold considerable promise. The National Cancer Institute sponsored a Clinical Trials Planning Meeting to address the issue of how to further investigate the use of immunotherapy in patients with HNSCC. The goals of the meeting were to consider phase 2 or 3 trial designs primarily in 3 different patient populations: those with previously untreated, human papillomavirus-initiated oropharyngeal cancers; those with previously untreated, human papillomavirus-negative HNSCC; and those with recurrent/metastatic HNSCC. In addition, a separate committee was formed to develop integrative biomarkers for the clinical trials. The meeting started with an overview of key immune components and principles related to HNSCC, including immunosurveillance and immune escape. Four clinical trial concepts were developed at the meeting integrating different immunotherapies with existing standards of care. These designs were presented for implementation by the head and neck committees of the National Cancer Institute-funded National Clinical Trials Network. This article summarizes the proceedings of this Clinical Trials Planning Meeting, the purpose of which was to facilitate the rigorous development and design of randomized phase 2 and 3 immunotherapeutic trials in patients with HNSCC. Although reviews usually are published immediately after the meeting is held, this report is unique because there are now tangible clinical trial designs that have been funded and put into practice and the studies are being activated to accrual. Cancer 2017;123:1259-1271. © 2016 American Cancer Society.

  5. Browser Based Platform in Maintaining Clinical Activities - Use of The iPads in Head and Neck Clinics

    NASA Astrophysics Data System (ADS)

    Yang, W. Y.; Moore, J.; Quon, H.; Evans, K.; Sharabi, A.; Herman, J.; Hacker-Prietz, A.; McNutt, T.

    2014-03-01

    Purpose: Incompatibility between documentation and clinical workflow causes physician resistance in organized data collection, which in turn complicates the use of data in patient care improvement. To resolve the gap, we developed an iPad compatible in situ browser-based platform that integrates clinical activity with data collection and analysis presentation. The ability to perform in-clinic activities and monitor decision making using the iPad was evaluated. Methods: A browser-based platform that can exchange and present analysed data from the MOSAIQ database was developed in situ, the iPads were distributed in head and neck clinics to present the browser for clinical activities, data collection and assessment monitoring. Performance of the iPads for in-clinic activities was observed. Results: All in-clinic documentation activities can be performed without workstation computers. Accessing patient record and previous assessments was significantly faster without having to open the MOSAIQ application. Patient assessments can be completed with the physician facing the patient. Graphical presentation of toxicity progression and patient radiation plans to the patient can be performed in single interface without patient leaving the seating area. Updates in patient treatment status and medical history were presented in real time without having to move paper charts around. Conclusions: The iPad can be used in clinical activities independent of computer workstations. Improvements in clinical workflow can be critical in reducing physician resistance in data maintenance. Using the iPad in providing real-time quality monitoring is intuitive to both providers and patients.

  6. Clinical signs and physical function in neck and upper extremities among elderly female computer users: the NEW study.

    PubMed

    Juul-Kristensen, B; Kadefors, R; Hansen, K; Byström, P; Sandsjö, L; Sjøgaard, G

    2006-01-01

    The aim of the study was to present the prevalence of clinical signs and symptoms among female computer users above 45 years, both in a group with self-reported neck/shoulder trouble (NS cases) and in a group without such trouble (NS controls). The hypothesis was that computer users with self-reported neck/shoulder trouble have more clinical findings than those not reporting trouble, and that a corresponding pattern holds true for physical function. In total 42 and 61 questionnaire-defined NS cases and NS controls participated and went through a clinical examination of the neck and upper extremities and five physical function tests: maximal voluntary contraction (MVC) of shoulder elevation, abduction, and handgrip, as well as endurance at 30% MVC shoulder elevation and a physical performance test. Based on clinical signs and symptoms, trapezius myalgia (38%), tension neck syndrome (17%) and cervicalgia (17%) were the most frequent diagnoses among NS cases, and were significantly more frequent among NS cases than NS controls. A total of 60% of the subjects with reported trouble had one or several of the diagnoses located in the neck/shoulder. Physical function of the shoulder was lower in subjects with self-reported trouble as well as in the subgroup of NS cases with clinical diagnoses. In conclusion, the present clinical diagnoses and physical function tests differed between NS cases and NS controls, and are therefore recommended to be included as quantitative objective measures in assessing musculoskeletal health. Physical function tests should be further developed in order to be able to detect pre-stages of work-related disorders for preventive strategies.

  7. Validity and test re-test reliability of the neck disability index in the Nigerian clinical setting.

    PubMed

    Odole, A C; Adegoke, B O A; Akomas, N C

    2011-06-01

    The neck disability index (NDI) is a valid and widely used clinical instrument, which enjoys the recommendation of the World Health Organization for outcome assessment in neck pain. Its psychometric properties have not been investigated in the Nigerian clinical setting. This study investigated the content validity and test-retest reliability of the NDI in order to encourage its integration in the Nigerian clinical setting. Content validity of NDI was assessed through an expert panel review for content relevance/coverage and pretesting. Thirty two subjects with neck pain, recruited through a purposive sampling technique participated in the study. The NDI was administered twice within 48 hours interval. Data were summarized in percentages. Intra class correlation coefficient was used to analyze data for test-retest reliability with alpha set at 0.05. Participants were 1 males, 21 females with a majority within age group 38-57. Twenty four (75%) participants had mild to moderate disability, 7 (21.9%) had severe to complete disability and one individual had no disability. There was a significant correlation (r = 0.969, P=0.01) between the scores obtained from the first administration of the NDI and the second administration. The NDI is a valid and reliable outcome measure and it is recommended for integration into the assessment of neck pain in the Nigerian clinical setting.

  8. A comparison of the clinical usefulness of neck circumference and waist circumference in individuals with severe obesity.

    PubMed

    Assyov, Yavor; Gateva, Antoaneta; Tsakova, Adelina; Kamenov, Zdravko

    2017-02-01

    Purpose/Aim: Neck circumference (NC) is an emerging anthropometric parameter that has been proposed to reflect metabolic health. The aim of the current study was to compare its clinical usefulness to waist circumference (WC) in the assessment of individuals with severe obesity.

  9. Clinical phase I/II research on ultrasound thermo-chemotherapy in oral and maxillofacial-head and neck carcinoma

    NASA Astrophysics Data System (ADS)

    Shen, Guofeng; Ren, Guoxin; Guo, Wei; Chen, Yazhu

    2012-11-01

    The principle of a ultrasound thermo-chemotherapy instrument and the clinical phase I/II research on short-term and long-term therapeutic effect and main side-effect of ultrasound hyperthermia combined with chemotherapy in oral and maxillofacial-head & neck carcinoma by the instrument will be presented in this paper.

  10. Management of the neck in maxillary sinus carcinomas

    PubMed Central

    Dooley, Laura; Shah, Jatin

    2016-01-01

    Purpose of Review To discuss and review the role for elective treatment of the neck in maxillary squamous cell carcinoma. Improvements in survival have been seen due to improved local therapies and control, therefore the treatment of the neck has become a topic of debate. Recent findings The risk of occult metastases in neck nodes is higher for T 3-4 tumors. The rate of nodal relapse in the N0 neck without elective treatment is 8-15%. With elective irradiation the nodal relapse rate decreases. However, most nodal relapses are accompanied by local failure or distant disease. Local failure remains the most common site of failure and cause of death in this patient population. Summary Treatment failure occurs overall in 62% of all patients, with local recurrence by far the most common site of treatment failure which is rarely amenable to salvage therapy. Therefore elective neck irradiation is not routinely indicated in the clinically N0 neck; those who recur only in the neck can be surgically salvaged more than 50% of the time. PMID:25692625

  11. A comparison of clinically utilized human papillomavirus detection methods in head and neck cancer

    PubMed Central

    Schlecht, Nicolas F.; Brandwein-Gensler, Margaret; Nuovo, Gerard J.; Li, Maomi; Dunne, Anne; Kawachi, Nicole; Smith, Richard V.; Burk, Robert D.; Prystowsky, Michael B.

    2011-01-01

    less accurate for head and neck squamous cell carcinoma on tissue microarrays than p16 immuno-histochemistry. Further testing is warranted before these assays should be recommended for clinical human papillomavirus detection. PMID:21572401

  12. Impact of Node Negative Target Volume Delineation on Contralateral Parotid Gland Dose Sparing Using IMRT in Head and Neck Cancer.

    PubMed

    Magnuson, William J; Urban, Erich; Bayliss, R Adam; Harari, Paul M

    2015-06-01

    There is considerable practice variation in treatment of the node negative (N0) contralateral neck in patients with head and neck cancer. In this study, we examined the impact of N0 neck target delineation volume on radiation dose to the contralateral parotid gland. Following institutional review board approval, 12 patients with head and neck cancer were studied. All had indications for treatment of the N0 neck, such as midline base of tongue or soft palate extension or advanced ipsilateral nodal disease. The N0 neck volumes were created using the Radiation Therapy Oncology Group head and neck contouring atlas. The physician-drawn N0 neck clinical target volume (CTV) was expanded by 25% to 200% to generate volume variation, followed by a 3-mm planning target volume (PTV) expansion. Surrounding organs at risk were contoured and complete intensity-modulated radiation therapy plans were generated for each N0 volume expansion. The median N0 target volume drawn by the radiation oncologist measured 93 cm(3) (range 71-145). Volumetric expansion of the N0 CTV by 25% to 200% increased the resultant mean dose to the contralateral parotid gland by 1.4 to 8.5 Gray (Gy). For example, a 4.1-mm increase in the N0 neck CTV translated to a 2.0-Gy dose increase to the parotid, 7.4 mm to a 4.5 Gy dose increase, and 12.5 mm to an 8.5 Gy dose increase, respectively. The treatment volume designated for the N0 neck has profound impact on resultant dose to the contralateral parotid gland. Variations of up to 15 mm are routine across physicians in target contouring, reflecting individual preference and training expertise. Depending on the availability of immobilization and image guidance techniques, experts commonly recommend 3 to 10 mm margin expansions to generate the PTV. Careful attention to the original volume of the N0 neck CTV, as well as expansion margins, is important in achieving effective contralateral gland sparing to reduce the resultant xerostomia and dysguesia that may ensue

  13. Site-Dependent Reference Point Microindentation Complements Clinical Measures for Improved Fracture Risk Assessment at the Human Femoral Neck.

    PubMed

    Jenkins, Thomas; Coutts, Louise V; D'Angelo, Stefania; Dunlop, Douglas G; Oreffo, Richard O C; Cooper, Cyrus; Harvey, Nicholas C; Thurner, Phillipp J

    2016-01-01

    In contrast to traditional approaches to fracture risk assessment using clinical risk factors and bone mineral density (BMD), a new technique, reference point microindentation (RPI), permits direct assessment of bone quality; in vivo tibial RPI measurements appear to discriminate patients with a fragility fracture from controls. However, it is unclear how this relates to the site of the most clinically devastating fracture, the femoral neck, and whether RPI provides information complementary to that from existing assessments. Femoral neck samples were collected at surgery after low-trauma hip fracture (n = 46; 17 male; aged 83 [interquartile range 77-87] years) and compared, using RPI (Biodent Hfc), with 16 cadaveric control samples, free from bone disease (7 male; aged 65 [IQR 61-74] years). A subset of fracture patients returned for dual-energy X-ray absorptiometry (DXA) assessment (Hologic Discovery) and, for the controls, a micro-computed tomography setup (HMX, Nikon) was used to replicate DXA scans. The indentation depth was greater in femoral neck samples from osteoporotic fracture patients than controls (p < 0.001), which persisted with adjustment for age, sex, body mass index (BMI), and height (p < 0.001) but was site-dependent, being less pronounced in the inferomedial region. RPI demonstrated good discrimination between fracture and controls using receiver-operating characteristic (ROC) analyses (area under the curve [AUC] = 0.79 to 0.89), and a model combining RPI to clinical risk factors or BMD performed better than the individual components (AUC = 0.88 to 0.99). In conclusion, RPI at the femoral neck discriminated fracture cases from controls independent of BMD and traditional risk factors but dependent on location. The clinical RPI device may, therefore, supplement risk assessment and requires testing in prospective cohorts and comparison between the clinically accessible tibia and the femoral neck. © 2015 American Society for Bone and Mineral

  14. The "Rolled-Up Sleeve" Technique for Microvascular Venous Anastomosis in Head and Neck Reconstruction: Animal Study and Clinical Series.

    PubMed

    Scaglioni, Mario F; Kuo, Yur-Ren; Chen, Yen-Chou

    2016-03-01

    Venous anastomosis is challenging especially when encountering the thin recipient vein wall in the head and neck region. The authors developed the "rolled-up sleeve" technique to solve this scenario. An animal study was performed to access the safety and reliability of the "rolled-up sleeve" technique. This technique was performed in 53 consecutive patients during head and neck reconstruction. In the animal study, all anastomoses were patent. Histological analysis revealed neo-endothelialization over the anastomotic site. This technique was applied to 59 recipient veins: branch of internal jugular vein (27), external jugular vein (17), superficial temporal vein (9), retromandibular vein (4), facial vein (2), and internal mammary vein (2). No venous thrombosis occurred in these clinical series. The "rolled-up sleeve" technique is a useful procedure that can be performed safely to deal with thin vascular walls for venous anastomoses in head and neck reconstructions.

  15. Clinical impact of surveillance for head and neck cancer in patients with esophageal squamous cell carcinoma

    PubMed Central

    Morimoto, Hiroyuki; Yano, Tomonori; Yoda, Yusuke; Oono, Yasuhiro; Ikematsu, Hiroaki; Hayashi, Ryuichi; Ohtsu, Atsushi; Kaneko, Kazuhiro

    2017-01-01

    AIM To evaluate the clinical impact of surveillance for head and neck (HN) region with narrow band imaging (NBI) in patients with esophageal squamous cell carcinoma (ESCC). METHODS Since 2006, we introduced the surveillance for HN region using NBI for all patients with ESCC before treatment, and each follow-up. The patients with newly diagnosed stage I to III ESCC were enrolled and classified into two groups as follows: Group A (no surveillance for HN region); between 1992 and 2000), and Group B (surveillance for HN region with NBI; between 2006 and 2008). We comparatively evaluated the detection rate of superficial head and neck squamous cell carcinoma (HNSCC), and the serious events due to metachronous advanced HNSCC during the follow-up. RESULTS A total 561 patients (group A: 254, group B: 307) were enrolled. Synchronous superficial HNSCC was detected in 1 patient (0.3%) in group A, and in 12 (3.9%) in group B (P = 0.008). During the follow up period, metachronous HNSCC were detected in 10 patients (3.9%) in group A and in 30 patients (9.8%) in group B (P = 0.008). All metachronous lesions in group B were early stage, and 26 patients underwent local resection, however, 6 of 10 patients (60%) in group A lost their laryngeal function and died with metachronous HNSCC. CONCLUSION Surveillance for the HN region by using NBI endoscopy increase the detection rate of early HNSCC in patients with ESCC, and led to decrease serious events related to advanced metachronous HNSCC. PMID:28246479

  16. Rapid hyperfractionated radiotherapy. Clinical results in 178 advanced squamous cell carcinomas of the head and neck

    SciTech Connect

    Nguyen, T.D.; Demange, L.; Froissart, D.; Panis, X.; Loirette, M.

    1985-07-01

    The authors present a series of 178 patients with Stage III or IV squamous cell carcinoma of the head and neck treated by rapid irradiation using multiple and small fractions per day. An initial group of 91 patients (G1) received a total dose of 72 Gy in 80 sessions and 10 days, according to the following split course schedule: J1 to J5, 36 Gy in 40 sessions, eight daily fractions of .9 Gy separated by 2 hours; J6 to J20, rest period; J21 to J25, same as in J1 except that the spinal cord was shielded. This protocol was altered for the following 87 patients (G2) by lessening the total dose to 60 to 66 Gy and the number of fractions to 60. The rest period was lengthened to 4 weeks. All patients but five completed the whole program and the minimal follow-up period was 24 months. At the end of irradiation, 121 patients achieved a total remission, but local recurrences occurred in 56%. Moreover, acute intolerance was considered as severe in 34% of G1 patients, and included extensive mucosal necrosis and bleeding. Although this rate was significantly reduced in G2 patients, late complications were observed in 20 of the 25 survivors, and included trismus, cervical sclerosis, and recurrent laryngeal edema. The crude survival rate is 13% at 2 years. Although this study was not randomized, this particular type of accelerated and hyperfractionated combination of irradiation did not really improve the clinical results in advanced carcinoma of the head and neck. Other schedules and probably other tumors, less extended, should be tested.

  17. Development and Validation of a Clinical Assessment Tool for Platysmal Banding in Cervicomental Aesthetics of the Female Neck.

    PubMed

    Gupta, Subhas; Biskup, Nataliya; Mattison, Gennaya; Leis, Amber

    2015-08-01

    In facial aesthetics, grading systems are useful tools for planning aesthetic procedures. One key component of rejuvenation--the anterior neck--has been relatively overlooked. In the 1980s, criteria were established for the appearance of a youthful neck. Considering the significant contribution of the anterior neck to the aesthetics of the lower face, updated and more extensive clinical evaluation tools are critical to successful execution and measurement of rejuvenation. A validated assessment scale has yet to be created for platysmal banding, one component of the anterior neck that significantly contributes to the aesthetics. The purpose of this study was to establish a validated platysmal banding scale for clinical application. Three-dimensional standardized photographs from over 100 volunteer patients of various ages and ethnicities were analyzed to develop a five-point scale for platysmal banding. The scale was validated by a group of academic and nonacademic attending plastic surgeons as well as senior level plastic surgery residents then analyzed through a two stage process to ensure both interrater and intrarater validity. We measured the Intraclass Correlation Coefficients (ICC) for the interrater reliability. ICCs ranged from moderate to excellent agreement. Cronbach's alpha, which represents intrarater reliability, was also calculated for the same sample with all results being good to excellent. This study established a validated scale to assess the degree of platysmal banding in the female neck. This grading system has potential application in the preprocedure planning for patients considering face and neck rejuvenation to address platysmal banding. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  18. Thoracic spine thrust manipulation versus cervical spine thrust manipulation in patients with acute neck pain: a randomized clinical trial.

    PubMed

    Puentedura, Emilio J; Landers, Merrill R; Cleland, Joshua A; Mintken, Paul E; Huijbregts, Peter; Fernández-de-Las-Peñas, César

    2011-04-01

    Randomized clinical trial. To determine if patients who met the clinical prediction rule (CPR) criteria for the success of thoracic spine thrust joint manipulation (TJM) for the treatment of neck pain would have a different outcome if they were treated with a cervical spine TJM. A CPR had been proposed to identify patients with neck pain who would likely respond favorably to thoracic spine TJM. Research on validation of that CPR had not been completed when this trial was initiated. In our clinical experience, though many patients with neck pain responded favorably to thoracic spine TJM, they often reported that their symptomatic cervical spine area had not been adequately addressed. Twenty-four consecutive patients, who presented to physical therapy with a primary complaint of neck pain and met 4 out of 6 of the CPR criteria for thoracic TJM, were randomly assigned to 1 of 2 treatment groups. The thoracic group received thoracic TJM and a cervical range-of-motion (ROM) exercise for the first 2 sessions, followed by a standardized exercise program for an additional 3 sessions. The cervical group received cervical TJM and the same cervical ROM exercise for the first 2 sessions, and the same exercise program given to the thoracic group for the next 3 sessions. Outcome measures collected at 1 week, 4 weeks, and 6 months from start of treatment included the Neck Disability Index, numeric pain rating scale, and Fear-Avoidance Beliefs Questionnaire. Patients who received cervical TJM demonstrated greater improvements in Neck Disability Index (P ≤.001) and numeric pain rating scale (P ≤.003) scores at all follow-up times. There was also a statistically significant improvement in the Fear-Avoidance Beliefs Questionnaire physical activity subscale score at all follow-up times for the cervical group (P ≤.004). The number needed to treat to avoid an unsuccessful overall outcome was 1.8 at 1 week, 1.6 at 4 weeks, and 1.6 at 6 months. Patients with neck pain who met 4 of 6

  19. RapidPlan head and neck model: the objectives and possible clinical benefit.

    PubMed

    Fogliata, A; Reggiori, G; Stravato, A; Lobefalo, F; Franzese, C; Franceschini, D; Tomatis, S; Mancosu, P; Scorsetti, M; Cozzi, L

    2017-04-27

    To evaluate a knowledge based planning model for RapidPlan (RP) generated for advanced head and neck cancer (HNC) patient treatments, as well its ability to possibly improve the clinical plan quality. The stability of the model was assessed also for a different beam geometry, different dose fractionation and different management of bilateral structures (parotids). Dosimetric and geometric data from plans of 83 patients presenting HNC were selected for the model training. All the plans used volumetric modulated arc therapy (VMAT, RapidArc) to treat two targets at dose levels of 69.96 and 54.45 Gy in 33 fractions with simultaneous integrated boost. Two models were generated, the first separating the ipsi- and contra-lateral parotids, while the second associating the two parotids to a single structure for training. The optimization objectives were adjusted to the final model to better translate the institutional planning and dosimetric strategies and trade-offs. The models were validated on 20 HNC patients, comparing the RP generated plans and the clinical plans. RP generated plans were also compared between the clinical beam arrangement and a simpler geometry, as well as for a different fractionation scheme. RP improved significantly the clinical plan quality, with a reduction of 2 Gy, 5 Gy, and 10 Gy of the mean parotid, oral cavity and laryngeal doses, respectively. A simpler beam geometry was deteriorating the plan quality, but in a small amount, keeping a significant improvement relative to the clinical plan. The two models, with one or two parotid structures, showed very similar results. NTCP evaluations indicated the possibility of improving (NTCP decreasing of about 7%) the toxicity profile when using the RP solution. The HNC RP model showed improved plan quality and planning stability for beam geometry and fractionation. An adequate choice of the objectives in the model is necessary for the trade-offs strategies.

  20. Robust Intensity Modulated Proton Therapy (IMPT) Increases Estimated Clinical Benefit in Head and Neck Cancer Patients

    PubMed Central

    van Dijk, Lisanne V.; Steenbakkers, Roel J. H. M.; ten Haken, Bennie; van der Laan, Hans Paul; van ‘t Veld, Aart A.; Langendijk, Johannes A.; Korevaar, Erik W.

    2016-01-01

    Purpose To compare the clinical benefit of robust optimized Intensity Modulated Proton Therapy (minimax IMPT) with current photon Intensity Modulated Radiation Therapy (IMRT) and PTV-based IMPT for head and neck cancer (HNC) patients. The clinical benefit is quantified in terms of both Normal Tissue Complication Probability (NTCP) and target coverage in the case of setup and range errors. Methods and Materials For 10 HNC patients, PTV-based IMRT (7 fields), minimax and PTV-based IMPT (2, 3, 4, 5 and 7 fields) plans were tested on robustness. Robust optimized plans differed from PTV-based plans in that they target the CTV and penalize possible error scenarios, instead of using the static isotropic CTV-PTV margin. Perturbed dose distributions of all plans were acquired by simulating in total 8060 setup (±3.5 mm) and range error (±3%) combinations. NTCP models for xerostomia and dysphagia were used to predict the clinical benefit of IMPT versus IMRT. Results The robustness criterion was met in the IMRT and minimax IMPT plans in all error scenarios, but this was only the case in 1 of 40 PTV-based IMPT plans. Seven (out of 10) patients had relatively large NTCP reductions in minimax IMPT plans compared to IMRT. For these patients, xerostomia and dysphagia NTCP values were reduced by 17.0% (95% CI; 13.0–21.1) and 8.1% (95% CI; 4.9–11.2) on average with minimax IMPT. Increasing the number of fields did not contribute to plan robustness, but improved organ sparing. Conclusions The estimated clinical benefit in terms of NTCP of robust optimized (minimax) IMPT is greater than that of IMRT and PTV-based IMPT in HNC patients. Furthermore, the target coverage of minimax IMPT plans in the presence of errors was comparable to IMRT plans. PMID:27030987

  1. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise

    PubMed Central

    Petersen, Evan J.; Smith, Tracy A.; Cowan, James E.; Rendeiro, Daniel G.; Deyle, Gail D.; Childs, John D.

    2009-01-01

    The objective of the study was to develop a clinical prediction rule (CPR) to identify patients with neck pain likely to improve with cervical traction. The study design included prospective cohort of patients with neck pain referred to physical therapy. Development of a CPR will assist clinicians in classifying patients with neck pain likely to benefit from cervical traction. Eighty patients with neck pain received a standardized examination and then completed six sessions of intermittent cervical traction and cervical strengthening exercises twice weekly for 3 weeks. Patient outcome was classified at the end of treatment, based on perceived recovery according to the global rating of change. Patients who achieved a change ≥+6 (“A great deal better” or “A very great deal better”) were classified as having a successful outcome. Univariate analyses (t tests and chi-square) were conducted on historical and physical examination items to determine potential predictors of successful outcome. Variables with a significance level of P ≤ 0.15 were retained as potential prediction variables. Sensitivity, specificity and positive and negative likelihood ratios (LRs) were then calculated for all variables with a significant relationship with the reference criterion of successful outcome. Potential predictor variables were entered into a step-wise logistic regression model to determine the most accurate set of clinical examination items for prediction of treatment success. Sixty-eight patients (38 female) were included in data analysis of which 30 had a successful outcome. A CPR with five variables was identified: (1) patient reported peripheralization with lower cervical spine (C4–7) mobility testing; (2) positive shoulder abduction test; (3) age ≥55; (4) positive upper limb tension test A; and (5) positive neck distraction test. Having at least three out of five predictors present resulted in a +LR equal to 4.81 (95% CI = 2.17–11.4), increasing the

  2. Anatomical and Clinical Implications of the Deep and Superficial Fat Compartments of the Neck.

    PubMed

    Gassman, Andrew A; Pezeshk, Ronnie; Scheuer, Jack F; Sieber, David A; Campbell, Carrie F; Rohrich, Rod J

    2017-09-01

    Anatomical study has proven vital to the understanding and improvement of rejuvenation techniques of the face and neck. The microscopic septa responsible for individual facial fat compartments are also present in the neck. The authors' anatomical studies of the neck, including supraplatysmal and subplatysmal elements, have influenced their surgical and nonsurgical techniques. Careful muscular resuspension and modification of both deep and superficial fat compartments can lead to impressive and lasting aesthetic outcomes. The authors present their algorithm and approach to both surgical and noninvasive methods for aesthetic neck contouring. The discussion contained here is augmented by video footage of injected, fresh cadaver dissection that highlights the anatomical relationships of neck fat compartments discussed in this article.

  3. Frequency of bilateral cervical metastases in hypopharyngeal squamous cell carcinoma: a retrospective analysis of 203 cases after bilateral neck dissection.

    PubMed

    Olzowy, Bernhard; Hillebrand, Matthias; Harréus, Ulrich

    2017-08-24

    The decision whether to perform an elective neck dissection in patients with head and neck squamous cell carcinoma and clinically negative lymph nodes (cN0) is made based on the probability of micrometastases in the neck for the given subsite and size of the primary. A retrospective chart review was performed of 203 patients with hypopharyngeal SCC who received a bilateral neck dissection. The frequency of histologically unveiled bilateral neck metastases was determined. A high frequency of contralateral metastases above 20% was detected for all carcinomas affecting the midline and those involving the medial wall of the pyriform sinus except of T1-stages (13%) and a low frequency for laterally located primaries (3%). Ipsilateral nodal status predicted contralateral neck metastases. Bilateral neck dissection should be recommended for primaries affecting the midline and T2-4 tumors involving the medial wall of the pyriform sinus.

  4. Endotracheal tube displacement during head and neck movements. Observational clinical trial.

    PubMed

    Tailleur, Robert; Bathory, Istvan; Dolci, Mirko; Frascarolo, Philippe; Kern, Christian; Schoettker, Patrick

    2016-08-01

    Measure the displacements of endotracheal tube (ETT) tip displacement during head and neck movements. Observational study. Ear-nose-throat (ENT) and neurosurgery operating room. We performed a maximal head-neck movement trial on 50 adult patients, American Society of Anaesthesiologists 1 or 2. Patients with body mass index >35 kg · m(-2), height <150 cm, airway malformations, pulmonary diseases, difficulties in neck flexion or extension, previous ENT surgery or radiotherapy, gastroesophageal reflux, or dental instability were excluded from the study. ENT and neurosurgery. We measured the change in distance between the ETT tip and the carina, using a fiberscope through the ETT. After intubation, a wide disparity of tube tip distance to the carina in the neutral position was noted with a median of 5.0 (3.5-7.0) cm. Cephalad tube movement was documented following maximal head and neck extension in 34 (68%) patients and right head rotation in 25 patients (50%). Caudal tube displacement was due to maximal head and neck flexion in 38 patients (76%) and left head rotation in 25 patients (50%). Selective right main bronchus intubation was noted in 2 (4%) patients after maximal head extension. Maximal head and neck movements led to unpredictable tube displacements. Proper reassessment of tube positioning after head and neck movement of intubated patients is therefore mandatory. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Single-tooth implants with different neck designs: a randomized clinical trial evaluating the aesthetic outcome.

    PubMed

    den Hartog, Laurens; Raghoebar, Gerry M; Slater, James J Huddleston; Stellingsma, Kees; Vissink, Arjan; Meijer, Henny J A

    2013-06-01

    To evaluate the aesthetic outcome of single-tooth implants in the aesthetic zone with different neck designs from a professional's and patient's perception. Ninety-three patients with a missing anterior tooth in the maxilla were randomly assigned to be treated with an implant with a smooth neck, a rough neck with grooves or a scalloped rough neck with grooves. Implants were installed in healed sites. One year after definitive crown placement (18 months post-implant placement), photographs were taken and the aesthetic outcome was assessed according to two objective aesthetic indexes: pink esthetic score/white esthetic score (PES/WES) and implant crown aesthetic index (ICAI). A questionnaire was used to assess the aesthetic outcome and general satisfaction from a patient's perception. standardized radiographs were taken to measure marginal bone level changes. One implant was lost. Although there was a significant difference in marginal bone loss between the different implant neck designs (smooth neck 1.19±0.82mm, rough neck 0.90±0.57mm, scalloped neck 2.01±0.77mm), there were no differences in aesthetic outcome. According to the professional's assessments using PES/WES and ICAI, 79.3% and 62% of the cases showed acceptable crown aesthetics, and 59.8% and 56.5% of the cases showed acceptable mucosa aesthetics. Overall, patients were satisfied about the aesthetics of the mucosa (81.5%) and crown (93.3%), and general patient satisfaction was high (9.0±1.0 out of a maximum of 10). According to the professional's assessment, a pre-implant augmentation procedure was associated with less favorable aesthetics of the mucosa. This study shows that the aesthetics of single-tooth implants in the maxillary aesthetic zone appears to be independent of the implant neck designs applied but dependent on the need for pre-implant surgery. © 2011 Wiley Periodicals, Inc.

  6. Portrait of a process: arts-based research in a head and neck cancer clinic.

    PubMed

    Gilbert, Mark A; Lydiatt, William M; Aita, Virginia A; Robbins, Regina E; McNeilly, Dennis P; Desmarais, Michele Marie

    2016-03-01

    The role of art in medicine is complex, varied and uncertain. To examine one aspect of the relationship between art and medicine, investigators analysed the interactions between a professional artist and five adult patients with head and neck cancer as they cocreated portraits in a clinical setting. The artist and four members of an interdisciplinary team analysed the portraits as well as journal entries, transcripts of portrait sessions and semistructured interviews. Over the course of 5 months, 24 artworks evolved from sittings that allowed both the patients and the artist to collaborate around stories of illness, suffering and recovery. Using narrative inquiry and qualitative arts-based research techniques five emergent themes were identified: embracing uncertainties; developing trusting relationships; engaging in reflective practices; creating shared stories; and empowerment. Similar themes are found in successful physician-patient relationships. This paper will discuss these findings and potential implications for healthcare and medical education. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Treatment success in neck pain: The added predictive value of psychosocial variables in addition to clinical variables.

    PubMed

    Groeneweg, Ruud; Haanstra, Tsjitske; Bolman, Catherine A W; Oostendorp, Rob A B; van Tulder, Maurits W; Ostelo, Raymond W J G

    2017-01-01

    Identification of psychosocial variables may influence treatment outcome. The objective of this study was to prospectively examine whether psychosocial variables, in addition to clinical variables (pain, functioning, general health, previous neck pain, comorbidity), are predictive factors for treatment outcome (i.e. global perceived effect, functioning and pain) in patients with sub-acute and chronic non-specific neck pain undergoing physical therapy or manual therapy. Psychosocial factors included treatment outcome expectancy and treatment credibility, health locus of control, and fear avoidance beliefs. This study reports a secondary analysis of a primary care-based pragmatic randomized controlled trial. Potential predictors were measured at baseline and outcomes, in 181 patients, at 7 weeks and 26 weeks. Hierarchical logistic regression models showed that treatment outcome expectancy predicted outcome success, in addition to clinical and demographic variables. Expectancy explained additional variance, ranging from 6% (pain) to 17% (functioning) at 7 weeks, and 8% (pain) to 16% (functioning) at 26 weeks. Locus of control and fear avoidance beliefs did not add significantly to predicting outcome. Based on the results of this study we conclude that outcome expectancy, in patients with non-specific sub-acute and chronic neck pain, has additional predictive value for treatment success above and beyond clinical and demographic variables. Psychological processes, health perceptions and how these factors relate to clinical variables may be important for treatment decision making regarding therapeutic options for individual patients. Copyright © 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  8. Neck Rhabdoid Tumors: Clinical Features and Consideration of Autologous Stem Cell Transplant.

    PubMed

    Wolfe, Adam D; Capitini, Christian M; Salamat, Shahriar M; DeSantes, Kenneth; Bradley, Kristin A; Kennedy, Tabassum; Dehner, Louis P; Patel, Neha J

    2017-04-03

    Extrarenal malignant rhabdoid tumors (MRT) have a poor prognosis despite aggressive therapy. Adding high-dose chemotherapy with autologous stem cell rescue (HDC-ASCR) as consolidative therapy for MRT is controversial. We describe 2 patients, age 13 years and 19 months, with unresectable neck MRT. After chemotherapy and radiotherapy, both underwent HDC-ASCR and remain in remission over 4 years later. We reviewed all published cases of neck MRT, and found poorer outcomes and more variable age of presentation and time to progression than MRT at other sites. Neck MRT may represent a higher-risk subset of MRT, and addition of HDC-ASCR merits consideration.

  9. Identification of risk factors of central lymph node metastasis and evaluation of the effect of prophylactic central neck dissection on migration of staging and risk stratification in patients with clinically node-negative papillary thyroid microcarcinoma.

    PubMed

    Yuan, Jiru; Li, Jinghua; Chen, Xiaoyi; Lin, Xiaodong; Du, Jialin; Zhao, Gang; Chen, Zhengbo; Wu, Zeyu

    2017-06-01

    The first aim of this study was to explore the risk factors that were associated with central lymph node metastasis (CLNM) in patients with clinically node-negative papillary thyroid microcarcinoma (cN0 PTMC) after prophylactic central neck dissection (PCND). The second aim was to evaluate the influence of PCND on migration of TNM staging and risk stratification (RS) in patients with cN0 PTMC. A total of 295 cN0 PTMC patients who underwent thyroidectomy with PCND in the Department of General Surgery at Guangdong General Hospital between March 2014 to December 2015 were assessed retrospectively. The relations of CLNM with clinicopathologic characteristics of cN0 PTMC were analyzed by univariate and multivariate logistic regression. The effect of PCND on migration of TNM staging and RS was also observed. The incidence of CLNM was 42.4% (125 of 295 cases) in patients with cN0 PTMC. Univariate analysis showed that age (P=0.000), ultrasonographic tumor size (P=0.009), pathologic tumor size (P=0.005), and multifocality (P=0.031) were significantly associated with the incidence of CLNM. No significant correlations were found between the presence of CLNM and other variables such as gender (P=0.399), bilaterality (P=0.118), capsular invasion (P=0.111), lymphovascular invasion (P=0.184), extent of thyroidectomy (P=0.319) and lymphadenectomy (P=0.458). Multivariate logistic regression analysis revealed that age <45 years (P=0.000) and multifocality (P=0.033) were independent predictors of CLNM in patients with cN0 PTMC. Because of the identification of CLNM in the implementation of PCND, 42 (14.2%) patients were upstaged, and 118 (40.0%) patients upgraded in RS. CLNM is highly prevalent in cN0 PTMC. Age <45 years and multifocality are independent risk factors of CLNM in cN0 PTMC patients. PCND can identify CLNM, which allows more accurate TNM staging/RS and may have an important impact on postoperative treatment in cN0 PTMC patients. Copyright © 2017 Société Française du

  10. [Clinical manifestation of Kaposi sarcoma in otorhinolaryngology head and neck surgery].

    PubMed

    Yu, De-xian; Pi, Shi-jun; Zhang, Wen-shan

    2013-03-01

    To improve the knowledge of Kaposi sarcoma and the relationship between Kaposi sarcoma and human immunodeficiency virus (HIV) infection, and to improve the ability to diagnose and treat Kaposi sarcoma and acquired immune deficiency syndrome (AIDS). Symptoms, signs and results of 121 patients encountered in the department of otorhinolaryngology head and neck surgery in Tanzania, who was diagnosed as Kaposi sarcoma actually with HIV infection and AIDS, were retrospectively analyzed in this study. There were 46 males and 75 females with age ranged from 5 to 65 years, medium 30 year. The mucous membranes and skin lesions was the most commonly seen clinical manifestation in 121 cases, these lesions appeared as raised blotches or lumps that might be purple, brown, or red, early stages typical lesions began as flat or slightly raised colored spots. Among the cases reported here, 25 patients (20.66%) showed progressive nose blockage and nose bleeding and the purple-red new-grows were found in the nose of these patients. Fifteen patients (12.40%) had flat or slightly raised colored spots in their mucous membrane of mouth (palate or tongue), and in other 7 patients, purple small lumps were found in the gums of the patients. There were same lesions in their pharynx in 9 cases. In 10 patients (8.26%), Kaposi sarcoma was found in tonsil looked like tonsillitis with enlarged tonsils by two to three degree. Twelve patients (9.92%) had masses in the neck with no pain. Thirty-five patients (28.92%)had lesions of purple black nodules, including 10 patients who had the same lesions with ulcer formation in the nodules. All patients had been followed-up for at least two-years. Eighty-five patients passed away in one year, survival rate of one year was 21.48% (26/121), only 12 patients survived from the disease over two years, two years' survival rate was 9.92% (12/121). Kaposi sarcoma is the characteristic disease for AIDS, mainly found on the membranes and skin. These lesions appears

  11. Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines.

    PubMed

    Robson, A; Sturman, J; Williamson, P; Conboy, P; Penney, S; Wood, H

    2016-05-01

    This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the pre-treatment clinical assessment of patients presenting with head and neck cancer. Recommendations • Comorbidity data should be collected as it is important in the analysis of survival, quality of life and functional outcomes after treatment as well as for comparing results of different treatment regimens and different centres. (R) • Patients with hypertension of over 180/110 or associated target organ damage, should have antihypertensive medication started pre-operatively as per British Hypertension Society guidelines. (R) • Rapidly correcting pre-operative hypertension with beta blockade appears to cause higher mortality due to stroke and hypotension and should not be used. (R) • Patients with poorly controlled or unstable ischaemic heart disease should be referred for cardiology assessment pre-operatively. (G) • Patients within one year of drug eluting stents should be discussed with the cardiologist who was responsible for their percutaneous coronary intervention pre-operatively with regard to cessation of antiplatelet medication due to risk of stent thrombosis. (G) • Patients with multiple recent stents should be managed in a centre with access to interventional cardiology. (G) • Surgery after myocardial infarction should be delayed if possible to reduce mortality risk. (R) • Patients with critical aortic stenosis (AS) should be considered for pre-operative intervention. (G) • Clopidogrel should be discontinued 7 days pre-operatively; warfarin should be discontinued 5 days pre-operatively. (R) • Patients with thromboembolic disease or artificial heart valves require heparin therapy to bridge peri-operative warfarin cessation, this should start 2 days after last warfarin dose. (R) • Cardiac drugs other than angotensin-converting enzyme inhibitors and angiotensin

  12. [Clinical application of positron-emission tomography for the identification of cervical nodal metastases of head and neck cancer compared with CT or MRI and clinical palpation].

    PubMed

    Chen, Zhong-Wei; Zhu, Li-Jun; Hou, Qing-Yi; Wang, Qi-Peng; Jiang, Sui; Feng, Hang

    2008-12-01

    To evaluate the value of positron-emission tomography (PET) for the identification of cervical nodal metastases of head and neck cancer compared with CT/MRI and clinical palpation. Forty patients of head and neck cancer underwent PET and CT/MRI examination 2 weeks before surgery. PET, CT/MRI and clinical palpation were interpreted separately to assess regional lymph node status. Histopathologic analysis was used as the gold standard for assessment of the lymph node involvement. Differences in sensitivity, specificity and accuracy among the imaging modalities and clinical palpation were analyzed. The sensitivity of PET for the identification of nodal metastases was 14.3% higher than that of CT/MRI (P = 0.648) and 14.3% higher than that of clinical palpation (P = 0.648), whereas the specificity of PET was 15.4% higher than that of CT/MRI (P = 0.188) and 7.7% higher than that of clinical palpation (P = 0.482). The accuracy of 18F-FDG PET, CT/MRI, and clinical palpation for the identification of cervical nodal metastases was 85.0%, 70.0% and 75.0% respectively. The sensitivity, specificity and accuracy of PET for the detection of cervical nodal metastases was higher than that of CT/MRI and clinical palpation. Although the results did not show a statistically significant difference, PET can still serve as a supplementary method for the identification of nodal metastases of head and neck cancer.

  13. A randomized clinical trial comparing general exercise, McKenzie treatment and a control group in patients with neck pain.

    PubMed

    Kjellman, Görel; Oberg, Birgitta

    2002-07-01

    Seventy-seven patients with neck pain in the primary health care were included in a prospective, randomized clinical trial and randomly assigned to general exercise, McKenzie treatment, or a control group. Seventy patients completed the treatment; response rate 93% at 12-month follow-up. All three groups showed significant improvement regarding the main outcomes, pain intensity and Neck Disability Index, even at 12-month follow-up, but there was no significant difference between the groups. In all, 79% reported that they were better or completely restored after treatment, although 51% reported constant/daily pain. In the McKenzie group compared with the control group, a tendency toward greater improvement was noted for pain intensity at 3 weeks and at 6-month follow-up, and for post-treatment Neck Disability Index. Significant improvement in Distress and Risk Assessment Method scores was shown in the McKenzie group only. The three groups had similar recurrence rates, although after 12 months the McKenzie group showed a tendency toward fewer visits for additional health care. The study did not provide a definite evidence of treatment efficacy in patients with neck pain, however, there was a tendency toward a better outcome with the two active alternatives compared with the control group.

  14. Enhanced patient reported outcome measurement suitable for head and neck cancer follow-up clinics.

    PubMed

    Ghazali, Naseem; Lowe, Derek; Rogers, Simon N

    2012-06-13

    The 'Worse-Stable-Better' (W-S-B) question was introduced to capture patient-perceived change in University of Washington Quality of Life (UW-QOL) domains. 202 head and neck cancer patients in remission prospectively completed UW-QOL and Patients Concerns Inventory (PCI). For each UW-QOL domain, patients indicated whether over the last month things had worsened (W), remained stable (S) or were better (B). 202 patients at 448 attendances selected 1752 PCI items they wanted to discuss in consultation, and 58% (1024/1752) of these were not covered by the UW-QOL. UW-QOL algorithms highlighted another 440 significant problems that the patient did not want to discuss (i.e. the corresponding items on the PCI were not selected).After making allowance for UW-QOL algorithms to identify 'significant problems' and PCI selection of corresponding issues for discussion there remained clear residual and notable variation in W-S-B responses, in particular to identify patients with significant problems that were getting worse, and patients without significant problems that wanted to discuss issues that were getting worse. Changes in mean UW-QOL scores were notably lower for those getting worse on the W-S-B question, typically by 10 or more units a magnitude that suggests clinically important changes in score. The W-S-B question adds little questionnaire burden and could help to better identify patients who might benefit from intervention. The results of this study suggest that the UW-QOL with the W-S-B modification should be used together with the PCI to allow optimal identification of issues for patient-clinician discussion during routine outpatient clinics.

  15. Enhanced patient reported outcome measurement suitable for head and neck cancer follow-up clinics

    PubMed Central

    2012-01-01

    Background The ‘Worse-Stable-Better’ (W-S-B) question was introduced to capture patient-perceived change in University of Washington Quality of Life (UW-QOL) domains. Methods 202 head and neck cancer patients in remission prospectively completed UW-QOL and Patients Concerns Inventory (PCI). For each UW-QOL domain, patients indicated whether over the last month things had worsened (W), remained stable (S) or were better (B). Results 202 patients at 448 attendances selected 1752 PCI items they wanted to discuss in consultation, and 58% (1024/1752) of these were not covered by the UW-QOL. UW-QOL algorithms highlighted another 440 significant problems that the patient did not want to discuss (i.e. the corresponding items on the PCI were not selected). After making allowance for UW-QOL algorithms to identify 'significant problems' and PCI selection of corresponding issues for discussion there remained clear residual and notable variation in W-S-B responses, in particular to identify patients with significant problems that were getting worse, and patients without significant problems that wanted to discuss issues that were getting worse. Changes in mean UW-QOL scores were notably lower for those getting worse on the W-S-B question, typically by 10 or more units a magnitude that suggests clinically important changes in score. Conclusions The W-S-B question adds little questionnaire burden and could help to better identify patients who might benefit from intervention. The results of this study suggest that the UW-QOL with the W-S-B modification should be used together with the PCI to allow optimal identification of issues for patient-clinician discussion during routine outpatient clinics. PMID:22695251

  16. Risk factors for central neck lymph node metastasis of clinically noninvasive, node-negative papillary thyroid microcarcinoma.

    PubMed

    Park, Joon Pyo; Roh, Jong-Lyel; Lee, Jeong Hyun; Baek, Jung Hwan; Gong, Gyungyub; Cho, Kyung-Ja; Choi, Seung-Ho; Nam, Soon Yuhl; Kim, Sang Yoon

    2014-09-01

    To examine predictive factors for subclinical central neck lymph node metastases (LNM) of papillary thyroid microcarcinoma (PTMC). The clinical and pathological findings of 287 patients with clinically noninvasive, node-negative, solitary papillary thyroid carcinoma (PTC), who had undergone thyroidectomy plus central compartment neck dissection and showed pathologically confirmed nodal metastases, were analyzed. Predictive risk factors for central LNM were quantified. Pathologic LNM was identified in 63 (32.6%) PTMC patients and 48 (51.0%) PTC patients (tumor size >1 cm; P = .003). Tumor size (>.7 cm; P = .011), multifocality (P = .010), and microscopic extracapsular extension (P = .050) were significant variables predictive of central LNM from PTMC in univariate analysis. Tumor size (odds ratio 2.28, 95% confidence interval 1.19 to 4.38; P = .014) and multifocality (odds ratio 2.38, 95% confidence interval 1.14 to 4.93; P = .020) were independent variables predictive of central LNM in multivariate analysis. Cervical LNM is highly prevalent in clinically noninvasive, node-negative PTC. Central neck LNM is associated with larger tumor size and multifocality of PTMC. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Analysis of clinically relevant somatic mutations in high-risk head and neck cutaneous squamous cell carcinoma.

    PubMed

    Zilberg, Catherine; Lee, Matthew Weicai; Yu, Bing; Ashford, Bruce; Kraitsek, Spiridoula; Ranson, Marie; Shannon, Kerwin; Cowley, Mark; Iyer, N Gopalakrishna; Palme, Carsten E; Ch'ng, Sydney; Low, Tsu-Hui Hubert; O'Toole, Sandra; Clark, Jonathan R; Gupta, Ruta

    2017-10-06

    Cutaneous squamous cell carcinoma is the second most prevalent malignancy, most frequently occurring in the head and neck (head and neck cutaneous squamous cell carcinoma). Treatment of locally advanced or metastatic disease is associated with functional morbidity and disfigurement. Underlying genetic mechanisms are poorly understood. Targeted sequencing of 48 clinically relevant genes was performed on DNA extracted from formalin-fixed and paraffin-embedded high-risk primary head and neck cutaneous squamous cell carcinomas that remained non-metastatic at minimum follow-up of 24 months. Associations of somatic mutations with clinicopathologic characteristics were evaluated and compared with those described in the literature for metastatic disease. Alterations in 44 cancer-associated genes were identified. TP53 was mutated in 100% of cases; APC, ATM, ERBB4, GNAQ, KIT, RB1 and ABL1 were altered in 60% of cases. FGFR2 mutations (40%) were exclusively seen in patients with perineural invasion. MLH1 mutations were exclusively seen in the two younger patients (<45 years). Lower incidences of NOTCH1 mutations were observed compared with that described in metastatic head and neck cutaneous squamous cell carcinoma in the literature. Somatic mutations susceptible to EGFR inhibitors, and other small molecular targeted therapeutics were seen in 60% of cases. This study provides insights into somatic mutations in non-metastatic, high-risk head and neck cutaneous squamous cell carcinoma and identifies potential therapeutic targets. Alterations in FGFR2 and NOTCH1 may have roles in local and distant disease progression.Modern Pathology advance online publication, 6 October 2017; doi:10.1038/modpathol.2017.128.

  18. The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline.

    PubMed

    Bussières, André E; Stewart, Gregory; Al-Zoubi, Fadi; Decina, Philip; Descarreaux, Martin; Hayden, Jill; Hendrickson, Brenda; Hincapié, Cesar; Pagé, Isabelle; Passmore, Steven; Srbely, John; Stupar, Maja; Weisberg, Joel; Ornelas, Joseph

    2016-10-01

    The objective was to develop a clinical practice guideline on the management of neck pain-associated disorders (NADs) and whiplash-associated disorders (WADs). This guideline replaces 2 prior chiropractic guidelines on NADs and WADs. Pertinent systematic reviews on 6 topic areas (education, multimodal care, exercise, work disability, manual therapy, passive modalities) were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and data extracted from admissible randomized controlled trials. We incorporated risk of bias scores in the Grading of Recommendations Assessment, Development, and Evaluation. Evidence profiles were used to summarize judgments of the evidence quality, detail relative and absolute effects, and link recommendations to the supporting evidence. The guideline panel considered the balance of desirable and undesirable consequences. Consensus was achieved using a modified Delphi. The guideline was peer reviewed by a 10-member multidisciplinary (medical and chiropractic) external committee. For recent-onset (0-3 months) neck pain, we suggest offering multimodal care; manipulation or mobilization; range-of-motion home exercise, or multimodal manual therapy (for grades I-II NAD); supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD). For persistent (>3 months) neck pain, we suggest offering multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner's advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For workers with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD). A multimodal approach including manual therapy, self-management advice, and exercise is an

  19. Neck pain

    PubMed Central

    2008-01-01

    Introduction Non-specific neck pain has a postural or mechanical basis and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but may become chronic in about 10% of people. Whiplash injuries follow sudden acceleration–deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident, although this varies between countries. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for people with non-specific neck pain without severe neurological deficit? What are the effects of treatments for acute whiplash injury? What are the effects of treatments for chronic whiplash injury? What are the effects of treatments for neck pain with radiculopathy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 91 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of the evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, biofeedback, drug treatments (analgesics, antidepressants, epidural steroid injections, muscle relaxants, non-steroidal anti-inflammatory drugs [NSAIDs]), early mobilisation, early return to normal activity, exercise, heat or cold, manipulation (alone or plus exercise), mobilisation, multimodal treatment, patient education, percutaneous radiofrequency neurotomy

  20. Supraclavicular artery perforator flap in management of post-burn neck reconstruction: clinical experience

    PubMed Central

    Ismail, H.; Elshobaky, A.

    2016-01-01

    Summary Anterior cervical contractures of the neck represent a great challenge for plastic and reconstructive surgeons. Necks can be reconstructed with a wide range of surgical techniques, including chimeric flaps, supercharged flap, pre-expanded flaps, “superthin” flaps and perforator flaps. The supraclavicular flap is easy to harvest without the need for free tissue transfer. It provides a relatively large flap for neck resurfacing with tissue very similar to that of the neck. Between January 2013 and March 2015, 20 patients suffering from postburn neck contracture underwent reconstruction with 20 unilateral supraclavicular artery perforator flaps. Nineteen patients had post-burn neck contractures (9 cases type Іc, 10 cases type Пc) while only one had post-burn granulation tissue in the neck. We harvested fifteen flaps from the right side and five from the left. Size of the reconstructed defect ranged from 23x10 to14x6, and flap size varied from 25/11 to 16/7cm. Period of follow up ranged from 27-2months (average 12.3). Nineteen flaps survived well (95% survival rate): only one was lost due to iatrogenic extensive dissection over the pedicle. Five cases showed distal superficial epidermolysis, and 2 cases showed 2 cm complete distal necrosis. All patients were managed conservatively. Our results coincide with other literature results confirming the efficacy and rich vascularity of this flap. In all cases with distal partial necrosis, flaps were 23 cm or more. We recommend that supraclavicular flaps of more than 22 cm in length are not harvested immediately and that flaps are expanded before harvesting. Expanding the supraclavicular flap increases its surface area and decreases donor site morbidity. PMID:28149252

  1. Supraclavicular artery perforator flap in management of post-burn neck reconstruction: clinical experience.

    PubMed

    Ismail, H; Elshobaky, A

    2016-09-30

    Anterior cervical contractures of the neck represent a great challenge for plastic and reconstructive surgeons. Necks can be reconstructed with a wide range of surgical techniques, including chimeric flaps, supercharged flap, pre-expanded flaps, "superthin" flaps and perforator flaps. The supraclavicular flap is easy to harvest without the need for free tissue transfer. It provides a relatively large flap for neck resurfacing with tissue very similar to that of the neck. Between January 2013 and March 2015, 20 patients suffering from postburn neck contracture underwent reconstruction with 20 unilateral supraclavicular artery perforator flaps. Nineteen patients had post-burn neck contractures (9 cases type Іc, 10 cases type Пc) while only one had post-burn granulation tissue in the neck. We harvested fifteen flaps from the right side and five from the left. Size of the reconstructed defect ranged from 23x10 to14x6, and flap size varied from 25/11 to 16/7cm. Period of follow up ranged from 27-2months (average 12.3). Nineteen flaps survived well (95% survival rate): only one was lost due to iatrogenic extensive dissection over the pedicle. Five cases showed distal superficial epidermolysis, and 2 cases showed 2 cm complete distal necrosis. All patients were managed conservatively. Our results coincide with other literature results confirming the efficacy and rich vascularity of this flap. In all cases with distal partial necrosis, flaps were 23 cm or more. We recommend that supraclavicular flaps of more than 22 cm in length are not harvested immediately and that flaps are expanded before harvesting. Expanding the supraclavicular flap increases its surface area and decreases donor site morbidity.

  2. Clinical features and outcomes of neck lymphatic metastasis in ovarian epithelial carcinoma

    PubMed Central

    2013-01-01

    Background Neck lymph node metastasis (NLNM) in epithelial ovarian cancer (EOC) is rare and treated as advanced stage cancer. However, ovarian cancer with lymphatic metastasis may manifest a different clinical course from peritoneal carcinomatosis. Methods The authors retrospectively assessed 20 patients with EOC and pathologically diagnosed as NLNM between January 2001 and December 2010. The patients were divided into two groups according to the time of NLNM identification. Statistical methods included Kaplan-Meier, log-rank, and Cox regression analysis. Results Eleven patients were diagnosed with NLNM at the same time of surgical exploration of EOC (Group A) and nine patients at cancer recurrence 43.3 months after initial surgery (Group B). In Group A, patients with tumors confined to the pelvic cavity had no recurrence or had isolated lymph node recurrence (ILNR), and survived longer than patients with abdominal tumor spreading (P = 0.0007). In Group B, 2 patients showed ILNR. The median survival time after NLNM was 42 months in Group A and 6 months in Group B (P = 0.01). Cox model demonstrated that non-serous histology, brain metastasis, and NLNM identified at cancer recurrence were major predictors for poor overall survival (Hazard ratio [HR] = 18.67, 6.93, and 4.52; P = 0.01, 0.02, and 0.04, respectively). Conclusions A subgroup of EOC patients with NLNM who presented limited pelvic cancer had much better overall survival than patients who had cancer spreading beyond the pelvic cavity or were diagnosed with NLNM at cancer recurrence. PMID:24088247

  3. Patient reported outcomes in head and neck cancer: selecting instruments for quality of life integration in clinical protocols

    PubMed Central

    2010-01-01

    Background Health Related Quality of Life has been used in medical research for more than twenty years, being progressively accepted during the last decade as an important patient reported outcome. Considering the multidimensional approach involved in Health Related Quality of Life assessment, instrument applicability and cultural adaptation must be tested for each population. In order to select the most appropriate instrument for Head and Neck cancer patients, two major Health Related Quality of Life specific questionnaires for Head and Neck cancer patients were compared. Conceptual differences, psychometric characteristics, scores, reliability, construct validity and sensitivity to symptomatology, tumour location, tumour size were analyzed. Methods 102 consecutive Head and Neck cancer patients completed two different Health Related Quality of Life questionnaires: EORTC QLQ-C30 and its specific head and neck module QLQ-H&N35 and the Functional Assessment of Cancer Therapy Scales (FACT-H&N). Patients completed the questionnaires, immediately before consultation as a part of the routine evaluation. Results A greater variability was always found in the EORTC QLC-C30 questionnaire's scores for all comparable domains. Both instruments revealed a good internal consistency and demonstrated to be good tools to distinguish symptomatic patients. The EORTC questionnaires still demonstrated sensitivity to distinguish T3 and T4 staging. Conceptual differences and the psychometric characteristics are discussed. Our results suggest that these two instruments assess different aspects of Health Related Quality of Life - the questionnaires should be used separately and chosen according to the study objectives and methodology. Conclusions This study emphases the importance in selecting the appropriate tool as a critical success factor in implementing routine Health Related Quality of Life assessment in clinical practice. This decision assumes particularly importance when utilization

  4. Prophylactic dissection of level V in primary mucosal SCC in the clinically N positive neck: A systematic review.

    PubMed

    McLean, Timothy; Kerr, Stephen J; Giddings, Charles E B

    2017-09-01

    To review the evidence for level V dissection in the management of previously untreated mucosal squamous cell carcinoma (SCC) of the head and neck presenting with nodal metastasis when level V is clinically uninvolved. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) were used to conduct a systematic review of the current literature, including all English language articles published after 1990. A literature search was performed on November 29, 2015, of Medline, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library. The search yielded a total of 270 papers. Strict inclusion and exclusion criteria were applied, leaving 20 eligible papers. Overall prevalence was calculated using random effect meta-analysis. The overall prevalence of level V occult disease in the node (N)-positive neck, irrespective of subsite, was 2.56% (95% confidence interval 1.29-3.84) (2,368 patients and 2,533 necks). The prevalence of occult level V metastasis was up to 7.7% for oral cavity and 8.3% for oropharyngeal tumors. Five studies reported regional recurrence rates over variable time periods. There is exceedingly limited data on outcomes, such as spinal accessory nerve function, quality of life, and perioperative complications. Mucosal head and neck SCC presenting with nodal metastasis but with level V clinically uninvolved has a low prevalence of occult level V disease. Routine dissection of level V does not appear to be warranted; however, a definitive conclusion is unable to be drawn due to limited data on morbidity and oncological outcomes. Laryngoscope, 127:2074-2080, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  5. Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash

    PubMed Central

    Anderson-Peacock, Elizabeth; Blouin, Jean-Sébastien; Bryans, Roland; Danis, Normand; Furlan, Andrea; Marcoux, Henri; Potter, Brock; Ruegg, Rick; Gross Stein, Janice; White, Eleanor

    2005-01-01

    OBJECTIVE To provide an evidence-based clinical practice guideline for the chiropractic cervical treatment of adults with acute or chronic neck pain not due to whiplash. This is a considerable health concern considered to be a priority by stakeholders, and about which the scientific information was poorly organized. OPTIONS Cervical treatments: manipulation, mobilization, ischemic pressure, clinic- and home-based exercise, traction, education, low-power laser, massage, transcutaneous electrical nerve stimulation, pillows, pulsed electromagnetic therapy, and ultrasound. OUTCOMES The primary outcomes considered were improved (reduced and less intrusive) pain and improved (increased and easier) ranges of motion (ROM) of the adult cervical spine. EVIDENCE An “extraction” team recorded evidence from articles found by literature search teams using 4 separate literature searches, and rated it using a Table adapted from the Oxford Centre for Evidence-based Medicine. The searches were 1) Treatment; August, 2003, using MEDLINE, CINAHL, AMED, MANTIS, ICL, The Cochrane Library (includes CENTRAL), and EBSCO, identified 182 articles. 2) Risk management (adverse events); October, 2004, identified 230 articles and 2 texts. 3) Risk management (dissection); September, 2003, identified 79 articles. 4) Treatment update; a repeat of the treatment search for articles published between September, 2003 and November, 2004 inclusive identified 121 articles. VALUES To enable the search of the literature, the authors (Guidelines Development Committee [GDC]) regarded chiropractic treatment as including elements of “conservative” care in the search strategies, but not in the consideration of the range of chiropractic practice. Also, knowledge based only on clinical experience was considered less valid and reliable than good-caliber evidence, but where the caliber of the relevant evidence was low or it was non-existent, unpublished clinical experience was considered to be equivalent to

  6. Interleaving cerebral CT perfusion with neck CT angiography. Part II: clinical implementation and image quality.

    PubMed

    Oei, Marcel T H; Meijer, Frederick J A; van der Woude, Willem-Jan; Smit, Ewoud J; van Ginneken, Bram; Manniesing, Rashindra; Prokop, Mathias

    2017-06-01

    Feasibility evaluation of the One-Step Stroke Protocol, which is an interleaved cerebral computed tomography perfusion (CTP) and neck volumetric computed tomography angiography (vCTA) scanning technique using wide-detector computed tomography, and to assess the image quality of vCTA. Twenty patients with suspicion of acute ischaemic stroke were prospectively scanned and evaluated with a head and neck CTA and with the One-Step Stroke Protocol. Arterial enhancement and contrast-to-noise ratio (CNR) in the carotid arteries was assessed. Three observers scored artefacts and image quality of the cervical arteries. The total z-coverage was evaluated. Mean enhancement in the carotid bifurcation was rated higher in the vCTA (595 ± 164 HU) than CTA (441 ± 117 HU). CNR was rated higher in vCTA. Image quality scores showed no significant difference in the region of the carotid bifurcation between vCTA and CTA. Lower neck image quality scores were slightly lower for vCTA due to artefacts, although not rated as diagnostically relevant. In ten patients, the origin of the left common carotid artery was missed by 1.6 ± 0.8 cm. Mean patient height was 1.8 ± 0.09 m. Carotid bifurcation and origin of vertebral arteries were covered in all patients. The One-Step Stroke Protocol is feasible with good diagnostic image quality of vCTA, although full z-coverage is limited in tall patients. • Interleaving cerebral CTP with neck CTA (One-Step Stroke Protocol) is feasible • Diagnostic quality of One-Step Stroke Protocol neck CTA is similar to conventional CTA • One-Step Stroke Protocol neck CTA suffers from streak artefacts in the lower neck • A limitation of One-Step Stroke Protocol CTA is lack of coverage in tall patients • Precise planning of One-Step Stroke Protocol neck CTA is necessary in tall patients.

  7. Cost-effectiveness analysis of a postoperative clinical care pathway in head and neck surgery with microvascular reconstruction

    PubMed Central

    2013-01-01

    Background The objective of this study is to evaluate the cost-effectiveness of a postoperative clinical care pathway for patients undergoing major head and neck oncologic surgery with microvascular reconstruction. Methods This is a comparative trial of a prospective treatment group managed on a postoperative clinical care pathway and a historical group managed prior to pathway implementation. Effectiveness outcomes evaluated were total hospital days, return to OR, readmission to ICU and rate of pulmonary complications. Costing perspective was from the government payer. Results 118 patients were included in the study. All outcomes demonstrated that the postoperative pathway group was both more effective and less costly, and is therefore a dominant clinical intervention. The overall mean pre- and post-pathway costs are $22,733 and $16,564 per patient, respectively. The incremental cost reduction associated with the postoperative pathway was $6,169 per patient. Conclusion Implementing the postoperative clinical care pathway in patients undergoing head and neck oncologic surgery with reconstruction resulted in improved clinical outcomes and reduced costs. PMID:24351020

  8. Adaptive Planning in Intensity-Modulated Radiation Therapy for Head and Neck Cancers: Single-Institution Experience and Clinical Implications

    SciTech Connect

    Ahn, Peter H.; Chen, Chin-Cheng; Ahn, Andrew I.; Hong, Linda; Scripes, Paola G.; Shen Jin; Lee, Chen-Chiao; Miller, Ekeni; Kalnicki, Shalom; Garg, Madhur K.

    2011-07-01

    Purpose: Anatomic changes and positional variability during intensity-modulated radiation therapy (IMRT) for head and neck cancer can lead to clinically significant dosimetric changes. We report our single-institution experience using an adaptive protocol and correlate these changes with anatomic and positional changes during treatment. Methods and Materials: Twenty-three sequential head and neck IMRT patients underwent serial computed tomography (CT) scans during their radiation course. After undergoing the planning CT scan, patients underwent planned rescans at 11, 22, and 33 fractions; a total of 89 scans with 129 unique CT plan combinations were thus analyzed. Positional variability and anatomic changes during treatment were correlated with changes in dosimetric parameters to target and avoidance structures between planning CT and subsequent scans. Results: A total of 15/23 patients (65%) benefited from adaptive planning, either due to inadequate dose to gross disease or to increased dose to organs at risk. Significant differences in primary and nodal targets (planning target volume, gross tumor volume, and clinical tumor volume), parotid, and spinal cord dosimetric parameters were noted throughout the treatment. Correlations were established between these dosimetric changes and weight loss, fraction number, multiple skin separations, and change in position of the skull, mandible, and cervical spine. Conclusions: Variations in patient positioning and anatomy changes during IMRT for head and neck cancer can affect dosimetric parameters and have wide-ranging clinical implications. The interplay between random positional variability and gradual anatomic changes requires careful clinical monitoring and frequent use of CT- based image-guided radiation therapy, which should determine variations necessitating new plans.

  9. The clinical examination of neck pain patients: the validity of a group of tests.

    PubMed

    De Hertogh, Willem J; Vaes, Peter H; Vijverman, Veerle; De Cordt, Ann; Duquet, William

    2007-02-01

    We evaluated whether a blinded observer could identify the neck pain patients in a sample of 42 subjects consisting of neck pain patients and asymptomatic controls.The allocation of subjects to either the control or patient group was based on the scoring of a VAS scale for pain intensity, a Bournemouth Questionnaire (BQ), a manual examination of the rotation of C0-2-7 (rated for Range Of Motion, end feel, onset of pain), an adapted Spurling test and Cervical Range Of Motion (CROM) measurements.The VAS and BQ resulted in a high % of correct allocations (>/= 77.5%) and a high specificity (90.9%). The Manual Examination Procedures (MEPs) have similar results especially when clustered. The combination of the VAS score, BQ and MEPs resulted in a sensitivity and specificity of 100% and 86.4%, respectively. Except for the flexion movement all CROM allocation percentages are around 50%, indicating a lesser diagnostic value.Our findings reinforce the validity of MEPs. Clustering pain measurements, BQ and MEPs provides the highest diagnostic value to identify neck pain patients or necks in need of treatment. 2006 Elsevier Ltd.

  10. A Retrospective Evaluation of Clinical Profile of Second Primary Head and Neck Cancer

    PubMed Central

    Bansal, Nupur; Kumar, J Vijaya; Khurana, Anil; Chauhan, Ashok

    2016-01-01

    Introduction Incidence of Second Primary Malignancy (SPM) after successful treatment of primary is increasing and may cause the problem for optimal treatment. Aim This study was conducted retrospectively to analyse incidence, disease free survival between malignancies, pattern of treatment and outcome. Materials and Methods Sixteen out of 22 patients of previously treated cases of head and neck cancer those develop SPM of head and neck region managed over a period of January 2012 to December 2015 in Department of Radiotherapy–II, Pt. BD Sharma PGIMS, Rohtak were analyzed retrospectively. Sixteen patients with unresectable disease were given reirradiation with external beam radiotherapy. Results Median age of presentation of first malignancy was 27 years (Ranged 26 -65 years), whereas median age was 60 years for second malignancy (range 45-71 years). All patients were smokers during first malignancy; 87.5% (14/16) had historyof smoking during second malignancy. Oropharynx (50%) was most common site of presentation of primary tumor whereas oral cavity was most common site of presentation in second primary tumor. Conclusion Incidence of Second primary head and neck tumor after successful treatment for primary Head and neck cancer are increasing due to newer treatment strategies, longer survival and follow up. Reirradiation, surgery and or chemotherapy are treatment modalities. However second primary tumor of this region are associated with poor prognosis. PMID:27891442

  11. Neck Pain

    MedlinePlus

    ... problems, most commonly with the structures of the cervical spine (neck). Only in rare instances is neck pain ... the neck. Pain can be localized to the cervical spine or may travel down an arm (radiculopathy). All ...

  12. Neck dissection

    MedlinePlus

    ... There are three main types of neck dissection surgery: Radical neck dissection: All the tissue on the side of ... Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap ...

  13. 'Fiddler's neck'.

    PubMed

    Peachey, R D; Matthews, C N

    1978-06-01

    'Fiddler's neck' is a condition affecting violin and viola players. Although well known to musicians it is not well recognized by dermatologists. Clinically the lesions usually consist of a localized area of lichenification of the left side of the neck--just below the angle of the jaw. Pigmentation, erythema and inflammatory papules or pustules are frequently present, while severe inflammatory induration, cyst formation and scarring occur in more severely affected subjects. The aetiology of the skin changes is probably due to a combination of factors; friction giving rise to lichenification, while local pressure, shearing stress and occlusion may play a part in producing the acne-like changes and cyst formation. In addition, poor hygiene may predispose to local sepsis.

  14. Identification of a High-Risk Group Among Patients With Oral Cavity Squamous Cell Carcinoma and pT1-2N0 Disease

    SciTech Connect

    Liao, Chun-Ta; Lin, Chien-Yu; Fan, Kang-Hsing; Wang, Hung-Ming; Ng, Shu-Hang; Lee, Li-Yu; Hsueh, Chuen; Chen, I-How; Huang, Shiang-Fu; Kang, Chung-Jan; and others

    2012-01-01

    Purpose: In the American Joint Committee on Cancer 2010 classification system, pT1-2N0 oral cavity squamous cell carcinoma (OSCC) is considered an early-stage cancer treatable with surgery alone (National Comprehensive Cancer Network 2010 guidelines). Our aim was to evaluate the feasibility of surgery alone for pT1-2N0 OSCC patients. Methods and Materials: Among 1279 previously untreated OSCC patients referred to our hospital between January 1996 and May 2008, we identified 457 consecutive patients with pT1-2N0 disease. All had radical tumor excision with neck dissection. A total of 387 patients showing pathologic margins greater than 4 mm and treated by surgery alone were included in the final analysis. All were followed up for at least 24 months after surgery or until death. The 5-year rates of control, distant metastasis, and survival were the main outcome measures. Results: The 5-year rates in the entire group of pT1-2N0 patients were as follows: local control, 91%; neck control, 92%; distant metastases, 1%; disease-free survival, 85%; disease-specific survival, 93%; and overall survival, 84%. Multivariate analysis identified poor differentiation and pathologic tumor depth of 4 mm or greater as independent risk factors for neck control, disease-free survival, and disease-specific survival. A scoring system using poor differentiation and tumor depth was formulated to define distinct prognostic groups. The presence of both poorly differentiated tumors and a tumor depth of 4 mm or greater resulted in significantly poorer 5-year neck control (p < 0.0001), disease-free (p < 0.0001), disease-specific (p < 0.0001), and overall survival (p = 0.0046) rates. Conclusion: The combination of poor differentiation and pathologic tumor depth of 4 mm or greater identified a subset of pT1-2N0 OSCC patients with poor outcome, who may have clinical benefit from postoperative adjuvant radiotherapy.

  15. Cervical kinematic training with and without interactive VR training for chronic neck pain - a randomized clinical trial.

    PubMed

    Sarig Bahat, Hilla; Takasaki, Hiroshi; Chen, Xiaoqi; Bet-Or, Yaheli; Treleaven, Julia

    2015-02-01

    Impairments in cervical kinematics are common in patients with neck pain. A virtual reality (VR) device has potential to be effective in the management of these impairments. The objective of this study was to investigate the effect of kinematic training (KT) with and without the use of an interactive VR device. In this assessor-blinded, allocation-concealed pilot clinical trial, 32 participants with chronic neck pain were randomised into the KT or kinematic plus VR training (KTVR) group. Both groups completed four to six training sessions comprising of similar KT activities such as active and quick head movements and fine head movement control and stability over five weeks. Only the KTVR group used the VR device. The primary outcome measures were neck disability index (NDI), cervical range of motion (ROM), head movement velocity and accuracy. Kinematic measures were collected using the VR system that was also used for training. Secondary measures included pain intensity, TAMPA scale of kinesiophobia, static and dynamic balance, global perceived effect and participant satisfaction. The results demonstrated significant (p < 0.05) improvements in NDI, ROM (rotation), velocity, and the step test in both groups post-intervention. At 3-month post-intervention, these improvements were mostly sustained; however there was no control group, which limits the interpretation of this. Between-group analysis showed a few specific differences including global perceived change that was greater in the KTVR group. This pilot study has provided directions and justification for future research exploring training using kinematic training and VR for those with neck pain in a larger cohort.

  16. Effects of nutritional intervention in head and neck cancer patients undergoing radiotherapy: A prospective randomized clinical trial.

    PubMed

    Kang, Wen-Xing; Li, Wentao; Huang, Shi-Gao; Dang, Yazhang; Gao, Hongxiang

    2016-09-01

    Head and neck malignant tumors have numerous locations of the disease. After patients receive radiotherapy, their nutritional status is very poor, thus the curative effect is unsatisfactory. The aims of the present study were to investigate and analyze the nutritional status of patients with head and neck cancer undergoing radiotherapy (RT) in order to provide positive nutrition intervention for assisting the radiotherapy effect. A total of 40 patients with head and neck cancer were selected using a method of subjective global assessment (SGA) to assess nutritional status, including calorie intake and energy expenditure. In a randomized, controlled study, 20 patients received intensive dietary counseling and nutritional therapy (G1) and 20 received regular dietary as controls (G0) preradiotherapy and postradiotherapy. The primary endpoint was calorie intake and energy expenditure. The secondary endpoint was SGA rating with nutritional therapy. At the end of RT, energy intake showed a net increase in G1 (1,691±301 kcal) compared with that in G0 (1,066±312 kcal) (P<0.05); energy expenditure increased in G1 (1,673±279 kcal) compared with G0 (1,490±298 kcal) (P<0.05). The prevalence of severe malnutrition following radiotherapy was significantly different between the two study groups (10 patients in G0 and 4 patients in G1; P<0.05). The number of the normal malnutrition patients postRT in G0 decreased from 4 to 2 and conversely, in G1 it increased from 3 to 6 (P<0.05). In conclusion, patients with head and neck cancer were most malnutritioned, which impacted on clinical outcome. Timely nutritional intervention can effectively prevent weight loss and muscle wasting. Additionally, it may improve quality of life by decreasing the frequency of severe malnutrition.

  17. Effects of nutritional intervention in head and neck cancer patients undergoing radiotherapy: A prospective randomized clinical trial

    PubMed Central

    Kang, Wen-Xing; Li, Wentao; Huang, Shi-Gao; Dang, Yazhang; Gao, Hongxiang

    2016-01-01

    Head and neck malignant tumors have numerous locations of the disease. After patients receive radiotherapy, their nutritional status is very poor, thus the curative effect is unsatisfactory. The aims of the present study were to investigate and analyze the nutritional status of patients with head and neck cancer undergoing radiotherapy (RT) in order to provide positive nutrition intervention for assisting the radiotherapy effect. A total of 40 patients with head and neck cancer were selected using a method of subjective global assessment (SGA) to assess nutritional status, including calorie intake and energy expenditure. In a randomized, controlled study, 20 patients received intensive dietary counseling and nutritional therapy (G1) and 20 received regular dietary as controls (G0) preradiotherapy and postradiotherapy. The primary endpoint was calorie intake and energy expenditure. The secondary endpoint was SGA rating with nutritional therapy. At the end of RT, energy intake showed a net increase in G1 (1,691±301 kcal) compared with that in G0 (1,066±312 kcal) (P<0.05); energy expenditure increased in G1 (1,673±279 kcal) compared with G0 (1,490±298 kcal) (P<0.05). The prevalence of severe malnutrition following radiotherapy was significantly different between the two study groups (10 patients in G0 and 4 patients in G1; P<0.05). The number of the normal malnutrition patients postRT in G0 decreased from 4 to 2 and conversely, in G1 it increased from 3 to 6 (P<0.05). In conclusion, patients with head and neck cancer were most malnutritioned, which impacted on clinical outcome. Timely nutritional intervention can effectively prevent weight loss and muscle wasting. Additionally, it may improve quality of life by decreasing the frequency of severe malnutrition. PMID:27588193

  18. Randomized clinical trial assessing whether additional massage treatments for chronic neck pain improve 12- and 26-week outcomes.

    PubMed

    Cook, Andrea J; Wellman, Robert D; Cherkin, Daniel C; Kahn, Janet R; Sherman, Karen J

    2015-10-01

    This is the first study to systematically evaluate the value of a longer treatment period for massage. We provide a framework of how to conceptualize an optimal dose in this challenging setting of nonpharmacologic treatments. The aim was to determine the optimal dose of massage for neck pain. Two-phase randomized trial for persons with chronic nonspecific neck pain. Primary randomization to one of five groups receiving 4 weeks of massage (30 minutes 2x/or 3x/wk or 60 minutes 1x, 2x, or 3x/wk). Booster randomization of participants to receive an additional six massages, 60 minutes 1x/wk, or no additional massage. A total of 179 participants from Group Health and the general population of Seattle, WA, USA recruited between June 2010 and August 2011 were included. Primary outcomes self-reported neck-related dysfunction (Neck Disability Index) and pain (0-10 scale) were assessed at baseline, 12, and 26 weeks. Clinically meaningful improvement was defined as greater than or equal to 5-point decrease in dysfunction and greater than or equal to 30% decrease in pain from baseline. Clinically meaningful improvement for each primary outcome with both follow-up times was analyzed using adjusted modified Poisson generalized estimating equations (GEEs). Secondary analyses for the continuous outcomes used linear GEEs. There were no observed differences by primary treatment group at 12 or 26 weeks. Those receiving booster dose had improvements in both dysfunction and pain at 12 weeks (dysfunction: relative risk [RR]=1.56 [1.08-2.25], p=.018; pain: RR=1.25 [0.98-1.61], p=.077), but those were nonsignificant at 26 weeks (dysfunction: RR=1.22 [0.85-1.74]; pain: RR=1.09 [0.82-1.43]). Subgroup analysis by primary and booster treatments found the booster dose only effective among those initially randomized to one of the 60-minute massage groups. "Booster" doses for those initially receiving 60 minutes of massage should be incorporated into future trials of massage for chronic neck pain

  19. Randomized clinical trial assessing whether additional massage treatments for chronic neck pain improve 12- and 26-week outcomes

    PubMed Central

    Cook, Andrea J.; Wellman, Robert D.; Cherkin, Daniel C.; Kahn, Janet R.; Sherman, Karen J.

    2015-01-01

    Background Context This is the first study to systematically evaluate the value of a longer treatment period for massage. We provide a framework of how to conceptualize an optimal dose in this challenging setting of non-pharmacological treatments. Purpose To determine the optimal dose of massage for neck pain. Study Design/Setting Two-phase randomized trial for persons with chronic non-specific neck pain. Primary randomization to one of 5 groups receiving 4 weeks of massage (30 minutes 2×/ or 3×/week or 60 minutes 1×, 2×, or 3×/week). Booster randomization of participants to receive an additional 6 massages, 60 minute 1×/week, or no additional massage. Patient Sample 179 participants from Group Health and the general population of Seattle, WA USA recruited between June 2010 and August 2011. Outcome Measures Primary outcomes self-reported neck-related dysfunction (Neck Disability Index) and pain (0–10 scale) were assessed at baseline, 12, and 26 weeks. Clinically meaningful improvement was defined as >5 point decrease in dysfunction and > 30% decrease in pain from baseline. Methods Clinically meaningful improvement for each primary outcome with both follow-up times was analyzed using adjusted modified Poisson generalized estimating equations. Secondary analyses for the continuous outcomes used linear generalized estimating equations. This study was funded the National Center for Complementary and Alternative Medicine, NIH, USA (R01 AT004411). The funders had no role in the interpretation or reporting of results. Results There were no observed differences by primary treatment group at 12 or 26 weeks. Those receiving booster dose had improvements in both dysfunction and pain at 12 weeks (dysfunction: RR=1.56(1.08–2.25), P=0.018; pain: RR=1.25(0.98–1.61); P=0.077), but those were non-significant at 26 weeks (dysfunction: RR=1.22(0.85–1.74); pain: RR=1.09(0.82–1.43)). Subgroup analysis by primary and booster treatments found the booster dose only

  20. Venous malformations of the head and neck: a diagnostic approach and a proposed management approach based on clinical, radiological, and histopathology findings.

    PubMed

    Aboelatta, Yasser Abdallah; Nagy, Eman; Shaker, Mohamed; Massoud, Karim Samir

    2014-07-01

    There is no easy road map for venous malformations (VMs) of the head and neck according to which treatment modality can be chosen. The purpose of this study was to identify different types of VMs of the head and neck based on clinical, histopathology, MRI, and venography findings that help in specification of different treatment modalities. Sixty-nine patients with VMs of the head and neck were included in this study. Our results proposed a diagnostic approach for VMs of the head and neck. MRI, venography, and clinical examination had important impact in decision-making, whereas histopathology had no impact. A management approach has been suggested for each type and its subtypes. Copyright © 2013 Wiley Periodicals, Inc.

  1. Efficacy of kinesiology tape versus postural correction exercises on neck disability and axioscapular muscles fatigue in mechanical neck dysfunction: A randomized blinded clinical trial.

    PubMed

    El-Abd, Aliaa M; Ibrahim, Abeer R; El-Hafez, Haytham M

    2017-04-01

    Mechanical neck dysfunction (MND), with axioscapular muscles fatigue, is highly prevalent worldwide. While postural correction is commonly used for its treatment, efficacy of kinesiology tape (KT) has received considerable attention. To determine the effectiveness of KT versus correction exercises on neck disability, and axioscapular muscles fatigue in MND patients. 46 MND patients were randomly assigned into 1 of 2 groups receiving 4 weeks treatment of either KT or correction exercises. Neck disability and axioscapular muscles fatigue as median frequency of electromyography (EMG-MF) were measured pre and post treatment. Group-by-time interaction was not significant in the multivariable test. Post hoc tests revealed that KT produced more disability reduction than the postural exercises. However, there was no significant interaction for EMG-MF. KT has been found to be more effective than postural exercises to reduce neck disability. However, both modalities have similar effects to reduce axioscapular muscles fatigue. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Impact of HPV-related head and neck cancer in clinical trials: opportunity to translate scientific insight into personalized care.

    PubMed

    Chung, Christine H; Schwartz, David L

    2012-08-01

    Patients with human papillomavirus (HPV)-positive squamous cell carcinoma of the oropharynx (SCCOP) enjoy better treatment outcomes than patients suffering from HPV-negative head and neck cancer. To maintain the integrity and utility of future clinical trials, HPV-positive SCCOP must be studied as a distinct entity. The discovery of HPV-positive disease has (1) convoluted comparison of current phase II trial data to historical controls, (2) made formal stratification for HPV infection status an imperative for future phase III trial design, and (3) drawn focus toward opportunities for personalization of treatment intensity. This review discusses these research issues.

  3. Clinical Management of Salivary Gland Hypofunction and Xerostomia in Head-and-Neck Cancer Patients: Successes and Barriers

    SciTech Connect

    Vissink, Arjan; Mitchell, James B.; Baum, Bruce J.; Limesand, Kirsten H.; Jensen, Siri Beier; Fox, Philip C.; Elting, Linda S.; Langendijk, Johannes A.; Coppes, Robert P.; Reyland, Mary E.

    2010-11-15

    The most significant long-term complication of radiotherapy in the head-and-neck region is hyposalivation and its related complaints, particularily xerostomia. This review addresses the pathophysiology underlying irradiation damage to salivary gland tissue, the consequences of radiation injury, and issues contributing to the clinical management of salivary gland hypofunction and xerostomia. These include ways to (1) prevent or minimize radiation injury of salivary gland tissue, (2) manage radiation-induced hyposalivation and xerostomia, and (3) restore the function of salivary gland tissue damaged by radiotherapy.

  4. Clinical management of salivary gland hypofunction and xerostomia in head and neck cancer patients: successes and barriers*

    PubMed Central

    Vissink, Arjan; Mitchell, James B; Baum, Bruce J; Limesand, Kirsten H; Jensen, Siri Beier; Fox, Philip C; Elting, Linda S; Langendijk, Johannes A; Coppes, Robert P; Reyland, Mary E

    2010-01-01

    The most significant long-term complication of radiotherapy in the head and neck region is hyposalivation and its related complaints, particularily xerostomia. This paper addresses the pathophysiology underlying irradiation damage to salivary gland tissue, the consequences of radiation injury, and issues contributing to the clinical management of salivary gland hypofunction and xerostomia. These include ways to: (1) prevent or minimize radiation injury of salivary gland tissue, (2) manage radiation-induced hyposalivation and xerostomia, and (3) restore the function of salivary gland tissue damaged by radiotherapy. PMID:20970030

  5. [Clinical and paraclinical follow-up after radiotherapy for head and neck cancer].

    PubMed

    Clément-Colmou, K; Troussier, I; Bardet, É; Lapeyre, M

    2015-10-01

    Head and neck cancer management often involves heavy multimodal treatments including radiotherapy. Despite the improvement of intensity-modulated radiation therapy, acute and late toxicities remain important. After such treatment, patients have to face different potential problems, depending on the post-therapeutic delay. In this way, short-term follow-up permits to appreciate the healing of acute toxicities and response to treatment. Long-term follow-up aims to recognize second primitive tumours and distant failure, and to detect and manage late toxicities. Medical and psychosocial supportive cares are essential, even after several years of complete remission. The objective of this article is to review the modalities of short-term and long-term follow-up of patients who receive a radiotherapy for head and neck cancer.

  6. Selective neck irradiation for supraglottic cancer: focus on Sublevel IIb omission.

    PubMed

    Kanayama, Naoyuki; Nishiyama, Kinji; Kawaguchi, Yoshifumi; Konishi, Koji; Ogawa, Kazuhiko; Suzuki, Motoyuki; Yoshii, Tadashi; Fujii, Takashi; Yoshino, Kunitoshi; Teshima, Teruki

    2016-01-01

    To estimate selective neck irradiation omitting surgical Sublevel IIb. Bilateral necks of 47 patients (94 necks) were subjected to definitive radiotherapy for supraglottic cancer. Sixty-nine and 25 necks were clinically node negative (cN-) and clinically node positive (cN+), respectively. We subdivided Sublevel IIb by the international consensus guideline for radiotherapy into Sublevel IIb/a, directly posterior to the internal jugular vein, and Sublevel IIb/b, which was behind Sublevel IIb/a and coincided with surgical Sublevel IIb. Bilateral (Sub)levels IIa, III, IV and IIb/a were routinely irradiated, whereas Sublevel IIb/b was omitted from the elective clinical target volume in 73/94 treated necks (78%). Two patients presented with ipsilateral Sublevel IIb/a metastases. No Sublevel IIb/b metastasis was observed. Five patients experienced cervical lymph node recurrence; Sublevel IIb/a recurrence developed in two patients, whereas no Sublevel IIb/b recurrence occurred even in the cN- necks of cN+ patients or cN0 patients. The 5-year regional control rates were 91.5% for Sublevel IIb/b-omitted patients and 77.8% for Sublevel IIb/b treated patients. Selective neck irradiation omitting Sublevel IIb/b did not compromise regional control and could be indicated for cN- neck of supraglottic cancer. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. Invasive head and neck cutaneous squamous cell carcinoma: clinical and histopathological characteristics, frequency of local recurrence and metastasis*

    PubMed Central

    Vasconcelos, Luiza; Melo, Juliana Carneiro; Miot, Hélio Amante; Marques, Mariângela Esther Alencar; Abbade, Luciana Patricia Fernandes

    2014-01-01

    BACKGROUND squamous cell carcinoma is the second most common type of skin malignancy and may evolve to regional lymph node and distant metastases. OBJECTIVE The objective of this study was to evaluate patients with head and neck cutaneous squamous cell carcinoma to identify its clinical and histopathological characteristics, as well as the frequency of local recurrence and metastasis. METHODS A retrospective cohort of patients with head and neck cutaneous squamous cell carcinoma. Inclusion criteria: histopathological confirmation, follow-up for longer than one year after diagnosis. Exclusion criteria: immunosuppression; lip and oral cavity squamous cell carcinoma; and non-surgical resection of the lesion. We evaluated demographic, clinical and anatomopathologic findings and explored their associations. RESULTS Sixty-one patients with 79 tumors and followed by 4.8±3.0 years were selected. The average age was 67.1 years, and 63% of tumors had up to two centimeters. Seven tumors (8.9%) recurred and two of them had positive margins. Recurrence was associated with higher Broders' grade (p<0.01). Two patients (3.3%) had regional lymph node metastases. There were no distant metastases. Seventy tumors were considered to be usual tumors (89.7%), and 68 (87.2%) were classified as Broders' grade 1 and 2. Additionally, 64.1% of tumors had a depth of invasion below four millimeters. Thirteen tumors (16.7%) had positive histological margins. CONCLUSIONS Most patients had good prognosis in the first year of follow-up, confirming that head and neck cutaneous squamous cell carcinoma has a better prognosis than squamous cell carcinoma of other regions such as mucosa, oral cavity, and internal organs. PMID:25054741

  8. Level IIB Neck Dissection in Oral Squamous Cell Carcinoma: Science or Myth?

    PubMed

    Ghantous, Yasmine; Akrish, Sharon; Abd-Elraziq, Morad; El-Naaj, Imad Abu

    2016-06-01

    Selective neck dissection enables us to reduce the morbidity of neck dissection while maintaining the same oncological results, mainly in clinically negative neck N0. The most common morbidity associated with selective neck dissection is spinal accessory nerve dysfunction and related shoulder disability, which are encountered during dissection of level IIB.The aim of authors' study is to evaluate the incidence of sublevel IIB lymphatic metastasis in clinically N0 oral squamous cell carcinoma (OSCC) patients.The study group comprised 48 men (68%) and 22 women (32%). The median number of the lymph nodes removed from level IIB was 6.5. All the investigated necks were clinically classified as N0, of which 14 (20%) turned out to have an occult nodal metastasis, including only 1 patient (1.42%) of level IIB occult metastasis, which originated from the primary tumor located in the tongue and also metastasized to level IIA. The most associated morbidity was shoulder pain and dysfunction, which presented in 60% of the patients.Also, an electronic search was conducted to find relevant studies investigating the prevalence of level IIB metastasis in OSCC. Ten studies were included for full text review, including the current study. The overall incidence of level IIB metastasis is 4% (17 patients); of these 17 patients, only 4 patients had isolated level IIB nodal metastases (2%).To conclude, neck dissecting, including dissecting level IIB, remains the keystone of treating OSCC. Its prognostic and therapeutic value exceeds its associated morbidity; therefore, dissecting level IIB is recommended in treating OSCC in clinically N0 patients.

  9. Clinical challenges in the implementation of a tomotherapy service for head and neck cancer patients in a regional UK radiotherapy centre

    PubMed Central

    Chatterjee, S; Mott, J H; Smyth, G; Dickson, S; Dobrowsky, W; Kelly, C G

    2011-01-01

    Objective Intensity-modulated radiotherapy (IMRT) is increasingly being used to treat head and neck cancer cases. Methods We discuss the clinical challenges associated with the setting up of an image guided intensity modulated radiotherapy service for a subset of head and neck cancer patients, using a recently commissioned helical tomotherapy (HT) Hi Art (Tomotherapy Inc, WI) machine in this article. We also discuss the clinical aspects of the tomotherapy planning process, treatment and image guidance experiences for the first 10 head and neck cancer cases. The concepts of geographical miss along with tomotherapy-specific effects, including that of field width and megavoltage CT (MVCT) imaging strategy, have been highlighted using the first 10 head and neck cases treated. Results There is a need for effective streamlining of all aspects of the service to ensure compliance with cancer waiting time targets. We discuss how patient toxicity audits are crucial to guide refinement of the newly set-up planning dose constraints. Conclusion This article highlights the important clinical issues one must consider when setting up a head and neck IMRT, image-guided radiotherapy service. It shares some of the clinical challenges we have faced during the setting up of a tomotherapy service. Implementation of a clinical tomotherapy service requires a multidisciplinary team approach and relies heavily on good team working and effective communication between different staff groups. PMID:21159810

  10. End results of a prospective trial on elective lateral neck dissection vs type III modified radical neck dissection in the management of supraglottic and transglottic carcinomas.

    PubMed

    1999-12-01

    Either modified type III radical neck dissection (MRND) or lateral neck dissections (LNDs) are considered valid treatments for patients with laryngeal carcinoma with clinically negative neck findings (N0). The object of this prospective study was to compare complications, neck recurrences, and survival results of elective MRND and LND on the management of laryngeal cancer patients. Patients and Methods This prospective randomized study began in 1990, and patient accrual was closed on December 1993. A total of 132 patients was included in the trial. All patients had previously untreated T2-T4 N0 M0 supraglottic or transglottic squamous cell carcinoma. No significant imbalance was found between groups with respect to demographic, clinical, pathologic, and other therapeutic variables. Seventy-one patients were given MRNDs (13 bilateral) and 61 were given LNDs (18 bilateral). The false-negative rate was 26%, and most positive nodes were sited at levels II and III. Complications and period of hospitalization were similar in both groups. There were 6 ipsilateral neck recurrences (4 in the MRND group, and 2 in the LND group). The 5-year actuarial survival calculated by Kaplan-Meier method was 72.3% in the MRND group and 62. 4% in the LND group (log-rank test p =.312). The rate of false-negative nodes in supraglottic and transglottic carcinomas was 26%, and most positive nodes were at levels II and III. The rates of 5-year overall survival, neck recurrences, and complications were similar in both groups. These results confirm the efficacy of lateral neck dissection in the elective treatment of the neck in patients with supraglottic and transglottic carcinomas. Copyright 1999 John Wiley & Sons, Inc. Head Neck 21: 694-702, 1999.

  11. Evaluation of neck pain by using a visual analog scale before and after laminoplasty in patients with cervical myelopathy: relationship with clinical results.

    PubMed

    Ara, Tsuyoshi; Iizuka, Haku; Sorimachi, Yasunori; Iizuka, Yoichi; Nakajima, Takashi; Nishinome, Masahiro; Tsutsumi, Satoshi; Takagishi, Kenji

    2010-06-01

    In this study the authors investigated the neck pain of patients with cervical myelopathy by using a visual analog scale (VAS) before and after laminoplasty, and they analyzed the association of amount of neck pain with the clinical results. A retrospective review was conducted in 41 patients with cervical myelopathy who underwent cervical laminoplasty. The patients were assessed using questionnaires to evaluate the neck pain intensity before surgery, and 2 years after surgery, the outcome was assessed using a VAS. The degree of cervical lordosis and range of motion (ROM) of the cervical spine were evaluated before and after laminoplasty. The neurological status was also evaluated before and after surgery. The patients were classified into 2 groups according to their preoperative neck pain: 1) the pain (PA) group, which included patients whose preoperative VAS score was more than 1 mm; and 2) the no pain (NP) group, which included patients whose preoperative VAS score was 0 mm. Inclusion in the PA group indicated a restriction of the cervical ROM before laminoplasty; however, the improvement of neck pain in this group and the deterioration of pain status in the NP group eliminated this difference after laminoplasty. Thereafter, the PA group was classified into 2 subgroups according to the improvement of the preoperative neck pain: 1) the improved group, which included patients whose postoperative VAS score decreased; and 2) the no improvement group, which included patients who were not in the improved group. No significant differences were observed in the average recovery and radiographic results between these 2 subgroups. Neck pain before surgery in the PA group indicated a restriction of the cervical ROM; however, the improvement of neck pain in this group and the deterioration of pain status in the NP group indicated the disappearance of this difference postoperatively. Moreover, improvement of preoperative neck pain was not associated with the radiographic

  12. Nodal recurrence of sinonasal cancer: does the risk of cervical relapse justify a prophylactic neck treatment?

    PubMed

    Mirghani, Haïtham; Hartl, Dana; Mortuaire, Geoffrey; Armas, Gian Luca; Aupérin, Anne; Chevalier, Dominique; Lefebvre, Jean Louis

    2013-04-01

    Sinonasal cancers are rare and no high-level evidence exists to determine their optimal management. Prophylactic neck treatment issue remains controversial. The aim of this study was to analyze the pattern of neck failure and to identify any prognostic factors that may influence neck control. A retrospective review of 155 consecutive patients treated for sinonasal malignancy, without prophylactic neck treatment, between 1995 and 2005 at tertiary cancer center was performed. Demographic, clinical, morphological and pathological parameters were correlated with oncologic outcomes. Eight out of 155 patients (5%) presented initially with neck node metastasis. Complete remission was obtained for 133 patients after treatment completion. During follow up, 16 out of 133 patients (12%) were affected with regional recurrence. Neck failure occurred in 8 out of 51 patients with local failure and in 8 out of 82 patients locally controlled. Isolated nodal failure was observed in 5 patients initially cN0 out of 133 (3.8%) representing 7.3% of all recurrences and 3 of them underwent successful salvage therapy. None of the tested factors were significantly associated with neck control (p>0.05). Lymph node at diagnosis time was significantly and independently associated with poor survival (p=0.0012). Isolated neck relapse, when local control is achieved, is rare and salvage treatment is effective. Routine prophylactic neck treatment has little interest. However, this approach could be profitable to few selected patients, who remain to be defined. Further investigations are needed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Future treatment directions for HPV-associated head and neck cancer based on radiobiological rationale and current clinical evidence.

    PubMed

    Marcu, Loredana G

    2016-07-01

    A relatively new entity of head and neck squamous cell carcinoma located in the oropharynx and associated to the human papillomavirus (HPV) is on the rise. This cancer represents a distinct entity from the non-HPV tumours, holds different biological characteristics and responds differently to treatment. An outcome analysis of locoregionally-advanced oropharyngeal versus non-oropharyngeal cancers treated with chemo-radiotherapy revealed a statistically significant improvement for oropharyngeal cancers, which are thought to be due to their HPV-association. Consequently, more attention is paid to HPV-related head and neck cancers, given that HPV status serves as prognostic marker in oropharyngeal cancer patients. Yet, HPV positivity is a simplistic approach for risk stratification, thus more robust biomarkers are needed to fulfil this task. Despite differences in clinical response, HPV-related oral cancers undergo similar therapy to their non-HPV counterparts. This review discusses future treatment directions for HPV-related oropharyngeal cancers based on radiobiological rationale and current clinical evidence. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Neuro Emotional Technique for the treatment of trigger point sensitivity in chronic neck pain sufferers: a controlled clinical trial.

    PubMed

    Bablis, Peter; Pollard, Henry; Bonello, Rod

    2008-05-21

    Trigger points have been shown to be active in many myofascial pain syndromes. Treatment of trigger point pain and dysfunction may be explained through the mechanisms of central and peripheral paradigms. This study aimed to investigate whether the mind/body treatment of Neuro Emotional Technique (NET) could significantly relieve pain sensitivity of trigger points presenting in a cohort of chronic neck pain sufferers. Sixty participants presenting to a private chiropractic clinic with chronic cervical pain as their primary complaint were sequentially allocated into treatment and control groups. Participants in the treatment group received a short course of Neuro Emotional Technique that consists of muscle testing, general semantics and Traditional Chinese Medicine. The control group received a sham NET protocol. Outcome measurements included pain assessment utilizing a visual analog scale and a pressure gauge algometer. Pain sensitivity was measured at four trigger point locations: suboccipital region (S); levator scapulae region (LS); sternocleidomastoid region (SCM) and temporomandibular region (TMJ). For each outcome measurement and each trigger point, we calculated the change in measurement between pre- and post- treatment. We then examined the relationships between these measurement changes and six independent variables (i.e. treatment group and the above five additional participant variables) using forward stepwise General Linear Model. The visual analog scale (0 to 10) had an improvement of 7.6 at S, 7.2 at LS, 7.5 at SCM and 7.1 at the TMJ in the treatment group compared with no improvement of at S, and an improvement of 0.04 at LS, 0.1 at SCM and 0.1 at the TMJ point in the control group, (P < 0.001). After a short course of NET treatment, measurements of visual analog scale and pressure algometer recordings of four trigger point locations in a cohort of chronic neck pain sufferers were significantly improved when compared to a control group which received

  15. Neuro Emotional Technique for the treatment of trigger point sensitivity in chronic neck pain sufferers: A controlled clinical trial

    PubMed Central

    Bablis, Peter; Pollard, Henry; Bonello, Rod

    2008-01-01

    Background Trigger points have been shown to be active in many myofascial pain syndromes. Treatment of trigger point pain and dysfunction may be explained through the mechanisms of central and peripheral paradigms. This study aimed to investigate whether the mind/body treatment of Neuro Emotional Technique (NET) could significantly relieve pain sensitivity of trigger points presenting in a cohort of chronic neck pain sufferers. Methods Sixty participants presenting to a private chiropractic clinic with chronic cervical pain as their primary complaint were sequentially allocated into treatment and control groups. Participants in the treatment group received a short course of Neuro Emotional Technique that consists of muscle testing, general semantics and Traditional Chinese Medicine. The control group received a sham NET protocol. Outcome measurements included pain assessment utilizing a visual analog scale and a pressure gauge algometer. Pain sensitivity was measured at four trigger point locations: suboccipital region (S); levator scapulae region (LS); sternocleidomastoid region (SCM) and temporomandibular region (TMJ). For each outcome measurement and each trigger point, we calculated the change in measurement between pre- and post- treatment. We then examined the relationships between these measurement changes and six independent variables (i.e. treatment group and the above five additional participant variables) using forward stepwise General Linear Model. Results The visual analog scale (0 to 10) had an improvement of 7.6 at S, 7.2 at LS, 7.5 at SCM and 7.1 at the TMJ in the treatment group compared with no improvement of at S, and an improvement of 0.04 at LS, 0.1 at SCM and 0.1 at the TMJ point in the control group, (P < 0.001). Conclusion After a short course of NET treatment, measurements of visual analog scale and pressure algometer recordings of four trigger point locations in a cohort of chronic neck pain sufferers were significantly improved when

  16. Effectiveness of jyoti meditation for patients with chronic neck pain and psychological distress--a randomized controlled clinical trial.

    PubMed

    Jeitler, Michael; Brunnhuber, Stefan; Meier, Larissa; Lüdtke, Rainer; Büssing, Arndt; Kessler, Christian; Michalsen, Andreas

    2015-01-01

    Chronic neck pain is a common medical complaint partly mediated by psychosocial distress and having a high socioeconomic impact. There is preliminary evidence that stress reduction by meditation might be beneficial in chronic pain syndromes. We aimed to evaluate the effectiveness of an 8-week meditation program (jyoti meditation) in patients with chronic neck pain by means of a randomized clinical trial. Eighty-nine patients (aged 49.7 ± 10.5 years, 73 female) with chronic neck pain who scored >40 mm on a 100-mm visual analog scale and had concomitant increased perceived stress were randomized to an 8-week meditation program (jyoti meditation) with weekly 90-minute classes (n = 45) or to a home-based exercise program (n = 44) with a wait list offer for meditation. Both groups were instructed to practice at home. Outcomes were assessed at baseline and after 8 weeks. Primary outcome measure was change of mean pain at rest (visual analog scale score) from baseline to week 8. Secondary outcomes included pain at motion, functional disability, pain-related bothersomeness, perceived stress, quality of life, and psychological outcomes. Patients had neck pain for a mean of 11 years. Eighteen patients in the meditation group and 16 patients in the exercise group were lost to follow-up. Meditation training significantly reduced pain when compared to the exercise group after 8 weeks (reduction of 45.5 ± 23.3 mm to 21.6 ± 17.2 mm in the meditation group, and 43.8 ± 22.0 mm to 37.7 ± 21.5 mm in the exercise group; mean difference: 13.2 mm [95% confidence interval: 2.1, 24.4; P = .02]). Pain-related bothersomeness decreased more in the meditation group (group difference 11.0 mm [95% confidence interval: 1.0, 21.0; P = .03]). No significant treatment effects were found for pain at motion, psychological scores, and quality of life, although the meditation group showed nonsignificant greater improvements compared to the exercise group. In conclusion

  17. Angioleiomyomas in the head and neck: A retrospective clinical and immunohistochemical analysis

    PubMed Central

    LIU, YING; LI, BO; LI, LONGJIANG; LIU, YANBIN; WANG, CHENXING; ZHA, LAGABAIYILA

    2014-01-01

    Angioleiomyoma is a benign soft-tissue tumor originating from vascular smooth muscle, and is rare in the head and neck. The present study retrospectively examined a cohort of patients with head and neck angioleiomyoma treated at the West China Hospital of Stomatology, and also subjected archived tissues to modern immunohistochemical analysis. In total, 21 patients were treated for angioleiomyoma between 1978 and 2012 at the West China Hospital of Stomatology, Sichuan University (Chengdu, Sichuan, China). Medical records were examined and paraffin block sections were cut and stained with hematoxylin and eosin, Masson’s trichrome stain and Van Gieson stain, prior to being subjected to immunohistochemical analysis to re-evaluate and confirm the diagnoses. Angioleiomyomas were found to account for only 0.18% of the benign head and neck tumors in the patients presenting to the hospital over the past 34 years. The diagnosis was more common in males (male:female ratio, 1.625:1) and the mean age at diagnosis was 42.5 years. The most common sites were the buccal mucosa, parotid gland and palate. More than half of the tumors (61.9%) were >2 cm in diameter. Five tumors presented with pain and/or tenderness. The histological subtype was reported as solid in five cases, venous in six, cavernous in nine and venous-cavernous in one. Three tumors exhibited nerve neurofibrils. All tumors were excised with no subsequent recurrence. Cytological and imaging examinations were not useful for pre-operative diagnosis. Angioleiomyoma is a benign tumor that causes limited morbidity. Surgical excision is the only effective treatment and recurrence is rare. The present study revealed that nerves were present in a small proportion (14.3%) of tumors. It was hypothesized that the compression of nerves accompanying numerous blood vessels in the tumor may cause pain, particularly in venous- and cavernous-type angioleiomyomas. PMID:24959254

  18. Salivary gland tumors and previous radiotherapy to the head or neck. Report of a clinical series

    SciTech Connect

    Katz, A.D.; Preston-Martin, S.

    1984-03-01

    To estimate what proportion of patients with newly diagnosed salivary gland tumors may have radiation-related disease, we interviewed all 275 patients in a surgical practice who had salivary gland resections during an 8 year period. Patients were asked about previous radiation treatment to the head and neck. Thirty-one patients (11 percent) had both an incident salivary gland tumor and a history of significant exposure. Four of these patients (13 percent) had multiple primary tumors of the salivary glands. The implications and generalizability of these findings have been discussed herein.

  19. Clinical management of tumour volume changes in VMAT head & neck radiation treatment

    NASA Astrophysics Data System (ADS)

    Alexander, K. M.; Gooding, J.; Schreiner, L. J.; Olding, T.

    2017-05-01

    The impact of changing anatomy due to tumour shrinkage was assessed for a VMAT head & neck plan optimized according to our centre’s planning protocol. A custom-built wax phantom accommodating ion chamber, MOSFET, EBT3 film and Fricke-xylenol orange-gelatin (FXG) gel dosimeters and a variable size bolus ‘tumour’ was used in the investigation. Results indicate that the practice of initiating a patient re-scan and verification plan is appropriate when a change in external body contour greater than 1 cm compared to the original anatomy is observed.

  20. Psychosocial Issues in Patients with Head and Neck Cancer: an Updated Review with a Focus on Clinical Interventions.

    PubMed

    Smith, Joshua D; Shuman, Andrew G; Riba, Michelle B

    2017-09-01

    There are frequent and diverse psychosocial issues that afflict patients with head and neck cancer (HNC) across the illness trajectory, prompting a focus on clinical interventions to prevent and mitigate psychosocial distress. We sought to characterize current understanding on the cause, effects, and interplay of various psychosocial factors in HNC and summarize updated, evidence-based interventions. The psychosocial experience of patients with HNC is characterized by a disproportionately high incidence of depression, suicide, continued substance dependence/abuse, and distress related to relationship conflict, social isolation, disfigurement, and damage to self-image. As we move towards a more thorough understanding and greater appreciation of the relationship between HNC and patient quality of life (QoL), future research focuses on implementation of effective, accessible clinical interventions to alleviate psychosocial distress in this population.

  1. Multi-Modal Preemptive Analgesia With Pregabalin, Acetaminophen, Naproxen, and Dextromethorphan in Radical Neck Dissection Surgery: A Randomized Clinical Trial

    PubMed Central

    Amiri, Hamid Reza; Mirzaei, Mojtaba; Beig Mohammadi, Mohammad Taghi; Tavakoli, Farhad

    2016-01-01

    Background Preemptive analgesia may be considered as a method not only to alleviate postoperative pain but also to decrease analgesic consumption. Different regimens are suggested, but there is currently no standard. Objectives The aim was to measure the efficacy of preemptive analgesia with pregabalin, acetaminophen, naproxen, and dextromethorphan in radical neck dissection surgery for reducing the intensity of pain and morphine consumption. Patients and Methods This study was conducted as a randomized double-blind clinical trial. Eighty adult patients (18 to 60 years of age) under the American society of anesthesiologists (ASA) physical status I and II undergoing elective radical neck dissection were enrolled. Patients were randomized into two groups of 40 with a simple randomization method. The case group received a combination of 15 mg/kg acetaminophen, 2.5 mg/kg pregabalin, 7 mg/kg naproxen, and 0.3 mg/kg dextromethorphan administered orally one hour prior to surgery. Postoperative pain was assessed with the universal pain assessment tool (UPAT) at 0, 2, 4, 6, 12, and 24 hours after surgery. Subjects received morphine based on postoperative pain control protocol. Total administered morphine doses were noted. Results Postoperative pain rates at 0, 2, 4, 6, 12, and 24 hours after surgery were significantly lower for the case group than the control group (P values = 0.014, 0.003, 0.00, 0.00, and 0.00, respectively). Total morphine doses for the preemptive analgesia group were 45% lower than those of the other group. Side effects were similar for both groups. Conclusions A single preoperative oral dose of pregabalin, acetaminophen, dextromethorphan, and naproxen one hour before surgery is an effective method for reducing postoperative pain and morphine consumption in patients undergoing radical neck dissection. PMID:27843771

  2. Improved Dosimetric and Clinical Outcomes With Intensity-Modulated Radiotherapy for Head-and-Neck Cancer of Unknown Primary Origin

    SciTech Connect

    Chen, Allen M.; Li Baoqing; Farwell, D. Gregory; Marsano, Joseph; Vijayakumar, Srinivasan; Purdy, James A.

    2011-03-01

    Purpose: To compare differences in dosimetric, clinical, and quality-of-life endpoints among a cohort of patients treated by intensity-modulated radiotherapy (IMRT) and conventional radiotherapy (CRT) for head-and-neck cancer of unknown primary origin. Methods and Materials: The medical records of 51 patients treated by radiation therapy for squamous cell carcinoma of the head and neck presenting as cervical lymph node metastasis of occult primary origin were reviewed. Twenty-four patients (47%) were treated using CRT, and 27 (53%) were treated using IMRT. The proportions of patients receiving concurrent chemotherapy were 54% and 63%, respectively. Results: The 2-year estimates of overall survival, local-regional control, and disease-specific survival for the entire patient population were 86%, 89%, and84%, respectively. There were no significant differences in any of these endpoints with respect to radiation therapy technique (p > 0.05 for all). Dosimetric analysis revealed that the use of IMRT resulted in significant improvements with respect to mean dose and V30 to the contralateral (spared) parotid gland. In addition, mean doses to the ipsilateral inner and middle ear structures were significantly reduced with IMRT (p < 0.05 for all). The incidence of severe xerostomia in the late setting was 58% and 11% among patients treated by CRT and IMRT, respectively (p < 0.001). The percentages of patients who were G-tube dependent at 6 months after treatment were 42% and 11%, respectively (p < 0.001). Conclusions: IMRT results in significant improvements in the therapeutic ratio among patients treated by radiation therapy for head-and-neck cancer of unknown primary origin.

  3. A prospective clinical trial to assess the optical efficacy of pink neck implants and pink abutments on soft tissue esthetics.

    PubMed

    Gil, Mindy S; Ishikawa-Nagai, Shigemi; Elani, Hawazin W; Da Silva, John D; Kim, David M; Tarnow, Dennis; Schulze-Späte, Ulrike; Bittner, Nurit

    2017-06-05

    The purpose of this prospective, randomized, controlled, multicenter clinical study was to analyze the optical effects of an anodized pink colored implant shoulder/abutment system in the peri-implant mucosa of immediately placed dental implants. Forty subjects with a restoratively hopeless tooth in the maxillary esthetic zone, were recruited and randomized to receive either a pink-neck implant, or a conventional gray implant. All patients received an immediate implant and immediate provisional and two identical CAD/CAM titanium abutments with different surface colors: pink and gray, and one zirconia all-ceramic crown. The color of the peri-implant mucosa was measured using a dental spectrophotometer and analyzed using CIELAB color system. The overall color difference between the peri-implant mucosa with a pink abutment and a gray abutment was ΔE = 4.22. Patients with gray implants presented a color change of ΔE = 3.86-4.17 with this abutment change, while patients with pink implants had a color change of ΔE = 3.84-4.69. The peri-implant mucosa with a pink abutment was significantly more red when compared with a gray abutment (P ≤ .01). When a pink abutment was used, there is a significant color change of the peri-implant mucosa that is above the detectable color threshold. Esthetic outcomes are important for the success of implant treatment of maxillary anterior implants. The phenomenon of the gray color of a dental implant and abutment shining through the peri-implant mucosa has been documented in the literature. The objective of this study was to assess the optical effect of an anodized pink-neck implant and a pink abutment on the color of peri-implant mucosa. This study demonstrates that using pink-neck implant and a pink abutment would contribute positively to the overall esthetic outcome for an anterior implant. © 2017 Wiley Periodicals, Inc.

  4. Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial.

    PubMed

    Mejuto-Vázquez, María J; Salom-Moreno, Jaime; Ortega-Santiago, Ricardo; Truyols-Domínguez, Sebastián; Fernández-de-Las-Peñas, César

    2014-04-01

    Randomized clinical trial. To determine the effects of trigger point dry needling (TrPDN) on neck pain, widespread pressure pain sensitivity, and cervical range of motion in patients with acute mechanical neck pain and active trigger points in the upper trapezius muscle. TrPDN seems to be effective for decreasing pain in individuals with upper-quadrant pain syndromes. Potential effects of TrPDN for decreasing pain and sensitization in individuals with acute mechanical neck pain are needed. Methods Seventeen patients (53% female) were randomly assigned to 1 of 2 groups: a single session of TrPDN or no intervention (waiting list). Pressure pain thresholds over the C5-6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle; neck pain intensity; and cervical spine range-of-motion data were collected at baseline (pretreatment) and 10 minutes and 1 week after the intervention by an assessor blinded to the treatment allocation of the patient. Mixed-model analyses of variance were used to examine the effects of treatment on each outcome variable. Patients treated with 1 session of TrPDN experienced greater decreases in neck pain, greater increases in pressure pain threshold, and higher increases in cervical range of motion than those who did not receive an intervention at both 10 minutes and 1 week after the intervention (P<.01 for all comparisons). Between-group effect sizes were medium to large immediately after the TrPDN session (standardized mean score differences greater than 0.56) and large at the 1-week follow-up (standardized mean score differences greater than 1.34). The results of the current randomized clinical trial suggest that a single session of TrPDN may decrease neck pain intensity and widespread pressure pain sensitivity, and also increase active cervical range of motion, in patients with acute mechanical neck pain. Changes in pain, pressure pain threshold, and cervical range of motion surpassed their respective minimal detectable change

  5. Geometric analysis and clinical outcome of two cemented stems for primary total hip replacement with and without modular necks.

    PubMed

    Haversath, Marcel; Wendelborn, Christine; Jäger, Marcus; Schmidt, Boris; Kowalczyk, Wojciech; Landgraeber, Stefan

    2017-09-15

    Restoration of the physiological biomechanical principles of the hip is crucial in total hip replacement. The aim of this study was to compare an arthroplasty system with different offset options (a: Exeter(®)) with a dual-modular stem (b: Profemur Xm(®)). A local and an inertial coordinate system were used to assist the description of the components' assembly in the prosthesis. A resection line of the femoral head in standard position was added to the arthroplasties and geometric parameters were measured. The outcomes of 93 patients were clinically evaluated (a: n = 50, b: n = 43). Preoperative planning was compared to postoperative radiographs (femoral offset, leg-length), and clinical scores (HHS, WOMAC, total range of motion) were assessed preoperatively, and then 1 and 2 years after surgery. The Exeter(®) offers an offset range from 32.1 to 56.9 mm and the Profemur Xm(®) a range from 29.3 to 55.3 mm. The leg-length variability of the Profemur Xm(®) has a range of 25.9 mm, the Exeter(®) a range of 13.7 mm. The Profemur Xm(®) offers more possible combinations of offset and leg-length reconstruction. The neck-stem angles of the Exeter(®) range from 125.2° to 126.3°, of the Profemur Xm(®) from 127.2° to 142.6°. There was no statistically significant difference in clinical outcome and radiological parameters. We conclude that both stems offer a wide range of options for anatomical reconstruction of the hip resulting in similarly good clinical results. The Profemur Xm(®) stem has advantages for the reconstruction of hips that deviate from standard anatomy but has the drawback of additional corrosive wear at the stem/neck interface.

  6. Prospective Evaluation to Establish a Dose Response for Clinical Oral Mucositis in Patients Undergoing Head-and-Neck Conformal Radiotherapy

    SciTech Connect

    Narayan, Samir Lehmann, Joerg; Coleman, Matthew A.; Vaughan, Andrew; Yang, Claus Chunli; Enepekides, Danny; Farwell, Gregory; Purdy, James A.; Laredo, Grace; Nolan, Kerry A.S.; Pearson, Francesca S.; Vijayakumar, Srinivasan

    2008-11-01

    Purpose: We conducted a clinical study to correlate oral cavity dose with clinical mucositis, perform in vivo dosimetry, and determine the feasibility of obtaining buccal mucosal cell samples in patients undergoing head-and-neck radiation therapy. The main objective is to establish a quantitative dose response for clinical oral mucositis. Methods and Materials: Twelve patients undergoing radiation therapy for head-and-neck cancer were prospectively studied. Four points were chosen in separate quadrants of the oral cavity. Calculated dose distributions were generated by using AcQPlan and Eclipse treatment planning systems. MOSFET dosimeters were used to measure dose at each sampled point. Each patient underwent buccal sampling for future RNA analysis before and after the first radiation treatment at the four selected points. Clinical and functional mucositis were assessed weekly according to National Cancer Institute Common Toxicity Criteria, Version 3. Results: Maximum and average doses for sampled sites ranged from 7.4-62.3 and 3.0-54.3 Gy, respectively. A cumulative point dose of 39.1 Gy resulted in mucositis for 3 weeks or longer. Mild severity (Grade {<=} 1) and short duration ({<=}1 week) of mucositis were found at cumulative point doses less than 32 Gy. Polymerase chain reaction consistently was able to detect basal levels of two known radiation responsive genes. Conclusions: In our sample, cumulative doses to the oral cavity of less than 32 Gy were associated with minimal acute mucositis. A dose greater than 39 Gy was associated with longer duration of mucositis. Our technique for sampling buccal mucosa yielded sufficient cells for RNA analysis using polymerase chain reaction.

  7. Clinical and radiological outcomes of two implants with different prosthetic interfaces and neck configurations: randomized, controlled, split-mouth clinical trial.

    PubMed

    Pozzi, Alessandro; Agliardi, Enrico; Tallarico, Marco; Barlattani, Alberto

    2014-02-01

    Peri-implant bone loss seems to occur following implant placement/loading regardless of all the efforts to eliminate it. Several factors, including surgical trauma, biologic width establishment, lack of passive fit of the superstructures, implant-abutment microgap, and occlusal overloading, may increase peri-implant bone loss. Over the years, new interface designs were introduced and clinical studies suggest that internal conical connection and platform shifting may be advantageous for marginal bone preservation. To compare clinical and radiological outcomes of two implant designs with different prosthetic interfaces and neck configurations in a randomized, controlled, split-mouth clinical trial. Thirty-four partially edentate patients randomly received at least one internal conical connection with back-tapered collar and platform shifting design or external-hexagon implants with flat-to-flat implant-abutment interface. Primary end point was peri-implant bone level changes at different time points, failures of implants and/or prosthesis, any complications, implant stability quotient (ISQ) values, and periodontal parameters. No dropout occurred. Marginal bone changes were statistically significantly different with better results for the internal conical connection. No implants and prosthesis failures have been observed, yielding a cumulative survival rate of 100%. A high ISQ value was found for both implants, and no statistically significant difference was found for ISQ mean values between interventions at each time point (p > .05). All implants showed no bleeding on probing and a very slight amount of plaque at the 1-year-in-function visit. Both implant designs investigated performed similarly in terms of failure rates, providing successful results up to 1 year after loading. The back-tapered neck configuration with conical connection and built-in platform shifting showed statistically lower marginal bone loss than straight neck configuration with flat

  8. The influence of age, gender, lifestyle factors and sub-clinical neck pain on the cervical flexion-rotation test and cervical range of motion.

    PubMed

    Smith, Kenric; Hall, Toby; Robinson, Kim

    2008-12-01

    The flexion-rotation test (FRT) is commonly used when assessing cervicogenic headache. Additionally, active range of motion (AROM) is frequently used to evaluate impairment in neck pain. No studies have investigated the interaction of the FRT and AROM with age, gender, pain and lifestyle factors. The purpose of this study was to determine the influence of these factors on the FRT and cervical AROM. A group of 66 participants (aged 20-78) were studied, 28 experienced sub-clinical neck pain (recurrent neck pain or discomfort which has not received treatment from a healthcare professional) while 38 did not. Age, gender, lifestyle factors and sub-clinical neck pain were assessed using a questionnaire. Measurement of AROM was performed by two examiners blind to the results of the questionnaire. Multiple linear regression analysis found that 59% of the variance in the FRT was explained by the presence of sub-clinical pain and cervical lateral flexion measures. Secondly, 58-72% of the variance in active cervical ROM measures was influenced by factors including the FRT, gender and movements of the neck in other planes. This study found that lifestyle factors do not influence the cervical FRT and AROM.

  9. Extraction of 3D Femur Neck Trabecular Bone Architecture from Clinical CT Images in Osteoporotic Evaluation: a Novel Framework.

    PubMed

    Sapthagirivasan, V; Anburajan, M; Janarthanam, S

    2015-08-01

    The early detection of osteoporosis risk enhances the lifespan and quality of life of an individual. A reasonable in-vivo assessment of trabecular bone strength at the proximal femur helps to evaluate the fracture risk and henceforth, to understand the associated structural dynamics on occurrence of osteoporosis. The main aim of our study was to develop a framework to automatically determine the trabecular bone strength from clinical femur CT images and thereby to estimate its correlation with BMD. All the 50 studied south Indian female subjects aged 30 to 80 years underwent CT and DXA measurements at right femur region. Initially, the original CT slices were intensified and active contour model was utilised for the extraction of the neck region. After processing through a novel process called trabecular enrichment approach (TEA), the three dimensional (3D) trabecular features were extracted. The extracted 3D trabecular features, such as volume fraction (VF), solidity of delta points (SDP) and boundness, demonstrated a significant correlation with femoral neck bone mineral density (r = 0.551, r = 0.432, r = 0.552 respectively) at p < 0.001. The higher area under the curve values of the extracted features (VF: 85.3 %; 95CI: 68.2-100 %, SDP: 82.1 %; 95CI: 65.1-98.9 % and boundness: 90.4 %; 95CI: 78.7-100 %) were observed. The findings suggest that the proposed framework with TEA method would be useful for spotting women vulnerable to osteoporotic risk.

  10. TCGA head Neck

    Cancer.gov

    Investigators with The Cancer Genome Atlas (TCGA) Research Network have discovered genomic differences – with potentially important clinical implications – in head and neck cancers caused by infection with the human papillomavirus (HPV).

  11. The effect of Neuroform stent-assisted coil embolization of wide-necked intracranial aneurysms and clinical factors on progressive aneurysm occlusion on angiographic follow-up.

    PubMed

    Gu, Da-Qun; Zhang, Xin; Luo, Bin; Long, Xiao-Ao; Duan, Chuan-Zhi

    2013-02-01

    Stent-assisted coil embolization is an endovascular treatment for wide-necked intracranial aneurysms, but the durability of this treatment is not well known. The aim of this study is to investigate the effect of the Neuroform stent (Boston Scientific/Target, Fremont, CA, USA) in progressive occlusion of wide-necked intracranial aneurysms, and to assess any correlation between clinical factors and angiographic follow-up results. The records of 52 patients treated with a Neuroform stent were retrieved for analysis of population characteristics, initial and follow-up angiographic results, and clinical outcomes. Initial angiographic results showed complete occlusion in 21 (40.4%), neck remnants in 22 (42.3%), and residual aneurysms in nine (17.3%). Angiographic follow-up was available in 45 of 52 (86.5%) patients: complete occlusion was achieved in 32 (71.1%), neck remnants were present in eight (17.8%) and residual aneurysms in five (11.1%). Of 31 patients with immediate incomplete obliteration, progressive complete occlusion was achieved in 16 of 28 (57.1%) patients. Clinical follow-up showed good outcomes according to the modified Rankin Scale score. A univariate analysis showed that there was no effect of the tested clinical variables of patient age (p=0.823), gender (p=0.419), aneurysm location (p=0.394), size (p=0.625) and rupture status (p=0.721) on aneurysm occlusion at follow-up. We conclude that the Neuroform stent-assisted neck remodelling technique improves progressive occlusion of wide-necked intracranial aneurysms with good clinical outcomes.

  12. Role of prophylactic central neck dissection in clinically node-negative differentiated thyroid cancer: assessment of the risk of regional recurrence.

    PubMed

    Calò, Pietro Giorgio; Lombardi, Celestino Pio; Podda, Francesco; Sessa, Luca; Santini, Luigi; Conzo, Giovanni

    2017-06-01

    Prophylactic central neck dissection in clinically node-negative patients remains controversial. The aim of this multicenter retrospective study was to determine the rate of metastases in the central neck in clinically node-negative differentiated thyroid cancer patients, to examine the morbidity, and to assess the risk of regional recurrence in patients treated with total thyroidectomy with concomitant bilateral or ipsilateral central neck dissection compared with those undergoing total thyroidectomy alone. 258 consecutive clinically node-negative patients were divided into three groups according to the procedures performed: total thyroidectomy only (group A), total thyroidectomy with concomitant ipsilateral central neck dissection (group B), and total thyroidectomy combined with bilateral central neck dissection (group C). Mean operative time and postoperative stay were shorter in Group A (p < 0.01). The incidence of postoperative transient hypoparathyroidism was lower in Group A (p = 0.03), whereas no differences in the incidence of permanent hypoparathyroidism and nerve palsy were present. Postoperative radioactive iodine administration was higher in group B and particularly C (p = 0.03) compared with group A. There were no statistically significant differences in terms of regional recurrence. Differentiated thyroid cancer has a high rate of central lymph node metastasis even in clinically node-negative patients; in the present study there was no statistically significant difference in the rates of locoregional recurrence between the three modalities of treatment. Total thyroidectomy appears to be an adequate treatment for clinically node-negative differentiated thyroid cancer. Prophylactic central neck dissection might be considered for differentiated thyroid cancer patients with large tumor size or extrathyroidal extension.

  13. Characterization of the existence of an N0-completion of a partial N0-matrix with an associated directed cycle.

    PubMed

    Jordán, Cristina; Torregrosa, Juan R

    2014-01-01

    An n × n matrix is called an N 0-matrix if all its specified principal minors are nonpositive. In the context of partial matrices, a partial matrix is called a partial N 0-matrix if all its specified principal minors are nonpositive. In this paper we characterize the existence of an N 0-matrix completion of a partial N 0-matrix whose associated graph is a directed cycle.

  14. Characterization of the Existence of an N 0-Completion of a Partial N 0-Matrix with an Associated Directed Cycle

    PubMed Central

    Jordán, Cristina

    2014-01-01

    An n × n matrix is called an N 0-matrix if all its specified principal minors are nonpositive. In the context of partial matrices, a partial matrix is called a partial N 0-matrix if all its specified principal minors are nonpositive. In this paper we characterize the existence of an N 0-matrix completion of a partial N 0-matrix whose associated graph is a directed cycle. PMID:24688437

  15. Clinical and biological factors affecting response to radiotherapy in patients with head and neck cancer: a review.

    PubMed

    Silva, P; Homer, J J; Slevin, N J; Musgrove, B T; Sloan, P; Price, P; West, C M L

    2007-10-01

    The main aim of this article was to review the clinical and biological factors that have been shown to influence the response of the head and neck squamous cell carcinoma (HNSCC) to primary radiotherapy and briefly discuss how some of these factors could be exploited to improve outcome. Medline based search covering 1982-2006 to identify the HNSCC literature where the effect of clinical and biological factors on locoregional control and overall survival were investigated. Clinical factors are routinely used in management decisions. Nevertheless, identically staged tumours receiving the same treatment may have different outcomes. Biological factors such as hypoxia, proliferation and radio-sensitivity play an important role in radiation response. However, these are not currently used in practise because tests that are clinically reliable and feasible are not available. High-quality translational research will allow us to develop biological tests that can be used in routine clinical practise to tailor individual treatment, with the ability to improve patient outcome further by modifying the underlying tumour biology.

  16. Immunotherapy for head and neck cancer: latest developments and clinical potential.

    PubMed

    Bauml, Joshua M; Cohen, Roger B; Aggarwal, Charu

    2016-05-01

    Head and neck squamous cell cancer (HNSCC) is a malignancy with a rapidly changing demographic profile, given the recent epidemic of human papilloma virus related cancers. Most patients present with locally advanced disease and receive combination therapeutic approaches with curative potential, albeit with significant toxicity. Up to a third of patients, however, will eventually develop recurrent or metastatic disease. The prognosis of such patients is dismal, as palliative treatment options remain limited. Immune-directed therapies offer a novel therapeutic strategy beyond cytotoxic chemotherapy and are currently being evaluated in a wide variety of malignancies. HNSCC is a particularly favorable disease for immunotherapy, as immune evasion and dysregulation have been shown to play a key role in the initiation and progression of HNSCC. This review focuses on the latest developments in immunotherapy in HNSCC, with a particular focus on checkpoint inhibitors, adoptive cellular therapies, and vaccines.

  17. Reducing chemotherapy use in clinically high-risk, genomically low-risk pN0 and pN1 early breast cancer patients: five-year data from the prospective, randomised phase 3 West German Study Group (WSG) PlanB trial.

    PubMed

    Nitz, Ulrike; Gluz, Oleg; Christgen, Matthias; Kates, Ronald E; Clemens, Michael; Malter, Wolfram; Nuding, Benno; Aktas, Bahriye; Kuemmel, Sherko; Reimer, Toralf; Stefek, Andrea; Lorenz-Salehi, Fatemeh; Krabisch, Petra; Just, Marianne; Augustin, Doris; Liedtke, Cornelia; Chao, Calvin; Shak, Steven; Wuerstlein, Rachel; Kreipe, Hans H; Harbeck, Nadia

    2017-06-29

    The prospective phase 3 PlanB trial used the Oncotype DX(®) Recurrence Score(®) (RS) to define a genomically low-risk subset of clinically high-risk pN0-1 early breast cancer (EBC) patients for treatment with adjuvant endocrine therapy (ET) alone. Here, we report five-year data evaluating the prognostic value of RS, Ki-67, and other traditional clinicopathological parameters. A central tumour bank was prospectively established within PlanB. Following an early amendment, hormone receptor (HR)+ , pN0-1 RS ≤ 11 patients were recommended to omit chemotherapy. Patients with RS ≥ 12, pN2-3, or HR-negative/HER2-negative disease were randomised to anthracycline-containing or anthracycline-free chemotherapy. Primary endpoint: disease-free survival (DFS). PlanB Clinicaltrials.gov identifier: NCT01049425. From 2009 to 2011, PlanB enrolled 3198 patients (central tumour bank, n = 3073) with the median age of 56 years, 41.1% pN+, and 32.5% grade 3 EBC. Chemotherapy was omitted in 348/404 (86.1%) eligible RS ≤ 11 patients. After 55 months of median follow-up, five-year DFS in ET-treated RS ≤ 11 patients was 94% (in both pN0 and pN1) versus 94% (RS 12-25) and 84% (RS > 25) in chemotherapy-treated patients (p < 0.001); five-year overall survival (OS) was 99 versus 97% and 93%, respectively (p < 0.001). Nodal status, central/local grade, tumour size, continuous Ki-67, progesterone receptor (PR), IHC4, and RS were univariate prognostic factors for DFS. In a multivariate analysis including all univariate prognostic markers, only pN2-3, central and local grade 3, tumour size >2 cm, and RS, but not IHC4 or Ki-67 were independent adverse factors. If RS was excluded, IHC4 or both Ki-67 and PR entered the model. The impact of RS was particularly pronounced in patients with intermediate Ki-67 (>10%, <40%) tumours. The excellent five-year outcomes in clinically high-risk, genomically low-risk (RS ≤ 11) pN0-1 patients without adjuvant chemotherapy support

  18. Increased expression of Rab coupling protein in squamous cell carcinoma of the head and neck and its clinical significance

    PubMed Central

    DAI, YAOZHANG; LIU, YONG; HUANG, DONGHAI; YU, CHANGYUN; CAI, GENGMING; PI, LEIMING; REN, CAIPING; CHEN, GEORGIA Z.; TIAN, YONGQUAN; ZHANG, XIN

    2012-01-01

    The role of Rab coupling protein (RCP) has not been previously investigated in squamous cell carcinoma of the head and neck (SCCHN). The aim of this study was to explore RCP protein expression and its clinicopathological significance in SCCHN. RCP protein expression in 95 SCCHN samples, 18 vocal nodule epithelia and 16 leukoplakia epithelia samples was analyzed by immunohistochemistry and correlated with clinicopathological parameters and patient outcome. Our data indicated that vocal nodule epithelia, leukoplakia epithelia and SCCHN showed a gradual increase in the expression of RCP protein. RCP overexpression was significantly associated with T classification, clinical staging, lymph node metastasis and recurrence. Survival analysis revealed that a high RCP expression was significantly correlated with shorter overall survival and disease-free survival. In conclusion, RCP protein may contribute to the malignant progression of SCCHN, and serves as a novel prognostic marker in patients with SCCHN. PMID:22783424

  19. The emerging role of immunotherapy in head and neck squamous cell carcinoma (HNSCC): anti-tumor immunity and clinical applications

    PubMed Central

    Economopoulou, Panagiota; Perisanidis, Christos; Giotakis, Evaggelos I.

    2016-01-01

    Head and neck squamous cell carcinoma (HNSCC) carries a poor prognosis, with low survival rates for advanced stage tumors and minimal improvement in survival trends through the past decades. It is becoming increasingly clear that HNSCC oncogenesis and evolution is characterized by profound immune defects, as cancer cells evade immunosurveillance due to accumulation of genetic mutations and tumor heterogeneity. Improved understanding of the role of the immune system in cancer has led to the identification of novel therapeutic targets, which are being investigated for their potential to provide durable responses. In this review, we will summarize the role of the immune system in HNSCC, the rationale behind immunotherapy strategies and their clinical applications. PMID:27275486

  20. Use of a Conventional Low Neck Field (LNF) and Intensity-Modulated Radiotherapy (IMRT): No Clinical Detriment of IMRT to an Anterior LNF During the Treatment of Head-and Neck-Cancer

    SciTech Connect

    Turaka, Aruna; Li Tianyu; Nicolaou, Nicos; Lango, Miriam N.; Burtness, Barbara; Horwitz, Eric M.; Ridge, John A.; Feigenberg, Steven J.

    2011-01-01

    Purpose: To determine differences in clinical outcomes using intensity-modulated radiotherapy (IMRT) or a standard low neck field (LNF) to treat low neck. Methods and Materials: This is a retrospective, single-institution study. Ninety-one patients with squamous cell carcinoma of the head and neck were treated with curative intent. According to physician preference, some patients were treated with LNF (Planning Target Volume 3) field using a single anterior photon field matched to the IMRT field. Field junctions were not feathered. The endpoints were time to failure and use of a percutaneous endoscopic gastrostomy (PEG) tube (as a surrogate of laryngeal edema causing aspiration), and analysis was done with {chi}{sup 2} and log-rank tests. Results: Median follow-up was 21 months (range, 2-89 months). Median age was 60 years. Thirty-seven patients (41%) were treated with LNF, 84% were Stage III or IV. A PEG tube was required in 30%, as opposed to 33% without the use of LNF. Node 2 or 3 neck disease was treated more commonly without LNF (38% vs. 24%, p = 0.009). Failures occurred in 12 patients (13%). Only 1 patient treated with LNF failed regionally, 4.5 cm above the match line. The 3-year disease-free survival rate was 87% and 79% with LNF and without LNF, respectively (p = 0.2), and the 3-year LR failure rate was 4% and 21%, respectively (p = 0.04). Conclusions: Using LNF to treat the low neck did not increase the risk of regional failure 'in early T and early N diseases' or decrease PEG tube requirements.

  1. Clinical implications of nonspecific pulmonary nodules identified during the initial evaluation of patients with head and neck squamous cell carcinoma.

    PubMed

    Kwon, Minsu; Lee, Sang Hoon; Lee, Yoon Se; Lee, Choong Wook; Roh, Jong-Lyel; Choi, Seung-Ho; Nam, Soon Yuhl; Kim, Sang Yoon

    2017-09-01

    We aimed to identify the clinical implications of nonspecific pulmonary nodules (NPNs) detected in the initial staging workup for patients with head and neck squamous cell carcinoma (HNSCC). Medical records of patients who had been diagnosed and treated in our hospital were retrospectively analysed. After definite treatment, changes of NPNs detected on initial evaluation were monitored via serial chest computed tomography. The associations between NPNs and the clinicopathological characteristics of primary HNSCC were evaluated. Survival analyses were performed according to the presence of NPNs. The study consisted of 158 (49.4%) patients without NPNs and 162 (50.6%) patients with NPNs. The cumulative incidence of probabilities of pulmonary malignancy (PM) development at 2 years after treatment were 9.0% and 6.2% in NPN-negative and NPN-positive patients, respectively. Overall and PM-free survival rates were not significantly different according to NPN status. Cervical lymph node (LN) involvement and a platelet-lymphocyte ratio (PLR) ≥126 increased the risk of PMs (both P <0.05). NPNs detected in the initial evaluation of patients with HNSCC did not predict the risk of pulmonary malignancies. Cervical LN involvement and PLR ≥126 may be independent prognostic factors affecting PM-free survival regardless of NPN status. • We aimed to identify the clinical implications of nonspecific pulmonary nodules (NPNs). • NPNs in head and neck cancer patients do not lead to pulmonary malignancies (PMs). • NPNs are not associated with overall or PM-free survival (PMFS). • Cervical lymph node involvement is an independent prognostic factor affecting PMFS. • Platelet-lymphocyte ratio ≥126 is another predictor of PMFS regardless of NPN presence.

  2. The application and challenges of clinical PD-PDT in the head and neck region: a short review.

    PubMed

    Bredell, Marius G; Besic, Emina; Maake, Caroline; Walt, Heinrich

    2010-12-02

    We review current clinical applications of photodiagnosis (PD) and photodynamic therapy (PDT) in the head and neck field and highlight the actual status, problems, challenges as well as the future of this emerging treatment modality. In recent years literature presented input from many new developments and their applications. This is due to better awareness and developing knowledge about PD-PDT from the clinical staff, both nurses and doctors. But it is also a result of improved drug and hardware development such as lasers, LEDs and related optical devices. Current photo-medical applications in the head and neck region range from diagnostics, treatment of premalignant and malignant lesions, aesthetic and cosmetic applications to the ever expanding anti-microbial applications. Although treatment of premalignant and early malignant lesions of the oropharyngeal cavity have long been the favourite lesions to treat with PDT patients with unsalvageable tumors have also been responding remarkably well to PDT, adding significant quality of life. There is growing interest in anti-microbiological PDT and recent progress has shown that this application is able to significantly reduce the number or even eradicate specific microbial pathogens. During many surgical treatments better control of microbiological activity through PDT may lead to a better outcome. Despite progressive development in this field a few problems remain: prolonged phototoxicity, limited penetration of the photosensitizer and light, inadequate specificity, PDT-related pain as well as the lack of uniformly accepted protocols both for light application as well as photosensitizers. Recent studies have shown that PDT based pain can be separated from other forms of pain, offering hope that a specific management of pain will be possible. If PDT will become fully accepted by patients and doctors we must care about the negative factors such as pain and prolonged phototoxicity.

  3. Review of the Clinical and Biologic Aspects of Human Papillomavirus-Positive Squamous Cell Carcinomas of the Head and Neck

    SciTech Connect

    Blitzer, Grace C.; Smith, Molly A.; Harris, Stephen L.; Kimple, Randall J.

    2014-03-15

    Human papillomavirus (HPV), a known etiology of a subset of head-and-neck squamous cell carcinomas (HNCs), causes numerous alterations in normal cellular functions. This article reviews the biology, detection, and treatment of HPV-positive HNC. The role of HPV oncoproteins in tumor development, the natural history of HPV infection, and risk factors for and prevention of transmission of oral HPV are considered. Commonly used methods for detecting HPV infection, including limitations of these methods, are discussed to aid the practicing clinician in using these tests in their clinical practice. Clinical characteristics of HPV-positive HNC, including potential explanations for the improved outcomes seen in patients with HPV-positive HNC, are assessed. Ongoing clinical trials specific for patients with HPV-positive HNC are described, and areas in need of additional research are summarized. Until the results of ongoing trials are known, treatment of HPV-positive HNC should not differ in clinical practice from treatment of similar non-HPV related cancers.

  4. Management of cervical lymph node metastasis in tonsillar squamous cell carcinoma: Is it necessary to treat node-negative contralateral neck?

    PubMed

    Cho, Kwang Jae; Joo, Young Hoon; Sun, Dong Il; Kim, Min Sik

    2011-08-01

    To investigate the appropriate management of cervical lymph node metastasis in patients with tonsillar squamous cell carcinoma (SCC). The medical records of 49 patients that were surgically treated for tonsillar SCC were evaluated. Preoperative and postoperative stages, clinical factors affecting the nodal metastasis, and its relationship with survival were examined. Among 49 ipsilateral neck dissection (ND) specimens, 34 neck specimens (69%) were pN+. Out of 17 cases that underwent ipsilateral elective NDs, 4 cases (24%) were found to have pN+ necks. The disease-specific survival of the 34 patients with pN+ necks and 4 patients with occult metastases was worse than that of the remaining patients with pN0 necks and without occult metastasis, respectively (p=0.049 and p=0.023, respectively). All cases (100%) that underwent contralateral therapeutic NDs had pN+ findings. Two out of the 21 cases (less than 10%) that underwent contralateral elective NDs turned out to have pN+ necks and did not show any difference in survival compared to the 19 cases with pN0 necks. The degree of differentiation was associated with contralateral nodal metastasis. Patients with tonsillar SCC require thorough ipsilateral neck treatment because of the high probability of nodal metastasis and the close association between lymph node metastasis and survival. The contralateral cN+ neck should also be treated; however, the contralateral cN0 neck might be preserved with caution on the cases with poorly differentiated primary tumors and/or ipsilateral cN+ necks. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  5. Positive predictive value of clinical diagnosis of head and neck non-melanoma skin malignancies. How accurate are we?

    PubMed

    Stathopoulos, Panagiotis; Ghaly, Ghaly; Sisodia, Bijal; Harrop, Colin

    2015-12-01

    ᅟ: The purpose of the current study was to determine the accuracy of the clinical diagnosis in non-melanoma skin malignancy as confirmed by histopathological examination of the specimen. Positive predictive value (PPV) was selected as a reliable measure of diagnostic accuracy. Clinical diagnosis was made in the outpatient clinic by a consultant oral and maxillofacial surgeon. We reviewed the electronic charts of 210 patients with non-melanoma skin malignant tumours and calculated the positive predictive value of the initial clinical diagnosis. Histological confirmation for each lesion was compared with the provisional clinical diagnosis made in the clinic. Of the 147 lesions provisionally diagnosed as basal cell carcinomas, 133 lesions were histologically confirmed to be basal cell carcinomas (BCC) (PPV 90.4 %). Of the 63 lesions provisionally thought to be squamous cell carcinomas, 47 lesions were histologically confirmed as squamous cell carcinomas (SCC) (PPV 74.6 %). The difference between the PPVs for the two types of malignancy in our study was not significant (p = 0.39). Statistics between our results for BCC and SCC and those reported from two other cancer institutes revealed no significant difference (p = 0.58 and 0.07). The present study supports that relying on clinical diagnosis with the purpose to formalise a treatment plan for head and neck non-melanoma skin cancer is safe and efficient. This is more reliable in cases of basal cell carcinoma in comparison to suspected squamous cell carcinomas. Although positive predictive value represents a reliable measure of diagnostic accuracy, it is increased when populations with higher prevalence of the disease are studied.

  6. Short-term combined effects of thoracic spine thrust manipulation and cervical spine nonthrust manipulation in individuals with mechanical neck pain: a randomized clinical trial.

    PubMed

    Masaracchio, Michael; Cleland, Joshua A; Hellman, Madeleine; Hagins, Marshall

    2013-03-01

    Randomized clinical trial. To investigate the short-term effects of thoracic spine thrust manipulation combined with cervical spine nonthrust manipulation (experimental group) versus cervical spine nonthrust manipulation alone (comparison group) in individuals with mechanical neck pain. Research has demonstrated improved outcomes with both nonthrust manipulation directed at the cervical spine and thrust manipulation directed at the thoracic spine in patients with neck pain. Previous studies have not determined if thoracic spine thrust manipulation may increase benefits beyond those provided by cervical nonthrust manipulation alone. Sixty-four participants with mechanical neck pain were randomized into 1 of 2 groups, an experimental or comparison group. Both groups received 2 treatment sessions of cervical spine nonthrust manipulation and a home exercise program consisting of active range-of-motion exercises, and the experimental group received additional thoracic spine thrust manipulations. Outcome measures were collected at baseline and at a 1-week follow-up, and included the numeric pain rating scale, the Neck Disability Index, and the global rating of change. Participants in the experimental group demonstrated significantly greater improvements (P<.001) on both the numeric pain rating scale and Neck Disability Index at the 1-week follow-up compared to those in the comparison group. In addition, 31 of 33 (94%) participants in the experimental group, compared to 11 of 31 participants (35%) in the comparison group, indicated a global rating of change score of +4 or higher at the 1-week follow-up, with an associated number needed to treat of 2. Individuals with neck pain who received a combination of thoracic spine thrust manipulation and cervical spine nonthrust manipulation plus exercise demonstrated better overall short-term outcomes on the numeric pain rating scale, the Neck Disability Index, and the global rating of change.

  7. Molecular predictors of clinical outcome in patients with head and neck squamous cell carcinoma

    PubMed Central

    Thomas, Giovana R; Nadiminti, Hari; Regalado, Jacinto

    2005-01-01

    Head and neck squamous cell carcinoma (HNSCC) involves the upper aerodigestive tract and can destroy the structure and function of organs involved in voice, speech, taste, smell and hearing, as well as vital structures necessary for survival. HNSCC has long been a treatment challenge because of the high rate of recurrences and of advanced disease at the time of diagnosis. Molecular identification of tissue biomarkers in diagnostic biopsy specimens may not only identify patients at risk for developing HNSCC but may also select patients that may benefit from more aggressive treatment modalities. Several biomarkers studied to date such as the proteins p53, cyclin D1, p16, Cox-2 enzyme, epidermal growth factor and vascular endothelial growth factor receptors, matrix metalloproteinases and the Fhit marker for genomic instability could be manipulated for the therapeutic benefit of these patients. This review presents the most updated information on molecular biomarkers with the greatest prognostic potential in HNSCC and discusses some factors that contribute to the controversy concerning their prognostic importance. PMID:16309541

  8. Malnutrition and Clinical Outcome of 234 Head and Neck Cancer Patients who Underwent Percutaneous Endoscopic Gastrostomy.

    PubMed

    Fonseca, Jorge; Santos, Carla Adriana; Brito, José

    2016-01-01

    Head and neck cancer (HNC) patients who underwent percutaneous endoscopic gastrostomy (PEG) present malnutrition risk and speech impairments. Their assessment relies on objective anthropometric/laboratory data. Focusing on HNC PEG patients, our aims were to evaluate: 1) outcome; 2) nutritional status when the patients underwent PEG; and 3) association of nutritional status/outcome, creating a survival predictive model. We evaluated the outcome based on NRS 2002, dietary assessment, body mass index (BMI), mid-upper arm circumference (MUAC), triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC), albumin, transferrin, and cholesterol on the day of gastrostomy. Using BMI, TSF, MAMC, and laboratory data, a survival predictive model was created. Of the 234 patients (cancer stages III-IV), 149 died, 33 were still PEG-fed, and 36 resumed oral intake (NRS-2002≥3, caloric needs <50% in all). BMI was 12.7-43. 189, 197, and 168 patients displayed, respectively, low MUAC, TSF, and MAMC. 91, 155, and 119 patients displayed low albumin, transferrin, and cholesterol. Albumin, cholesterol, and transferrin were strongly associated with the outcome. A predictive model was created, discriminating between short-term survivors (<4 months) and long-term survivors. HNC patients were malnourished. Using anthropometric/laboratory parameters, a predictive model provides discrimination between patients surviving PEG for <4 months and long-term survivors. Teams taking care of PEG patients may provide special support to potential short-term survivors.

  9. An Estimation of Radiobiological Parameters for Head-and-Neck Cancer Cells and the Clinical Implications

    PubMed Central

    Qi, X. Sharon; Yang, Qiuhui; Lee, Steve P.; Li, X. Allen; Wang, Dian

    2012-01-01

    In vitro survival measurements using two human head-and-neck cancer (HNC) cell lines were performed. The specially designed split-dose surviving fraction was obtained and fitted to the linear-quadratic formalism. The repair halftime (Tr), the potential doubling time (Td), α/β and radiosensitivity α, were estimated. Other radiobiological models: EUD, BED, TCP, etc., were used to examine the potential treatment effectiveness of different IMRT techniques. Our data indicated the repair halftime of ~17 min based on two HNC cell lines. The combined α/β, α and Td are α/β = 8.1 ± 4.1 Gy, α = 0.22 ± 0.08 Gy−1, Td = 4.0 ± 1.8 day, respectively. The prolonged IMRT dose delivery for entire HNC treatment course could possibly result in the loss of biological effectiveness, i.e., the target EUDs decreased by 11% with fraction dose delivery time varying from 5 to 30 min. We determined the sublethal damage repair halftime and other radiobiological parameters for HNC cells, and to evaluate treatment effectiveness of the prolonged dose delivery times associated with different IMRT techniques. The estimated repair halftime for HNC is relatively short and may be comparable to the step-and-shoot IMRT fraction dose delivery time. The effectiveness of IMRT treatment may be improved by reducing the fraction delivery time for HNC treatment. PMID:24213325

  10. Changes of perfusion of microvascular free flaps in the head and neck: a prospective clinical study.

    PubMed

    Mücke, Thomas; Rau, Andrea; Merezas, Andreas; Kanatas, Anastasios; Mitchell, David A; Wagenpfeil, Stefan; Wolff, Klaus-Dietrich; Steiner, Timm

    2014-11-01

    Reconstruction with a free flap is routine in head and neck surgery. However, reliable assessment of perfusion can be difficult, so we prospectively evaluated it in 4 types of microvascular free flaps in the oral cavity (n=196) and assessed differences in blood flow by non-invasive monitoring with a laser Doppler flowmetry unit. We measured oxygen saturation, haemoglobin concentration, and velocity on the surface of the flap preoperatively at the donor site, and on the flap on the first, second, and seventh postoperative days, and after 4 weeks in 186/196 patients, mean (SD) age of 60 (13) years. We studied the radial forearm (n=76, 41%), fibular (n=45, 24%), anterolateral thigh (n=53, 28%), and soleus perforator (n=12, 7%) flaps. The values for the radial forearm flap differed significantly from the others. There were significant differences in haemoglobin concentrations between the fibular and soleus perforator flaps, and between the anterolateral thigh and soleus perforator flaps (p=0.002 each). Free flaps are unique in the way that perfusion develops after microvascular anastomoses. Knowledge of how each flap is perfused may indicate different patterns of healing that could potentially influence long term rehabilitation and detection of future deficits in perfusion.

  11. Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain.

    PubMed

    Escortell-Mayor, E; Riesgo-Fuertes, R; Garrido-Elustondo, S; Asúnsolo-Del Barco, A; Díaz-Pulido, B; Blanco-Díaz, M; Bejerano-Álvarez, E

    2011-02-01

    This study investigated effectiveness of manual therapy (MT) with transcutaneous electrical nerve stimulation (TENS) to reduce pain intensity in patients with mechanical neck disorder (MND). A randomized multi-centered controlled clinical trial was performed in 12 Primary Care Physiotherapy Units in Madrid Region. Ninety patients were included with diagnoses of subacute or chronic MND without neurological damage, 47 patients received MT and 43 TENS. The primary outcome was pain intensity measured in millimeters using the Visual Analogue Scale (VAS). Also disability, quality of life, adverse effects and sociodemographic and prognosis variables were measured. Three evaluations were performed (before, when the procedure finished and six months after). Seventy-one patients (79%) completed the follow-up measurement at six months. In more than half of the treated patients the procedure had a clinically relevant "short term" result after having ended the intervention, when either MT or TENS was used. The success rate decreased to one-third of the patients 6 months after the intervention. No differences can be found in the reduction of pain, in the decrease of disability nor in the quality of life between both therapies. Both analyzed physiotherapy techniques produce a short-term pain reduction that is clinically relevant.

  12. Clinical Outcome of Paraclinoid Internal Carotid Artery Aneurysms After Microsurgical Neck Clipping in Comparison with Endovascular Embolization

    PubMed Central

    Bae, Dong-Hyun; Won, Yu-Deok; Choi, Kyu-Sun; Cheong, Jin-Hwan; Yi, Hyeong-Joong; Kim, Choong-Hyun

    2014-01-01

    Objective Because of the complex anatomical association among vascular, dural, and bony structures, paraclinoid internal carotid artery (ICA) aneurysms remain a major challenge for vascular neurosurgeons. We studied the clinical outcomes of 61 paraclinoid ICA aneurysms after microsurgical clipping in comparison with endovascular coiling. Materials and Methods Between January 2008 and December 2012, we treated 61 paraclinoid ICA aneurysms created by surgical clipping or endovascular coiling. Preoperative neurologic status and postoperative outcome were evaluated using the Glasgow coma scale (GCS) and the modified Rankin scale (mRS). Postoperative hydrocephalus and vasospasm were reviewed using the patients' medical charts. Results Most patients were in good clinical condition before the operations and had good treatment outcomes. Clinical vasospasm was observed after the operation in five patients, and hydrocephalus occurred in six patients. No statistically significant difference regarding aneurysm size, sex, GCS score, H-H grade, and mRS was observed between the surgical clipping group and the endovascular coiling group. In addition, the treatment results and complications did not show statistically significant difference in either group. Conclusion Surgical occlusion of paraclinoid ICA aneurysms is difficult; however, no significant differences were observed in the treatment results or complications when compared with coil embolization. In particular, use of an adequate surgical technique may lead to better outcomes than those for coil embolization in the treatment of large and/or wide-neck paraclinoid ICA aneurysms. PMID:25340024

  13. Clinical correlates of promoter hypermethylation of four target genes in head and neck cancer: a cooperative group correlative study.

    PubMed

    Roh, Jong-Lyel; Wang, Xin Victoria; Manola, Judith; Sidransky, David; Forastiere, Arlene A; Koch, Wayne M

    2013-05-01

    Promoter hypermethylation is a well-documented mechanism for tumor-specific alteration of suppressor gene activity in human malignancy including head and neck cancer (HNC). The abrogation of specific suppressor gene activity may influence tumor behavior and clinical outcome. In this study we examined methylation of DCC, KIF1A, EDNRB, and p16(INK4a) in a large cohort of HNC patients from Eastern Cooperative Group (ECOG) 4393/Radiation Therapy Oncology Group (RTOG) 9614 to identify clinical correlates of methylation of these genes. Methylation was assessed by quantitative methylation-specific PCR in DNA from tumor specimens and was considered as a continuous and a binary variable. Clinical data including demographics, stage, risk factor exposure, treatment, and outcome were collected by ECOG and RTOG. Methylation status was also correlated with mutation of TP53 (previously reported) and human papilloma virus status. Methylation results were available for 368 cases, 353 of which also have p53 mutation status. At least one methylation event was present in all tumors. In multivariate analysis of the entire cohort, methylation of p16 was associated with decreased survival (HR = 1.008; P = 0.045). However, in tumors with disruptive TP53 mutation (poor prognostic group), the additional presence of methylation of p16 was protective (P = 0.019 considering p16 methylation as a continuous variable). Methylation of tumor-related genes contributes to the biological behavior of HNC and influences overall survival in conjunction with other known prognostic molecular events. ©2013 AACR.

  14. The clinical feasibility of deep hyperthermia treatment in the head and neck: new challenges for positioning and temperature measurement

    NASA Astrophysics Data System (ADS)

    Paulides, M. M.; Bakker, J. F.; Linthorst, M.; van der Zee, J.; Rijnen, Z.; Neufeld, E.; Pattynama, P. M. T.; Jansen, P. P.; Levendag, P. C.; van Rhoon, G. C.

    2010-05-01

    To apply high-quality hyperthermia treatment to tumours at deep locations in the head and neck (H&N), we have designed and built a site-specific phased-array applicator. Earlier, we demonstrated its features in parameter studies, validated those by phantom measurements and clinically introduced the system. In this paper we will critically review our first clinical experiences and demonstrate the pivotal role of hyperthermia treatment planning (HTP). Three representative patient cases (thyroid, oropharynx and nasal cavity) are selected and discussed. Treatment planning, the treatment, interstitially measured temperatures and their interrelation are analysed from a physics point of view. Treatments lasting 1 h were feasible and well tolerated and no acute treatment-related toxicity has been observed. Maximum temperatures measured are in the range of those obtained during deep hyperthermia treatments in the pelvic region but mean temperatures are still to be improved. Further, we found that simulated power absorption correlated well with measured temperatures illustrating the validity of our treatment approach of using energy profile optimizations to arrive at higher temperatures. This is the first data proving that focussed heating of tumours in the H&N is feasible. Further, HTP proved a valuable tool in treatment optimization. Items to improve are (1) the transfer of HTP settings into the clinic and (2) the registration of the thermal dose, i.e. dosimetry.

  15. A clinical review of 38 cases of cervical tuberculous lymphadenitis in Japan - The role of neck dissection.

    PubMed

    Omura, Sayaka; Nakaya, Muneo; Mori, Ayumi; Oka, Mineko; Ito, Akiko; Kida, Wataru; Inayoshi, Yasuhiro; Inoue, Aki; Fuchigami, Teruhiko; Takamori, Mikio

    2016-12-01

    After tuberculous pleurisy, lymphadenitis arising from cervical lesion is the second most common form of extrapulmonary tuberculosis. It is generally treated with antituberculosis agents, but some patients resist chemotherapy. In such cases, surgical resection is often considered as an alternative treatment. This study aims to evaluate the therapeutic outcome of cervical tuberculous lymphadenitis and the future course of treatment of this disease. We retrospectively reviewed the clinical charts of patients diagnosed at the Tokyo Metropolitan Tama Medical Center between 2009 and 2015 and identified 38 cases of cervical tuberculous lymphadenitis. Precisely 798 patients were registered for primary tuberculosis at our institution during the same period. Patient ages ranged from 21 to 85 years (average: 58.9 years), and the male-to-female ratio was 1:1.2. The range of tuberculosis progression was as follows: 30 (78.9%) in only the cervical lymph node, 3 in the other (axillary, mediastinal, and abdominal) lymph nodes, 1 in the lung and vertebrae lumbales, 2 in the lung, and 1 in the pleural membrane. All 38 patients were initially treated with antituberculous drugs at the Department of Pulmonary Medicine based on guidelines for tuberculosis cases in Japan. In seven cases, the antituberculous drugs were replaced due to side effects. Four cases involved a single drug-resistant strain, and one case involved a double drug-resistant strain. Thirty-three (86.8%) cases were cured by chemotherapy alone. The three patients resistant to chemotherapy were successfully treated through neck dissection. Thirty-six cases (94.7%) were cured by chemotherapy or chemotherapy and surgery. Local therapy could prove effective in cervical tuberculous lymphadenitis patients who exhibit an inadequate response to drugs. The role of neck dissection in cervical tuberculous lymphadenitis remains an important consideration. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. Prevalence and clinical features of human papillomavirus in head and neck squamous cell carcinoma in Okinawa, southern Japan.

    PubMed

    Deng, Zeyi; Hasegawa, Masahiro; Matayoshi, Sen; Kiyuna, Asanori; Yamashita, Yukashi; Maeda, Hiroyuki; Suzuki, Mikio

    2011-11-01

    Previous studies from Okinawa, a subtropical island in southern Japan, demonstrated a higher prevalence of human papillomavirus (HPV) in oral carcinoma and a higher incidence of oral and pharyngeal carcinoma than those for mainland Japan. The present study aims to investigate epidemiologic and clinical features of HPV in head and neck squamous cell carcinoma (HNSCC) in Okinawa. A total of 150 DNA samples from 150 Okinawan patients with head and neck squamous cell carcinoma (HNSCC) were screened for HPV sequences by PCR using three consensus primer sets, and HPV types were determined by direct sequencing. The samples were consisted of 46 cases from the hypopharynx, 44 from the oropharynx, 16 from the larynx, 25 from the oral cavity, 10 from the maxillary sinus, and 9 from the nasopharynx. HPV DNA was detected in 45 (30.0%) HNSCCs, and HPV-16 was identified in 86.7% of positive specimens. The highest prevalence of the HPV sequence was found in oropharyngeal carcinomas (50.0%), especially in tonsillar cancer (63.6%). Multivariate analysis showed that oropharyngeal carcinoma (P = 0.002; OR = 5.34; 95% CI = 1.83-15.58), oral cavity carcinoma (P = 0.012; OR = 4.94; 95% CI = 1.43-17.10), and histological poor differentiation (P = 0.011; OR = 4.25; 95% CI = 1.39-13.04) each independently increased the prevalence of HPV infection. The present study reveals that patients with HNSCC, e.g., oropharyngeal and oral cavity carcinomas, in Okinawa have relatively high HPV-16 positive rates and low HPV-18 positive rates comparing with mainland Japan.

  17. Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial.

    PubMed

    De Meulemeester, Kayleigh E; Castelein, Birgit; Coppieters, Iris; Barbe, Tom; Cools, Ann; Cagnie, Barbara

    2017-01-01

    The aim of this study was to investigate short-term and long-term treatment effects of dry needling (DN) and manual pressure (MP) technique with the primary goal of determining if DN has better effects on disability, pain, and muscle characteristics in treating myofascial neck/shoulder pain in women. In this randomized clinical trial, 42 female office workers with myofascial neck/shoulder pain were randomly allocated to either a DN or MP group and received 4 treatments. They were evaluated with the Neck Disability Index, general numeric rating scale, pressure pain threshold, and muscle characteristics before and after treatment. For each outcome parameter, a linear mixed-model analysis was applied to reveal group-by-time interaction effects or main effects for the factor "time." No significant differences were found between DN and MP. In both groups, significant improvement in the Neck Disability Index was observed after 4 treatments and 3 months (P < .001); the general numerical rating scale also significantly decreased after 3 months. After the 4-week treatment program, there was a significant improvement in pain pressure threshold, muscle elasticity, and stiffness. Both treatment techniques lead to short-term and long-term treatment effects. Dry needling was found to be no more effective than MP in the treatment of myofascial neck/shoulder pain. Copyright © 2016. Published by Elsevier Inc.

  18. A pilot study evaluating real-time shear wave ultrasound elastography of miscellaneous non-nodal neck masses in a routine head and neck ultrasound clinic.

    PubMed

    Bhatia, Kunwar S S; Yuen, Edmund H Y; Cho, Carmen C M; Tong, Cina S L; Lee, Yolanda Y P; Ahuja, Anil T

    2012-06-01

    A pilot study was performed to evaluate shear wave ultrasound elastography (SWE) for miscellaneous non-nodal/salivary/thyroid neck lesions. Forty-six lesions undergoing conventional sonography also underwent SWE. Elastic moduli from the stiffest areas in lesions were correlated with diagnosis. Forty lesions were benign (9 lipomas, 8 lymphatic/venous vascular malformations, 7 thyroglossal duct cysts, 4 branchial cleft cysts, 4 abscesses/phlegmons, 3 neurogenic tumors and 1 each of paraganglioma, sebaceous cyst, pseudotumor, hypertrophic scar, ranula) and 6 were malignant (1 malignant fibrous histiocytoma, 2 primary squamous cell carcinomas and 3 intramuscular metastases [2 squamous cell carcinomas, 1 malignant melanoma]).Median stiffness of malignant lesions (226.4 kPa, range 55.6 to 300.0) was higher than benign lesions (28.3 kPa, range 4.0 to 300.0) (p < 0.001). SWE cut-off with highest accuracy (174.4 kPa) achieved 83.3% sensitivity and 97.5% specificity, and the cut-off with 100% sensitivity (55.6 kPa) achieved 75% specificity. All malignant lesions were suspected on conventional sonography. The preliminary data indicate that SWE is feasible for miscellaneous neck lesions. SWE would not have altered management in terms of detecting undisclosed malignancies, although as a quantitative technique, it may increase the diagnostic confidence of less experienced operators performing head and neck ultrasound. Copyright © 2012 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  19. Institutional Clinical Trial Accrual Volume and Survival of Patients With Head and Neck Cancer

    PubMed Central

    Wuthrick, Evan J.; Zhang, Qiang; Machtay, Mitchell; Rosenthal, David I.; Nguyen-Tan, Phuc Felix; Fortin, André; Silverman, Craig L.; Raben, Adam; Kim, Harold E.; Horwitz, Eric M.; Read, Nancy E.; Harris, Jonathan; Wu, Qian; Le, Quynh-Thu; Gillison, Maura L.

    2015-01-01

    Purpose National Comprehensive Cancer Network guidelines recommend patients with head and neck cancer (HNC) receive treatment at centers with expertise, but whether provider experience affects survival is unknown. Patients and Methods The effect of institutional experience on overall survival (OS) in patients with stage III or IV HNC was investigated within a randomized trial of the Radiation Therapy Oncology Group (RTOG 0129), which compared cisplatin concurrent with standard versus accelerated fractionation radiotherapy. As a surrogate for experience, institutions were classified as historically low- (HLACs) or high-accruing centers (HHACs) based on accrual to 21 RTOG HNC trials (1997 to 2002). The effect of accrual volume on OS was estimated by Cox proportional hazards models. Results Median RTOG accrual (1997 to 2002) at HLACs was four versus 65 patients at HHACs. Analysis included 471 patients in RTOG 0129 (2002 to 2005) with known human papillomavirus and smoking status. Patients at HLACs versus HHACs had better performance status (0: 62% v 52%; P = .04) and lower T stage (T4: 26.5% v 35.3%; P = .002) but were otherwise similar. Radiotherapy protocol deviations were higher at HLACs versus HHACs (18% v 6%; P < .001). When compared with HHACs, patients at HLACs had worse OS (5 years: 51.0% v 69.1%; P = .002). Treatment at HLACs was associated with increased death risk of 91% (hazard ratio [HR], 1.91; 95% CI, 1.37 to 2.65) after adjustment for prognostic factors and 72% (HR, 1.72; 95% CI, 1.23 to 2.40) after radiotherapy compliance adjustment. Conclusion OS is worse for patients with HNC treated at HLACs versus HHACs to cooperative group trials after accounting for radiotherapy protocol deviations. Institutional experience substantially influences survival in locally advanced HNC. PMID:25488965

  20. Improving the prediction of overall survival for head and neck cancer patients using image biomarkers in combination with clinical parameters.

    PubMed

    Zhai, Tian-Tian; van Dijk, Lisanne V; Huang, Bao-Tian; Lin, Zhi-Xiong; Ribeiro, Cássia O; Brouwer, Charlotte L; Oosting, Sjoukje F; Halmos, Gyorgy B; Witjes, Max J H; Langendijk, Johannes A; Steenbakkers, Roel J H M; Sijtsema, Nanna M

    2017-08-01

    To develop and validate prediction models of overall survival (OS) for head and neck cancer (HNC) patients based on image biomarkers (IBMs) of the primary tumor and positive lymph nodes (Ln) in combination with clinical parameters. The study cohort was composed of 289 nasopharyngeal cancer (NPC) patients from China and 298 HNC patients from the Netherlands. Multivariable Cox-regression analysis was performed to select clinical parameters from the NPC and HNC datasets, and IBMs from the NPC dataset. Final prediction models were based on both IBMs and clinical parameters. Multivariable Cox-regression analysis identified three independent IBMs (tumor Volume-density, Run Length Non-uniformity and Ln Major-axis-length). This IBM model showed a concordance(c)-index of 0.72 (95%CI: 0.65-0.79) for the NPC dataset, which performed reasonably with a c-index of 0.67 (95%CI: 0.62-0.72) in the external validation HNC dataset. When IBMs were added in clinical models, the c-index of the NPC and HNC datasets improved to 0.75 (95%CI: 0.68-0.82; p=0.019) and 0.75 (95%CI: 0.70-0.81; p<0.001), respectively. The addition of IBMs from the primary tumor and Ln improved the prognostic performance of the models containing clinical factors only. These combined models may improve pre-treatment individualized prediction of OS for HNC patients. Copyright © 2017. Published by Elsevier B.V.

  1. Economic Analyses in Squamous Cell Carcinoma of the Head and Neck: A Review of the Literature From a Clinical Perspective

    SciTech Connect

    Souza, Jonas A. de; Santana, Iuri A.; Castro, Gilberto de; Lima Lopes, Gilberto de; Tina Shih, Ya-Chen

    2014-08-01

    The purpose of this review was to describe cost-effectiveness and cost analysis studies across treatment modalities for squamous cell carcinoma of the head and neck (SCCHN), while placing their results in context of the current clinical practice. We performed a literature search in PubMed for English-language studies addressing economic analyses of treatment modalities for SCCHN published from January 2000 to March 2013. We also performed an additional search for related studies published by the National Institute for Health and Clinical Excellence in the United Kingdom. Identified articles were classified into 3 clinical approaches (organ preservation, radiation therapy modalities, and chemotherapy regimens) and into 2 types of economic studies (cost analysis and cost-effectiveness/cost-utility studies). All cost estimates were normalized to US dollars, year 2013 values. Our search yielded 23 articles: 13 related to organ preservation approaches, 5 to radiation therapy modalities, and 5 to chemotherapy regimens. In general, studies analyzed different questions and modalities, making it difficult to reach a conclusion. Even when restricted to comparisons of modalities within the same clinical approach, studies often yielded conflicting findings. The heterogeneity across economic studies of SCCHN should be carefully understood in light of the modeling assumptions and limitations of each study and placed in context with relevant settings of clinical practices and study perspectives. Furthermore, the scarcity of comparative effectiveness and quality-of-life data poses unique challenges for conducting economic analyses for a resource-intensive disease, such as SCCHN, that requires a multimodal care. Future research is needed to better understand how to compare the costs and cost-effectiveness of different modalities for SCCHN.

  2. Downregulation of SERPINB13 expression in head and neck squamous cell carcinomas associates with poor clinical outcome.

    PubMed

    de Koning, Pieter J A; Bovenschen, Niels; Leusink, Frank K J; Broekhuizen, Roel; Quadir, Razi; van Gemert, Jan T M; Hordijk, Gerrit J; Chang, Wun-Shaing W; van der Tweel, Ingeborg; Tilanus, Marcel G J; Kummer, J Alain

    2009-10-01

    Tumorigenesis of head and neck squamous cell carcinomas (HNSCC) is associated with various genetic changes such as loss of heterozygosity (LOH) on human chromosome 18q21. This chromosomal region maps a gene cluster coding for a family of intracellular serine protease inhibitors (serpins), including SERPINB13. As SERPINB13 expression in HNSCC has recently been shown to be downregulated both at the mRNA and protein levels, here we investigated if such a low SERPINB13 expression is associated with histopathological and clinical parameters of HNSCC tumors and patient survival. By generating specific antibodies followed by immunohistochemistry on a well-defined cohort of 99 HNSCC of the oral cavity and oropharynx, SERPINB13 expression was found to be partially or totally downregulated in 75% of the HNSCC as compared with endogenous expression in non-neoplastic epithelial cells. Downregulation of SERPINB13 protein expression in HNSCC was significantly associated with the presence of LOH at the SERPINB13 gene in the tumors (p = 0.006), a poor differentiation grade of the tumors (p = 0.001), the presence of a lymph node metastasis (p = 0.012), and a decreased disease-free (p = 0.033) as well as overall (p = 0.018) survival of the patients. This is the first report demonstrating that downregulation of SERPINB13 protein expression in HNSCC is positively associated with poor clinical outcome. Therefore, SERPINB13 seems to act as an important protease inhibitor involved in the progression of HNSCC.

  3. Validation workflow for a clinical Bayesian network model in multidisciplinary decision making in head and neck oncology treatment.

    PubMed

    Cypko, Mario A; Stoehr, Matthaeus; Kozniewski, Marcin; Druzdzel, Marek J; Dietz, Andreas; Berliner, Leonard; Lemke, Heinz U

    2017-02-15

    Oncological treatment is being increasingly complex, and therefore, decision making in multidisciplinary teams is becoming the key activity in the clinical pathways. The increased complexity is related to the number and variability of possible treatment decisions that may be relevant to a patient. In this paper, we describe validation of a multidisciplinary cancer treatment decision in the clinical domain of head and neck oncology. Probabilistic graphical models and corresponding inference algorithms, in the form of Bayesian networks, can support complex decision-making processes by providing a mathematically reproducible and transparent advice. The quality of BN-based advice depends on the quality of the model. Therefore, it is vital to validate the model before it is applied in practice. For an example BN subnetwork of laryngeal cancer with 303 variables, we evaluated 66 patient records. To validate the model on this dataset, a validation workflow was applied in combination with quantitative and qualitative analyses. In the subsequent analyses, we observed four sources of imprecise predictions: incorrect data, incomplete patient data, outvoting relevant observations, and incorrect model. Finally, the four problems were solved by modifying the data and the model. The presented validation effort is related to the model complexity. For simpler models, the validation workflow is the same, although it may require fewer validation methods. The validation success is related to the model's well-founded knowledge base. The remaining laryngeal cancer model may disclose additional sources of imprecise predictions.

  4. The mutational spectrum of squamous-cell carcinoma of the head and neck: targetable genetic events and clinical impact.

    PubMed

    Mountzios, G; Rampias, T; Psyrri, A

    2014-10-01

    Squamous-cell cancer of the head and neck (SCCHN) represents a heterogeneous disease entity, with various etiological factors implicated in the genesis of distinct molecular subsets of tumors, which exhibit different biological and clinical behavior. Treatment of SCCHN is expected to change in the next decade as targeted therapies continue to make strides. Recently, next-generation sequencing studies conducted on ∼190 SCCHN specimens shed light into the molecular pathogenesis of the disease. These studies discovered mutations in genes involved in the differentiation program of squamous epithelium and the Notch/p63 axis (such as NOTCH1, TP63 and FBXW7), and validated genetic alterations derived from previous studies (such as mutations in TP53, CDKN2A, PIK3CA, CCND1 and HRAS) as driver genetic events in SCCHN neoplastic transformation. More recently, comprehensive data from The Cancer Genome Atlas (TCGA) project on 306 SCCHN specimens provided further insight into SCCHN inherent molecular complexity, identifying novel significantly mutated genes, including FAT1, MLL2, TGFRBR2, HLA-A, NFE2l2 and CASP8. In this article, we provide an overview of the mutational spectrum of SCCHN, with emphasis on the clinical implementation of this knowledge. We also discuss the potential integration of new data within the framework of precision cancer medicine.

  5. Botulinum Toxin for the Treatment of Myofascial Pain Syndromes Involving the Neck and Back: A Review from a Clinical Perspective

    PubMed Central

    Climent, José M.; Fenollosa, Pedro; Martin-del-Rosario, Francisco

    2013-01-01

    Introduction. Botulinum toxin inhibits acetylcholine (ACh) release and probably blocks some nociceptive neurotransmitters. It has been suggested that the development of myofascial trigger points (MTrP) is related to an excess release of ACh to increase the number of sensitized nociceptors. Although the use of botulinum toxin to treat myofascial pain syndrome (MPS) has been investigated in many clinical trials, the results are contradictory. The objective of this paper is to identify sources of variability that could explain these differences in the results. Material and Methods. We performed a content analysis of the clinical trials and systematic reviews of MPS. Results and Discussion. Sources of differences in studies were found in the diagnostic and selection criteria, the muscles injected, the injection technique, the number of trigger points injected, the dosage of botulinum toxin used, treatments for control group, outcome measures, and duration of followup. The contradictory results regarding the efficacy of botulinum toxin A in MPS associated with neck and back pain do not allow this treatment to be recommended or rejected. There is evidence that botulinum toxin could be useful in specific myofascial regions such as piriformis syndrome. It could also be useful in patients with refractory MPS that has not responded to other myofascial injection therapies. PMID:23533477

  6. ICF Core Set for Head and Neck Cancer: Do the Categories Discriminate Among Clinically Relevant Subgroups of Patients?

    ERIC Educational Resources Information Center

    Tschiesner, Uta; Oberhauser, Cornelia; Cieza, Alarcos

    2011-01-01

    The multidisciplinary assessment of functioning in patients with head and neck cancer (HNC) according to the "ICF Core Set for Head and Neck Cancer" (ICF-HNC) was developed in an international and multi-disciplinary approach. The ICF-HNC is an application of the ICF that was adopted by the World Health Organization. The objective of this study was…

  7. ICF Core Set for Head and Neck Cancer: Do the Categories Discriminate Among Clinically Relevant Subgroups of Patients?

    ERIC Educational Resources Information Center

    Tschiesner, Uta; Oberhauser, Cornelia; Cieza, Alarcos

    2011-01-01

    The multidisciplinary assessment of functioning in patients with head and neck cancer (HNC) according to the "ICF Core Set for Head and Neck Cancer" (ICF-HNC) was developed in an international and multi-disciplinary approach. The ICF-HNC is an application of the ICF that was adopted by the World Health Organization. The objective of this study was…

  8. Immunonutrition improves functional capacities in head and neck and esophageal cancer patients undergoing radiochemotherapy: a randomized clinical trial.

    PubMed

    Vasson, M-P; Talvas, J; Perche, O; Dillies, A-F; Bachmann, P; Pezet, D; Achim, A-C; Pommier, P; Racadot, S; Weber, A; Ramdani, M; Kwiatkowski, F; Bouteloup, C

    2014-04-01

    Malnutrition is frequent in head and neck (HN) and esophageal cancer patients and aggravated by radiochemotherapy (RCT), increasing morbi-mortality and treatment toxicity. Our goal was to investigate the effect of immunonutrition consisting of an arginine, omega-3 fatty acid, nucleotides-enriched diet on nutritional status, and functional capacity in HN or esophageal cancer patients undergoing RCT. 37 patients were randomized in a double-blind clinical trial. 5 days before and until the end of RCT (5-7 weeks), they received either an Immunomodulating Enteral Nutrition (IEN) or an isonitrogenous, isoenergetic Standard Enteral Nutrition (SEN). Anthropometrical parameters, nutritional risk index (NRI), serum albumin, plasma antioxidant capacity, and functional capacity were recorded between the beginning and the end of RCT. A significant gain in total body weight (+2.1 ± 3.1 kg) was observed in IEN patients. Albuminemia and NRI were improved concomitantly in IEN malnourished patients. Plasma antioxidant capacity was improved (+100 ± 13 μM EqTrolox) in IEN patients. Functional capacity measured by WHO Performance Status and Karnofsky index was maintained in IEN patients but significantly reduced in SEN patients. These preliminary data show that immunonutrition could improve the nutritional status together with functional capacity in HN and esophageal cancer patients undergoing RCT. This clinical trial promoted by the University Hospital Center of Clermont-Ferrand has been registered at ClinicalTrial.gov website under the following reference: NCT00333099. Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  9. Significant differences in demographic, clinical, and pathological features in relation to smoking and alcohol consumption among 1,633 head and neck cancer patients

    PubMed Central

    Moyses, Raquel Ajub; López, Rossana Verónica Mendoza; Cury, Patrícia Maluf; Siqueira, Sheila Aparecida Coelho; Curioni, Otávio Alberto; de Gois Filho, José Francisco; Figueiredo, David Livingstone Alves; Head; GENCAPO, Neck Genome Project; Tajara, Eloiza Helena; Michaluart, Pedro

    2013-01-01

    OBJECTIVE: As a lifestyle-related disease, social and cultural disparities may influence the features of squamous cell carcinoma of the head and neck in different geographic regions. We describe demographic, clinical, and pathological aspects of squamous cell carcinoma of the head and neck according to the smoking and alcohol consumption habits of patients in a Brazilian cohort. METHODS: We prospectively analyzed the smoking and alcohol consumption habits of 1,633 patients enrolled in five São Paulo hospitals that participated in the Brazilian Head and Neck Genome Project – Gencapo. RESULTS: The patients who smoked and drank were younger, and those who smoked were leaner than the other patients, regardless of alcohol consumption. The non-smokers/non-drinkers were typically elderly white females who had more differentiated oral cavity cancers and fewer first-degree relatives who smoked. The patients who drank presented significantly more frequent nodal metastasis, and those who smoked presented less-differentiated tumors. CONCLUSIONS: The patients with squamous cell carcinoma of the head and neck demonstrated demographic, clinical, and pathological features that were markedly different according to their smoking and drinking habits. A subset of elderly females who had oral cavity cancer and had never smoked or consumed alcohol was notable. Alcohol consumption seemed to be related to nodal metastasis, whereas smoking correlated with the degree of differentiation. PMID:23778492

  10. Transoral Endoscopic Head and Neck Surgery and Its Role Within the Multidisciplinary Treatment Paradigm of Oropharynx Cancer: Robotics, Lasers, and Clinical Trials.

    PubMed

    Holsinger, F Christopher; Ferris, Robert L

    2015-10-10

    Transoral endoscopic head and neck surgery is a new approach for the treatment of oropharyngeal tumors. Using either a robotic system and/or laser, surgeons gain access through the mouth via minimally invasive technique and thus have improved visualization of the tumors of the oropharynx, without disfiguring incisions. This transoral route of access minimizes long-term speech and swallowing dysfunction. Surgeons view this approach as a considerable technologic advance, analogous to the evolution in radiation therapy from conventional two- and three-dimensional conformal techniques to intensity-modulated techniques. Although the use of radiation with or without chemotherapy to treat oropharyngeal cancer (OPC) is supported by evidence from prospective clinical trials, there are no prospective data supporting the use of this new surgical approach for OPC. Here, we review the fundamentals of transoral endoscopic head and neck surgery, with robotics and laser technology, and discuss ongoing clinical trials for patients with OPC. © 2015 by American Society of Clinical Oncology.

  11. Head and Neck Cancer Survivorship Care Guideline: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Cancer Society Guideline.

    PubMed

    Nekhlyudov, Larissa; Lacchetti, Christina; Davis, Nancy B; Garvey, Thomas Q; Goldstein, David P; Nunnink, J Chris; Ninfea, Jose I Ruades; Salner, Andrew L; Salz, Talya; Siu, Lillian L

    2017-02-27

    Purpose This guideline provides recommendations on the management of adults after head and neck cancer (HNC) treatment, focusing on surveillance and screening for recurrence or second primary cancers, assessment and management of long-term and late effects, health promotion, care coordination, and practice implications. Methods ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. The American Cancer Society (ACS) HNC Survivorship Care Guideline was reviewed for developmental rigor by methodologists. An ASCO Expert Panel reviewed the content and recommendations, offering modifications and/or qualifying statements when deemed necessary. Results The ASCO Expert Panel determined that the ACS HNC Survivorship Care Guideline, published in 2016, is clear, thorough, clinically practical, and helpful, despite the limited availability of high-quality evidence to support many of the recommendations. ASCO endorsed the ACS HNC Survivorship Care Guideline, adding qualifying statements aimed at promoting team-based, multispecialty, multidisciplinary, collaborative head and neck survivorship care. Recommendations The ASCO Expert Panel emphasized that caring for HNC survivors requires a team-based approach that includes primary care clinicians, oncology specialists, otolaryngologists, dentists, and other allied professionals. The HNC treatment team should educate the primary care clinicians and patients about the type(s) of treatment received, the likelihood of potential recurrence, and the potential late and long-term complications. Primary care clinicians should recognize symptoms of recurrence and coordinate a prompt evaluation. They should also be prepared to manage late effects either directly or by referral to appropriate specialists. Health promotion is critical, particularly regarding tobacco cessation and dental care. Additional information is available at www

  12. Transverse Cervical Artery: Consistent Anatomical Landmarks and Clinical Experience with Its Use as a Recipient Artery in Complex Head and Neck Reconstruction.

    PubMed

    Tessler, Oren; Gilardino, Mirko S; Bartow, Matthew J; St Hilaire, Hugo; Womac, Daniel; Dionisopoulos, Tassos; Lessard, Lucie

    2017-03-01

    Many head and neck reconstructions occur in patients with extensive history of surgery or radiation treatment. This leads to complicated free flap reconstructions, especially in choosing recipient vessels in a "frozen neck." The transverse cervical artery is an optimal second-line recipient artery in head and neck reconstruction. Seventy-two neck sides in 36 cadavers were dissected, looking for the transverse cervical artery and transverse cervical vein. Anatomical location of these vessels, their diameter, and length were documented. A retrospective analysis on 19 patients who had head and neck reconstruction using the transverse cervical artery as a recipient artery was undertaken as well with regard to outcome of procedures, reason for surgery, previous operations, and use of vein grafts during surgery. The transverse cervical artery was present in 72 of 72 of cadaveric specimens, and was infraclavicular in two of 72 specimens. Transverse cervical artery length ranged from 4.0 to 7.0 cm, and the mean diameter was 2.65 mm. The transverse cervical vein was present in 61 of 72 cadaveric specimens, the length ranged from 4.0 to 7.0 cm, and the mean diameter was 2.90 mm. The transverse cervical artery averaged 33 mm from midline, and branched off the thyrocervical trunk at an average 17 mm superior to the clavicle. Transverse cervical artery stenosis was markedly less in comparison with external carotid artery stenosis. In a 20-year clinical follow-up study, the transverse cervical artery was the recipient artery in 19 patients. A vein graft was used in one patient, and no flap loss occurred in any of the 19 patients. The transverse cervical artery is a reliable and robust option as a recipient artery in free flap head and neck reconstruction.

  13. Musculoskeletal disorders of the neck and upper limb among sewing machine operators: a clinical investigation.

    PubMed

    Andersen, J H; Gaardboe, O

    1993-12-01

    One hundred and seven women participated in a clinical study of an age-stratified random sample of sewing machine operators compared to a group of auxiliary nurses and home helpers. Four groups, according to years of being a sewing machine operator, consisted of: (controls) 25; (0-7 years) 21; (8-15 years) 25; and (more than 15 years) 36. The numbers of the main clinical diagnoses in the four groups were: cervicobrachial fibromyalgia (myofascial pain syndrome) 2, 4, 11, 24; cervical syndrome 0, 1, 3, 10; and rotator cuff syndrome 1, 1, 6, 11. The observed exposure-response relationship between clinical outcomes and years as a sewing machine operator was maintained when adjusting for current exposure to musculoskeletal strain and other potential confounders. Muscle palpation proved to be a reproducible examination with kappa values around 0.70.

  14. [Current advances in diagnosis and surgical treatment of lymph node metastasis in head and neck cancer].

    PubMed

    Teymoortash, A; Werner, J A

    2012-03-01

    Still today, the status of the cervical lymph nodes is the most important prognostic factor for head and neck cancer. So the individual treatment concept of the lymphatic drainage depends on the treatment of the primary tumor as well as on the presence or absence of suspect lymph nodes in the imaging diagnosis. Neck dissection may have either a therapeutic objective or a diagnostic one. The selective neck dissection is currently the method of choice for the treatment of patients with advanced head and neck cancers and clinical N0 neck. For oncologic reasons, this procedure is generally recommended with acceptable functional and aesthetic results, especially under the aspect of the mentioned staging procedure. In this review article, current aspects on pre- and posttherapeutic staging of the cervical lymph nodes are described and the indication and the necessary extent of neck dissection for head and neck cancer is discussed. Additionally the critical question is discussed if the lymph node metastasis bears an intrinsic risk of metastatic development and thus its removal in a most possible early stage plays an important role. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Current advances in diagnosis and surgical treatment of lymph node metastasis in head and neck cancer

    PubMed Central

    Teymoortash, A.; Werner, J. A.

    2012-01-01

    Still today, the status of the cervical lymph nodes is the most important prognostic factor for head and neck cancer. So the individual treatment concept of the lymphatic drainage depends on the treatment of the primary tumor as well as on the presence or absence of suspect lymph nodes in the imaging diagnosis. Neck dissection may have either a therapeutic objective or a diagnostic one. The selective neck dissection is currently the method of choice for the treatment of patients with advanced head and neck cancers and clinical N0 neck. For oncologic reasons, this procedure is generally recommended with acceptable functional and aesthetic results, especially under the aspect of the mentioned staging procedure. In this review article, current aspects on pre- and posttherapeutic staging of the cervical lymph nodes are described and the indication and the necessary extent of neck dissection for head and neck cancer is discussed. Additionally the critical question is discussed if the lymph node metastasis bears an intrinsic risk of metastatic development and thus its removal in a most possible early stage plays an important role. PMID:23320056

  16. Five-year outcomes of the PYTHAGORAS U.S. clinical trial of the Aorfix endograft for endovascular aneurysm repair in patients with highly angulated aortic necks.

    PubMed

    Malas, Mahmoud B; Hicks, Caitlin W; Jordan, William D; Hodgson, Kim J; Mills, Joseph L; Makaroun, Michel S; Belkin, Michael; Fillinger, Mark F

    2017-06-01

    Early and midterm outcomes of the Prospective Aneurysm Trial: High Angle Aorfix Bifurcated Stent Graft (PYTHAGORAS) trial in patients with highly angulated aortic necks (≥60 degrees) have already been published and shown comparable outcomes to other endografts in normal anatomy. Herein, we present the long-term outcomes of the PYTHAGORAS trial of Aorfix (Lombard Medical, Irvine, Calif) for patients with highly angulated aortic neck anatomy. The Aorfix endograft is a highly conformable nitinol/polyester device designed for transrenal fixation. The U.S. trial enrolled 218 patients and observed all patients at 1 month, 6 months, and 12 months and then annually for a total of 5 years. Endovascular aneurysm repair (EVAR)-specific complications were compared between the standard-angle (<60 degrees) and highly angulated (≥60 degrees) neck groups at 5 years using standard statistical methods. Kaplan-Meier analysis was performed to evaluate the overall 5-year survival and freedom from aneurysm rupture, aneurysm-related mortality, and reintervention. Of the 218 patients enrolled in the trial, there were 67 patients in the standard-angle neck group (I) and 151 patients in the highly angulated neck group (II). Mean proximal neck angle was 45 degrees in group I vs 83 degrees in group II (P < .001). At 5 years, 87% of surviving patients were followed up. The 5-year EVAR-specific results showed no type I or type III endoleak in either group, 4% migration in group I vs 3% in group II, and 4% sac expansion in group I vs 15.0% in group II (P ≥ .27). The 5-year freedom from all-cause mortality was 69% (73% in group I vs 68% in group II; P = .43); from aneurysm-related mortality, 96% (99% vs 95%; P = .44); from aneurysm rupture, 99% (99% vs 99%; P = 1.0); and from device-related secondary intervention, 83% (88% vs 80%; P = .18). None of these differed between groups. The U.S. PYTHAGORAS trial of the Aorfix endograft is the first EVAR clinical trial to include a

  17. Clinical value of monoclonal antibodies and tyrosine kinase inhibitors in the treatment of head and neck squamous cell carcinoma.

    PubMed

    Blaszczak, Wiktoria; Barczak, Wojciech; Wegner, Anna; Golusinski, Wojciech; Suchorska, Wiktoria Maria

    2017-04-01

    Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous group of malignant tumours that affects over 500,000 patients per year. Treatment failure is generally due to the heterogeneity of these tumours and to the serious adverse effects associated with treatment. Immunological system impairment, which is common in HNSCC, further contributes to treatment failure by mediating tumour escape mechanisms. To date, the only clinically approved targeted therapy agent is cetuximab, a monoclonal antibody (mAb) that binds to, and inhibits, epidermal growth factor receptor, which is widely overexpressed in HNSCC. Cetuximab has been proven to induce antibody-dependent cellular cytotoxicity, further magnifying its therapeutic effect. DNA sequencing of HNSCC cells has identified the presence of mutated genes, thus making their protein products potential targets for therapeutic inhibition. Immune mechanisms have been found to have a significant impact on carcinogenesis, thus providing the rationale to support efforts to identify anticancer compounds with immunomodulatory properties. In the context of the rapid development of novel targeted agents, the aim of the present paper is to review our current understanding of HNSCC and to review the novel anticancer agents (mAbs and TKIs) introduced in recent years, including an assessment of their efficacy and mechanisms of action.

  18. Clinical Value of High Mobility Group Box 1 and the Receptor for Advanced Glycation End-products in Head and Neck Cancer: A Systematic Review.

    PubMed

    Nguyen, Austin; Bhavsar, Sheila; Riley, Erinn; Caponetti, Gabriel; Agrawal, Devendra

    2016-10-01

    Introduction High mobility group box 1 is a versatile protein involved in gene transcription, extracellular signaling, and response to inflammation. Extracellularly, high mobility group box 1 binds to several receptors, notably the receptor for advanced glycation end-products. Expression of high mobility group box 1 and the receptor for advanced glycation end-products has been described in many cancers. Objectives To systematically review the available literature using PubMed and Web of Science to evaluate the clinical value of high mobility group box 1 and the receptor for advanced glycation end-products in head and neck squamous cell carcinomas. Data synthesis A total of eleven studies were included in this review. High mobility group box 1 overexpression is associated with poor prognosis and many clinical and pathological characteristics of head and neck squamous cell carcinomas patients. Additionally, the receptor for advanced glycation end-products demonstrates potential value as a clinical indicator of tumor angiogenesis and advanced staging. In diagnosis, high mobility group box 1 demonstrates low sensitivity. Conclusion High mobility group box 1 and the receptor for advanced glycation end-products are associated with clinical and pathological characteristics of head and neck squamous cell carcinomas. Further investigation of the prognostic and diagnostic value of these molecules is warranted.

  19. Neck lump

    MedlinePlus

    ... the neck lump treated. When to Contact a Medical Professional Call your health care provider if you have an abnormal neck swelling or ... to Expect at Your Office Visit The health care provider will take your medical history and do a physical exam. You may ...

  20. Transoral Endoscopic Head and Neck Surgery and Its Role Within the Multidisciplinary Treatment Paradigm of Oropharynx Cancer: Robotics, Lasers, and Clinical Trials

    PubMed Central

    Holsinger, F. Christopher; Ferris, Robert L.

    2015-01-01

    Transoral endoscopic head and neck surgery is a new approach for the treatment of oropharyngeal tumors. Using either a robotic system and/or laser, surgeons gain access through the mouth via minimally invasive technique and thus have improved visualization of the tumors of the oropharynx, without disfiguring incisions. This transoral route of access minimizes long-term speech and swallowing dysfunction. Surgeons view this approach as a considerable technologic advance, analogous to the evolution in radiation therapy from conventional two- and three-dimensional conformal techniques to intensity-modulated techniques. Although the use of radiation with or without chemotherapy to treat oropharyngeal cancer (OPC) is supported by evidence from prospective clinical trials, there are no prospective data supporting the use of this new surgical approach for OPC. Here, we review the fundamentals of transoral endoscopic head and neck surgery, with robotics and laser technology, and discuss ongoing clinical trials for patients with OPC. PMID:26351337

  1. Sustained effects of comprehensive inpatient rehabilitative treatment and sleeping neck support in patients with chronic cervicobrachialgia: a prospective and randomized clinical trial.

    PubMed

    Bernateck, Michael; Karst, Matthias; Merkesdal, Sonja; Fischer, Michael J; Gutenbrunner, Christoph

    2008-12-01

    The objective of this study was to investigate the long-term efficacy of inpatient rehabilitation using sleeping neck support in patients suffering from chronic cervicobrachialgia. A prospective, randomized clinical trial with a 12-month follow-up was done. A total of 149 patients suffering from chronic cervicobrachialgia received a 4-week inpatient rehabilitation programme. The patients were randomly divided into two groups. The patients in one group were given a special neck pillow to use during and after the rehabilitative treatment (n=76); the patients in the other group were not given the pillow (n=73). Two weeks before, during, and after (3, 6, 9, and 12 months) the 4-week treatment period, the patients completed a questionnaire dealing with the intensity of their cervicobrachial complaints (pain intensity, muscular tension, paraesthesia, and sleep disorders caused by pain or paraesthesia). During the inpatient treatment period, no significant differences were detected between the groups; however, 1-12 months after discharge, the group with sleeping neck support showed a significantly (P<0.05) smaller increase in the intensity of cervical spine pain. Sleep disturbances caused by pain were also reduced significantly (P<0.001 after 3 months, respectively, P<0.05 after 12 months). Inpatient rehabilitative treatment has sustained effects in patients suffering from chronic cervicobrachialgia, particularly when a sleeping neck support is added.

  2. Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation, exercise, and patient education.

    PubMed

    Cleland, Joshua A; Childs, John D; Fritz, Julie M; Whitman, Julie M; Eberhart, Sarah L

    2007-01-01

    To date, no studies have investigated the predictive validity of variables from the initial examination to identify patients with neck pain who are likely to benefit from thoracic spine thrust manipulation. The purpose of this study was to develop a clinical prediction rule (CPR) to identify patients with neck pain who are likely to experience early success from thoracic spine thrust manipulation. This was a prospective, cohort study of patients with mechanical neck pain who were referred for physical therapy. Subjects underwent a standardized examination and then a series of thoracic spine thrust manipulation techniques. They were classified as having experienced a successful outcome at the second and third sessions based on their perceived recovery. Potential predictor variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for prediction of treatment success. Data for 78 subjects were included in the data analysis, of which 42 had a successful outcome. A CPR with 6 variables was identified. If 3 of the 6 variables (positive likelihood ratio=5.5) were present, the chance of experiencing a successful outcome improved from 54% to 86%. The CPR provides the ability to a priori identify patients with neck pain who are likely to experience early success with thoracic spine thrust manipulation. However, future studies are necessary to validate the rule.

  3. Do post-operative changes of neck-shaft angle and femoral component anteversion have an effect on clinical outcome following uncemented total hip arthroplasty?

    PubMed

    Müller, M; Abdel, M P; Wassilew, G I; Duda, G; Perka, C

    2015-12-01

    The accurate reconstruction of hip anatomy and biomechanics is thought to be important in achieveing good clinical outcomes following total hip arthroplasty (THA). To this end some newer hip designs have introduced further modularity into the design of the femoral component such that neck-shaft angle and anteversion, which can be adjusted intra-operatively. The clinical effect of this increased modularity is unknown. We have investigated the changes in these anatomical parameters following conventional THA with a prosthesis of predetermined neck-shaft angle and assessed the effect of changes in the hip anatomy on clinical outcomes. In total, 44 patients (mean age 65.3 years (standard deviation (SD) 7); 17 male/27 female; mean body mass index 26.9 (kg/m²) (SD 3.1)) underwent a pre- and post-operative three-dimensional CT scanning of the hip. The pre- and post-operative neck-shaft angle, offset, hip centre of rotation, femoral anteversion, and stem alignment were measured. Additionally, a functional assessment and pain score were evaluated before surgery and at one year post-operatively and related to the post-operative anatomical changes. The mean pre-operative neck-shaft angle was significantly increased by 2.8° from 128° (SD 6.2; 119° to 147°) to 131° (SD 2.1; 127° to 136°) (p = 0.009). The mean pre-operative anteversion was 24.9° (SD 8; 7.9 to 39.1) and reduced to 7.4° (SD 7.3; -11.6° to 25.9°) post-operatively (p < 0.001). The post-operative changes had no influence on function and pain. Using a standard uncemented femoral component, high pre- and post-operative variability of femoral anteversion and neck-shaft angles was found with a significant decrease of the post-operative anteversion and slight increase of the neck-shaft angles, but without any impact on clinical outcome.

  4. Quality and comfort in head and neck hyperthermia: A redesign according to clinical experience and simulation studies.

    PubMed

    Rijnen, Zef; Togni, Paolo; Roskam, Roel; van de Geer, Stefan G; Goossens, Richard H M; Paulides, Margarethus M

    2015-01-01

    Clinical phase III trials have shown the benefit of adding hyperthermia to radiotherapy and chemotherapy for head and neck cancer (H&N). The HYPERcollar, a functional prototype capable of applying hyperthermia to the entire H&N region was developed. Specific absorption rate-based hyperthermia treatment planning (HTP) is used to optimise HYPERcollar treatments. Hence, besides treatment quality, reproduction and reproducibility of the HTP are also pivotal. In the current work we analysed the impact of key parameters on treatment quality and completely redesigned the mechanical layout of the HYPERcollar for improved treatment quality and patient comfort. The requirements regarding patient position and the water bolus shape were quantified by simulation studies. The complete mechanical redesign was based on these requirements and non-modellable improvements were experimentally validated. From simulation studies we imposed the required positioning accuracy to be within ±5 mm. Simulation studies also showed that the water bolus shape has an important impact on treatment quality. Solutions to meet the requirements were 1) a redesign of the applicator, 2) a redesign of the water bolus, and 3) a renewed positioning strategy. Experiments were used to demonstrate whether the solutions meet the requirements. The HYPERcollar redesign improves water bolus shape, stability and skin contact. The renewed positioning strategy allows for positioning of the patient within the required precision of ±5 mm. By clinically introducing the new design, we aim at improving not only treatment quality and reproducibility, but also patient comfort and operator handling, which are all important for a better hyperthermia treatment quality.

  5. The clinical application of the 100mL water swallow test in head and neck cancer.

    PubMed

    Patterson, Joanne M; Hildreth, Anthony; McColl, Elaine; Carding, Paul N; Hamilton, David; Wilson, Janet A

    2011-03-01

    Water swallow tests have been used as to screen patients with neurological dysphagia who are at risk of aspiration. This study examines the clinical utility of the 100mL water swallow test (WST) in head and neck cancer, by measuring its sensitivity and specificity for identifying aspiration and for monitoring swallow performance up to one year following (chemo)radiotherapy. Patients referred for (chemo)radiotherapy were assessed on the WST (n=173) pre-treatment and 3, 6 and 12months post-treatment. Patients failed the test if they coughed or had a wet voice quality post swallow or were unable to finish the task. A Flexible Endoscopic Evaluation of Swallowing was conducted at the same time points, to test for the presence of aspiration. The WST was timed and the number of swallows required was recorded. Sensitivity of the WST for predicting aspiration was >67%, specificity >46%. There was marked deterioration from pre- to 3months post-treatment for the time taken to drink 100mL (p=0.005), but this improved over the first year (p=0.001). Disease characteristics, patient demographics, radiotherapy dose, or treatment volume were not predictors of this improvement. The 100mL WST is a quick and simple assessment for identifying patients with aspiration, post (chemo)radiotherapy. This test is a useful adjunct to a clinical examination, helping to highlight patients who require an instrumental assessment such as videofluoroscopy. Furthermore, quantitative measures can be derived from this test, which can be used as a measure of swallow performance over time. Copyright © 2010 Elsevier Ltd. All rights reserved.

  6. Adherence to and uptake of clinical practice guidelines: lessons learned from a clinical practice guideline on chemotherapy concomitant with radiotherapy in head-and-neck cancer

    PubMed Central

    Hall, S.F.; Irish, J.C.; Gregg, R.W.; Groome, P.A.; Rohland, S.

    2015-01-01

    Background Clinical practice guidelines (cpgs) are systematically developed statements designed to assist practitioners and patients in making decisions about appropriate heath care interventions. Clinical practice guidelines are expensive and time-consuming to create. A cpg on concurrent chemotherapy with radiation therapy (ccrt) was developed in Ontario at a time when treatment approaches for head-and-neck cancer were changing significantly. Methods An assessment of treatments and outcomes based on electronic and chart data obtained from a population-based study of 571 patients with oropharynx cancer treated in Ontario (2003–2004) was combined with a review of relevant knowledge transfer (publications and presentations at major meetings) to understand variation in adherence to a cpg. Results In 9 Ontario cancer treatment centres, ccrt was used for 55% of all patients with oropharyngeal cancer; however, at the centres individually, that proportion ranged from 82% to 39%. Furthermore, there was no agreement on the chemotherapy regimen: 2–4 years later (a period during which newer regimens were emerging), only 4 of 9 centres were following the guideline for most patients. When outcomes of treated patients were compared for centres with “higher” and “lower” use of ccrt, no difference in survival was observed (p = 0.64). Conclusions At a time of treatment evolution, the new guideline was controversial, and there are many reasons for the mixed adherence. An estimation of adherence should be included during both development and review of guidelines. PMID:25908922

  7. Neck-Related Physical Function, Self-Efficacy, and Coping Strategies in Patients With Cervical Radiculopathy: A Randomized Clinical Trial of Postoperative Physiotherapy.

    PubMed

    Wibault, Johanna; Öberg, Birgitta; Dedering, Åsa; Löfgren, Håkan; Zsigmond, Peter; Persson, Liselott; Andell, Maria; R Jonsson, Margareta; Peolsson, Anneli

    2017-06-01

    The purpose of this study was to compare postoperative rehabilitation with structured physiotherapy to the standard approach in patients with cervical radiculopathy (CR) in a prospective randomized study at 6 months follow-up based on measures of neck-related physical function, self-efficacy, and coping strategies. Patients with persistent CR and scheduled for surgery (N = 202) were randomly assigned to structured postoperative physiotherapy or a standard postoperative approach. Structured postoperative physiotherapy combined neck-specific exercises with a behavioral approach. Baseline, 3-month, and 6-month evaluations included questionnaires and clinical examinations. Neck muscle endurance, active cervical range of motion, self-efficacy, pain catastrophizing (CSQ-CAT), perceived control over pain, and ability to decrease pain were analyzed for between-group differences using complete case and per-protocol approaches. No between-group difference was reported at the 6-month follow-up (P = .05-.99), but all outcomes had improved from baseline (P < .001). Patients undergoing structured postoperative physiotherapy with ≥50% attendance at treatment sessions had larger improvements in CSQ-CAT (P = .04) during the rehabilitation period from 3 to 6 months after surgery compared with the patients who received standard postoperative approach. No between-group difference was found at 6 months after surgery based on measures of neck-related physical function, self-efficacy, and coping strategies. However, the results confirm that neck-specific exercises are tolerated by patients with CR after surgery and may suggest a benefit from combining surgery with structured postoperative physiotherapy for patients with CR. Copyright © 2017. Published by Elsevier Inc.

  8. Upper cervical and upper thoracic thrust manipulation versus nonthrust mobilization in patients with mechanical neck pain: a multicenter randomized clinical trial.

    PubMed

    Dunning, James R; Cleland, Joshua A; Waldrop, Mark A; Arnot, Cathy F; Young, Ian A; Turner, Michael; Sigurdsson, Gisli

    2012-01-01

    Randomized clinical trial. To compare the short-term effects of upper cervical and upper thoracic high-velocity low-amplitude (HVLA) thrust manipulation to nonthrust mobilization in patients with neck pain. Although upper cervical and upper thoracic HVLA thrust manipulation and nonthrust mobilization are common interventions for the management of neck pain, no studies have directly compared the effects of both upper cervical and upper thoracic HVLA thrust manipulation to nonthrust mobilization in patients with neck pain. Patients completed the Neck Disability Index, the numeric pain rating scale, the flexion-rotation test for measurement of C1-2 passive rotation range of motion, and the craniocervical flexion test for measurement of deep cervical flexor motor performance. Following the baseline evaluation, patients were randomized to receive either HVLA thrust manipulation or nonthrust mobilization to the upper cervical (C1-2) and upper thoracic (T1-2) spines. Patients were reexamined 48-hours after the initial examination and again completed the outcome measures. The effects of treatment on disability, pain, C1-2 passive rotation range of motion, and motor performance of the deep cervical flexors were examined with a 2-by-2 mixed-model analysis of variance (ANOVA). One hundred seven patients satisfied the eligibility criteria, agreed to participate, and were randomized into the HVLA thrust manipulation (n = 56) and nonthrust mobilization (n = 51) groups. The 2-by-2 ANOVA demonstrated that patients with mechanical neck pain who received the combination of upper cervical and upper thoracic HVLA thrust manipulation experienced significantly (P<.001) greater reductions in disability (50.5%) and pain (58.5%) than those of the nonthrust mobilization group (12.8% and 12.6%, respectively) following treatment. In addition, the HVLA thrust manipulation group had significantly (P<.001) greater improvement in both passive C1-2 rotation range of motion and motor performance of

  9. SERIAL NECK ULTRASOUND IS MORE LIKELY TO IDENTIFY FALSE-POSITIVE ABNORMALITIES THAN CLINICALLY SIGNIFICANT DISEASE IN LOW-RISK PAPILLARY THYROID CANCER PATIENTS.

    PubMed

    Yang, Samantha Peiling; Bach, Ariadne M; Tuttle, R Michael; Fish, Stephanie A

    2015-12-01

    American Thyroid Association (ATA) low-risk papillary thyroid cancer (PTC) patients without structural evidence of disease on initial posttreatment evaluation have a low risk of recurrence. Despite this, most patients undergo frequent surveillance neck ultrasound (US). The objective of the study was to evaluate the clinical utility of routine neck US in ATA low-risk PTC patients with no structural evidence of disease after their initial thyroid surgery. We performed a retrospective review of 171 ATA low-risk PTC patients after total thyroidectomy, with or without radioactive iodine (RAI) ablation, who had a neck US without suspicious findings after therapy. The main outcome measure was a comparison of the frequency of finding false-positive US abnormalities and the frequency of identifying structural disease recurrence. Over a median follow-up of 8 years, 171 patients underwent a median of 5 neck US (range 2-17). Structural recurrence with low-volume disease (≤1 cm) was identified in 1.2% (2/171) of patients at a median of 2.8 years (range 1.6-4.1 years) after their initial diagnosis. Recurrence was associated with rising serum thyroglobulin (Tg) level in 1 of the 2 patients and was detected without signs of biochemical recurrence in the other patient. Conversely, false-positive US abnormalities were identified in 67% (114/171) of patients after therapy, leading to additional testing without identifying clinically significant disease. In ATA low-risk patients without structural evidence of disease on initial surveillance evaluation, routine screening US is substantially more likely to identify false-positive results than clinically significant structural disease recurrence.

  10. SERIAL NECK ULTRASOUND IS MORE LIKELY TO IDENTIFY FALSE-POSITIVE ABNORMALITIES THAN CLINICALLY SIGNIFICANT DISEASE IN LOW-RISK PAPILLARY THYROID CANCER PATIENTS

    PubMed Central

    Yang, Samantha Peiling; Bach, Ariadne M.; Tuttle, R. Michael; Fish, Stephanie A.

    2016-01-01

    Objective American Thyroid Association (ATA) low-risk papillary thyroid cancer (PTC) patients without structural evidence of disease on initial posttreatment evaluation have a low risk of recurrence. Despite this, most patients undergo frequent surveillance neck ultrasound (US). The objective of the study was to evaluate the clinical utility of routine neck US in ATA low-risk PTC patients with no structural evidence of disease after their initial thyroid surgery. Methods We performed a retrospective review of 171 ATA low-risk PTC patients after total thyroidectomy, with or without radioactive iodine (RAI) ablation, who had a neck US without suspicious findings after therapy. The main outcome measure was a comparison of the frequency of finding false-positive US abnormalities and the frequency of identifying structural disease recurrence. Results Over a median follow-up of 8 years, 171 patients underwent a median of 5 neck US (range 2–17). Structural recurrence with low-volume disease (≤1 cm) was identified in 1.2% (2/171) of patients at a median of 2.8 years (range 1.6–4.1 years) after their initial diagnosis. Recurrence was associated with rising serum thyroglobulin (Tg) level in 1 of the 2 patients and was detected without signs of biochemical recurrence in the other patient. Conversely, false-positive US abnormalities were identified in 67% (114/171) of patients after therapy, leading to additional testing without identifying clinically significant disease. Conclusion In ATA low-risk patients without structural evidence of disease on initial surveillance evaluation, routine screening US is substantially more likely to identify false-positive results than clinically significant structural disease recurrence. PMID:26372300

  11. Early history of neck dissection.

    PubMed

    Rinaldo, Alessandra; Ferlito, Alfio; Silver, Carl E

    2008-12-01

    With the exception of distant metastases, the presence of lymph node metastasis in the neck is accepted as the single most important adverse independent prognostic factor and an indicator of survival in squamous carcinoma of the head and neck. Neck dissection in its various forms is the standard surgical treatment for clinical, subclinical and subpathologic metastatic cancer to the neck. The pertinent literature from the beginning of the nineteenth century to the middle of the twentieth century was reviewed. The four giants of late nineteenth century surgery: von Langenbeck, Billroth, von Volkmann and Kocher developed and reported the early cases of different types of neck dissection. Butlin, in England, conceived and developed the concept of elective neck dissection. In 1888, the Polish surgeon Jawdyńsky reported and described in detail the first successful extended en bloc neck dissection. Crile, in 1905 and 1906, reported the first significant series of radical en bloc neck dissections, bringing this procedure to the attention of the medical world as an effective operation with reproducible technique and results. The greatest impetus to the status of this surgical procedure came from Martin and colleagues, who published a monumental report in 1951 of 1,450 cases that established the place and technique of radical neck dissection in the modern treatment of head and neck cancer. Neck dissection, for treatment of cervical lymph node metastases in head and neck cancer, was conceived and attempted in the nineteenth century, with some limited success reported by the end of that era. An effective operation was described and reported in the early twentieth century and evolved by the mid century into a fundamental tool in the management of patients with head and neck cancer.

  12. Impact of HPV infection on the clinical outcome of p-CAIR trial in head and neck cancer.

    PubMed

    Snietura, Miroslaw; Piglowski, Wojciech; Jaworska, Magdalena; Mucha-Malecka, Anna; Wozniak, Grzegorz; Lange, Dariusz; Suwinski, Rafal

    2011-05-01

    The purpose of the study was to analyse the influence of HPV infection on the outcome of a randomized clinical trial of conventional (CF) versus 7-days-a-week postoperative radiotherapy (p-CAIR) for squamous cell cancer of the head and neck (SCCHN). Between 2001 and 2004, 279 patients with high-risk SCC of the larynx or cancer of the oral cavity/oropharynx were randomized to receive 63 Gy in fractions of 1.8 Gy given 5 days a week or 7 days a week (Radiother Oncol 87:155-163, 2008). The presence of HPV DNA in 131 archival paraffin blocks was assessed with multiplex quantitative real-time PCR using five consensus primers for the conservative L1 region and molecular beacon probes targeting 14 high-risk HPV subtypes. Following the RT-PCR procedure, we could determine the presence and type of HPV16, HPV18 and the other 12 less frequent oncogenic subtypes. Out of 131 samples, 9 were positive for HPV infection (6.9%), all of them with HPV16 subtype. None of the 65 laryngeal tumours was HPV positive. The 5-year LRC in HPV-positive patients was 100%, compared to 58% in the HPV-negative group (p = 0.02, log-rank test). Amongst 122 patients with HPV-negative tumours, 5-year LRC was 50.3% in p-CF versus 65.2 in p-CAIR (p = 0.37). HPV infection was associated with low expression of EGFR and cyclin D. This study demonstrates a favourable outcome for HPV-positive patients with SCCHN treated with postoperative radiotherapy. While considering the small number of HPV+ tumours, the data set can be considered as hypothesis generating only, the outcome raises new questions on the necessity of aggressive postoperative treatment in HPV+ patients.

  13. Clinical features and prognostic factors in patients with head and neck cancer: Results from a multicentric study.

    PubMed

    Leoncini, Emanuele; Vukovic, Vladimir; Cadoni, Gabriella; Pastorino, Roberta; Arzani, Dario; Bosetti, Cristina; Canova, Cristina; Garavello, Werner; La Vecchia, Carlo; Maule, Milena; Petrelli, Livia; Pira, Enrico; Polesel, Jerry; Richiardi, Lorenzo; Serraino, Diego; Simonato, Lorenzo; Ricciardi, Walter; Boccia, Stefania

    2015-06-01

    The purpose of this study is to evaluate whether demographics, lifestyle habits, clinical data and alcohol dehydrogenase polymorphisms rs1229984 and rs1573496 associated with first primary head and neck (HNC) are associated with overall survival, recurrence, and second primary cancer (SPC). We conducted a follow-up study in five centres including 801 cases. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for overall survival, recurrence and SPC. Five-years overall survival was 62% for HNC cases, 55% for oral cavity, 53% for oropharynx, 41% for hypopharynx, and 71% for larynx. Predictors of survival were older ages (HR=1.18 for 5 years increase; CI: 1.07-1.30), higher tumour stage (HR=4.16; CI: 2.49-6.96), and high alcohol consumption (HR=3.93; CI: 1.79-8.63). A combined therapy (HR=3.29; CI: 1.18-9.13) was associated with a worst prognosis for oral cavity cancer. The only predictor was higher tumour stage (HR=2.25; CI: 1.26-4.03) for recurrence, and duration of smoking (HR=1.91; CI: 1.00-3.68) for SPC. ADH1B rs1229984 polymorphism HRs for HNC and oesophageal cancer death and for alcohol related cancer death were 0.67 (95% CI: 0.42-1.08), and 0.64 (95% CI: 0.40-1.03), respectively. The survival expectation differs among HNC sites. Increasing age and stage, and high alcohol consumption were unfavourable predictors of HNC survival overall. Duration of tobacco consumption before the first primary tumour was a risk factor for SPC. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. The development of a Patients Concerns Inventory (PCI) to help reveal patients concerns in the head and neck clinic.

    PubMed

    Rogers, S N; El-Sheikha, J; Lowe, D

    2009-07-01

    The purpose of the Patients Concerns Inventory (PCI) is to identify the concerns that patients would like to discuss during their consultation. The PCI covers a range of issues including hearing, intimacy, fatigue, financial/benefits, PEG tube, relationships, regret, support for family, and wound healing. It also lists MDT members that patients would like to see or be referred on to. The PCI is completed using a touch-screen computer (TST) immediately before consultation. Responses are networked into the consultation room. A 28 weeks pilot for one consultant ran from August 2007 with 123 (of maximum 150) patients. The median time to complete the TST was 8min. Patients most frequently selected fear of recurrence (37%), dental health/teeth (27%), chewing (24%), pain in head/neck (20%), fatigue/tiredness (19%), saliva (18%) and swallowing (18%). The two MDT members they wished to see were dentist (19%) and speech/language therapist (10%). The vast majority felt the PCI made a difference (quite a bit/very much) to their consultation as it made it 'a bit more personal', 'reminds them of the points they want discussed', 'allows the consultation to get straight to the point'. Although the PCI can raise many issues it did not noticeably prolong the consultation (median 8min with PCI, 7min without PCI). The Patients Concerns Inventory (PCI) helps focus the consultation onto patient needs and promotes multidisciplinary care. Following this very successful pilot the PCI is being rolled out to other consultants in the H & N clinic.

  15. Adoptive therapy of head and neck squamous cell carcinoma with antibody coated immune cells: a pilot clinical trial.

    PubMed

    Riechelmann, Herbert; Wiesneth, Markus; Schauwecker, Peter; Reinhardt, Peter; Gronau, Silke; Schmitt, Anita; Schroen, Carsten; Atz, Judith; Schmitt, Michael

    2007-09-01

    Catumaxomab is an antibody that binds with one arm epithelial cell adhesion molecule (EpCAM) positive tumors and with the other arm CD3+ T cells. Intravenous application of therapeutic antibodies may result in intravascular cytokine release. In this pilot trial we assessed whether cytokine release can be controlled by ex vivo cell opsonization and cytokine wash-out before administration of catumaxomab, preserving its anti-cancer activity. In addition, preliminary data on safety of and clinical response to catumaxomab coated autologous immune cells were acquired. Peripheral blood mononuclear cells (PBMNC) of four patients with recurrent head and neck carcinoma were collected by leukapheresis, incubated ex vivo with catumaxomab for 24 h and cleared from released cytokines. Each patient received an escalated number of antibody-coated PBMNC equivalent to 1 x 10(4), 1 x 10(5), 1 x 10(6) and 1 x 10(7) CD3(+) cells/kgBW intravenously at bi-weekly intervals. After opsonization, PBMNC released substantial amounts of interferon gamma (IFNgamma) and tumor necrosis factor alpha (TNFalpha) in vitro, which were removed before administration. Catumaxomab up-regulated CD25, CD69, and CD83 on PBMNC, and catumaxomab loaded PBMNC released IFNgamma and granzyme B when coincubated with EpCAM(+) BHY cells, suggesting cell activation and target directed biological activity. During the study period, one patient died of aspiration pneumonia and one patient needed a tracheotomy. Treatment related adverse events (AE) occurred at the highest cell dose in two patients, whereas 1 x 10(6) loaded CD3(+) cells/kgBW were well tolerated by all patients. One patient showed stable disease for 6 months and one patient is in complete remission for 27 months. Ex vivo opsonization of PBMNC with catumaxomab provided biologically active, tumor targeting cells. Extracorporeal PBMNC coating may be an option to control intravascular cytokine release induced by therapeutic antibodies.

  16. Clinically significant copy number alterations and complex rearrangements of MYB and NFIB in head and neck adenoid cystic carcinoma.

    PubMed

    Persson, Marta; Andrén, Ywonne; Moskaluk, Christopher A; Frierson, Henry F; Cooke, Susanna L; Futreal, Philip Andrew; Kling, Teresia; Nelander, Sven; Nordkvist, Anders; Persson, Fredrik; Stenman, Göran

    2012-08-01

    Adenoid cystic carcinoma (ACC) of the head and neck is a malignant tumor with poor long-term prognosis. Besides the recently identified MYB-NFIB fusion oncogene generated by a t(6;9) translocation, little is known about other genetic alterations in ACC. Using high-resolution, array-based comparative genomic hybridization, and massively paired-end sequencing, we explored genomic alterations in 40 frozen ACCs. Eighty-six percent of the tumors expressed MYB-NFIB fusion transcripts and 97% overexpressed MYB mRNA, indicating that MYB activation is a hallmark of ACC. Thirty-five recurrent copy number alterations (CNAs) were detected, including losses involving 12q, 6q, 9p, 11q, 14q, 1p, and 5q and gains involving 1q, 9p, and 22q. Grade III tumors had on average a significantly higher number of CNAs/tumor compared to Grade I and II tumors (P = 0.007). Losses of 1p, 6q, and 15q were associated with high-grade tumors, whereas losses of 14q were exclusively seen in Grade I tumors. The t(6;9) rearrangements were associated with a complex pattern of breakpoints, deletions, insertions, inversions, and for 9p also gains. Analyses of fusion-negative ACCs using high-resolution arrays and massively paired-end sequencing revealed that MYB may also be deregulated by other mechanisms in addition to gene fusion. Our studies also identified several down-regulated candidate tumor suppressor genes (CTNNBIP1, CASP9, PRDM2, and SFN) in 1p36.33-p35.3 that may be of clinical significance in high-grade tumors. Further, studies of these and other potential target genes may lead to the identification of novel driver genes in ACC.

  17. Curative treatment of head and neck squamous cell carcinoma : Organ preservation strategies in clinical routine in German-speaking countries.

    PubMed

    Kurzweg, T; Kimmeyer, J; Knecht, R; Hoffmann, T K; Busch, C-J; Lörincz, B B; Schuler, P J; Laban, S

    2016-07-01

    For the treatment of head and neck squamous cell carcinoma (HNSCC), there are currently no official standard of care guidelines in German-speaking countries, with the exception of oral cavity cancer. In order to learn about the applied treatment modalities in the clinical routine, we conducted a web-based survey to evaluate the local standards of palliative and curative treatment of HNSCC. This article focuses on the curative treatment options and organ preservation strategies. The survey consisted of a web-based questionnaire that was performed between November 2013 and July 2014. The questionnaire included ten multiple-choice questions and four open questions in the section about curative treatment. Altogether, 62 of the 204 addressed centers participated in the survey. For primary chemoradiation (CRT), most centers used a platinum-based chemotherapy (52/54, 96.3 %). Induction chemotherapy (ICT) was offered in 37 of the 62 centers (60 %). In oral cavity cancer, CRT and ICT were used in 37.5 and 4.3 % of the cases, respectively. In oropharyngeal cancer, CRT and ICT were applied in 44.5 and 10.3 % of cases, respectively. For hypopharyngeal cancer, 44.8 % of the patients received CRT and 11.8 % received ICT, while for laryngeal cancer 35.9 % received CRT and 9.4 % underwent ICT. Our data showed that a variety of treatments are used for HNSCC within German-speaking countries. Many centers offer ICT. The majority of the hospitals uses platinum-based therapy as a conservative first-line option in their organ preservation protocols.

  18. Clinical outcome of laminoplasty for cervical ossification of the posterior longitudinal ligament with K-line (−) in the neck neutral position but K-line (+) in the neck extension position

    PubMed Central

    Li, Jun; Zhang, Yan; Zhang, Ning; Xv, Zheng-Kuan; Li, Hao; Chen, Gang; Li, Fang-Cai; Chen, Qi-Xin

    2017-01-01

    Abstract Patients with cervical ossification of the posterior longitudinal ligament (OPLL) who are K-line (−) are thought to have poor clinical outcomes after laminoplasty. The aim of this study is to compare the clinical results of patients with OPLL who were K-line (−) in the neck neutral position but K-line (+) in the neck extension position (NEP group) with patients with OPLL who were K-line (+) in the neck neutral position (NNP group). Retrospectively, 42 patients who underwent cervical laminoplasty for OPLL by our surgical group during 2012 and 2013 were reviewed and were followed for at least 2 years. The patients were divided into 2 groups according to K-line status. Standing plain radiographs of the cervical spine were obtained pre- and postoperatively. Cervical spine alignment parameters included the C2–7 Cobb angle and range of motion (ROM) measured on lateral radiographs. Clinical evaluation included pre- and postoperative JOA, NDI, and VAS scores. Ten patients were classified in the NEP group, and 32 patients were classified in the NNP group. Preoperatively, the OPLL involved segments were 4.10 ± 1.66 in the NEP group and 2.53 ± 1.16 in the NNP group (P = .005). The canal-occupying ratios were 58.40 ± 11.11% in the NEP group and 29.08 ± 11.38% in the NNP group (P < .001). The mean Cobb angle of both the groups had not changed significantly at the last follow-up. The mean cervical ROM of both the groups had decreased at the last follow-up. The mean JOA score of the NEP group improved significantly from 9.70 ± 2.16 to 12.50 ± 2.27 (P = .014). The mean JOA score of the NNP group improved significantly from 11.91 ± 1.69 to 14.93 ± 1.58 (P < .001). The mean JOA recovery rate was 32.71 ± 40.45% in the NEP group and 59.00 ± 33.80% in the NNP group (P = .036). The NDI scores of both groups were significantly decreased, and the VAS scores of both groups had not changed significantly at

  19. Clinical outcome of laminoplasty for cervical ossification of the posterior longitudinal ligament with K-line (-) in the neck neutral position but K-line (+) in the neck extension position: A retrospective observational study.

    PubMed

    Li, Jun; Zhang, Yan; Zhang, Ning; Xv, Zheng-Kuan; Li, Hao; Chen, Gang; Li, Fang-Cai; Chen, Qi-Xin

    2017-06-01

    Patients with cervical ossification of the posterior longitudinal ligament (OPLL) who are K-line (-) are thought to have poor clinical outcomes after laminoplasty. The aim of this study is to compare the clinical results of patients with OPLL who were K-line (-) in the neck neutral position but K-line (+) in the neck extension position (NEP group) with patients with OPLL who were K-line (+) in the neck neutral position (NNP group).Retrospectively, 42 patients who underwent cervical laminoplasty for OPLL by our surgical group during 2012 and 2013 were reviewed and were followed for at least 2 years. The patients were divided into 2 groups according to K-line status. Standing plain radiographs of the cervical spine were obtained pre- and postoperatively. Cervical spine alignment parameters included the C2-7 Cobb angle and range of motion (ROM) measured on lateral radiographs. Clinical evaluation included pre- and postoperative JOA, NDI, and VAS scores.Ten patients were classified in the NEP group, and 32 patients were classified in the NNP group. Preoperatively, the OPLL involved segments were 4.10 ± 1.66 in the NEP group and 2.53 ± 1.16 in the NNP group (P = .005). The canal-occupying ratios were 58.40 ± 11.11% in the NEP group and 29.08 ± 11.38% in the NNP group (P < .001). The mean Cobb angle of both the groups had not changed significantly at the last follow-up. The mean cervical ROM of both the groups had decreased at the last follow-up. The mean JOA score of the NEP group improved significantly from 9.70 ± 2.16 to 12.50 ± 2.27 (P = .014). The mean JOA score of the NNP group improved significantly from 11.91 ± 1.69 to 14.93 ± 1.58 (P < .001). The mean JOA recovery rate was 32.71 ± 40.45% in the NEP group and 59.00 ± 33.80% in the NNP group (P = .036). The NDI scores of both groups were significantly decreased, and the VAS scores of both groups had not changed significantly at the last follow

  20. Incidence of oral cancer occult metastasis and survival of T1-T2N0 oral cancer patients.

    PubMed

    El-Naaj, Imad Abu; Leiser, Yoav; Shveis, Myrela; Sabo, Edmond; Peled, Micha

    2011-10-01

    In head and neck cancer, the most important prognostic factor is the presence or absence of neck metastasis. Although still debated in the published data regarding the "wait and see" policy for Stage T1-T2 oral cancer, a large number of clinicians support the necessity of neck dissection, especially in cases of oral tongue carcinoma, because of the poor prognosis and high risk of recurrence. The aim of the present study was to summarize and quantify the incidence of occult metastasis in oral cancer treatment at the oral and maxillofacial surgery department, Rambam Medical Center, in the past 10 years. A total of 142 neck dissections performed at our department in the past 10 years (1998 to 2009) and a series of 68 patients (44 men and 22 women) treated for Stage T1N0 or T2N0 oral cancer were included in the present retrospective study. All patients underwent surgical resection of the oral cancer and selective neck dissection of the ipsilateral side. Occult lymph node metastases were detected in 11 patients (16% overall, 9 in the tongue, 1 in the buccal mucosa, and 1 in the gingiva of the mandible). The frequency of occult metastasis from tongue carcinoma was 34% (9 of 26 cases). The 5-year survival rate in the present study was 78.9%. In patients who underwent chemotherapy, radiotherapy, brachytherapy, or a combination of the 3 after surgical management, the overall survival rate decreased significantly to 22.5% (P = .006, log-rank test). The incidence of occult metastasis in patients with oral cancer in the present study was 16% overall. In those with tongue carcinoma, a much greater incidence (34%) of occult metastasis was detected. Furthermore, the need for chemoradiotherapy after initial surgical management, mainly because of occult metastasis, was a significant negative predictor of patient outcome. The results of the present study emphasize the need for prophylactic neck dissection in patients with oral cancer diagnosed with Stage T1N0 or T2N0 disease

  1. A New Pedicled Internal Mammary Osteomyocutaneous Chimeric Flap (PIMOC) for Salvage Head and Neck Reconstruction: Anatomic Study and Clinical Application.

    PubMed

    Barreiro, Guilherme C; Snider, Chelsea C; Galvão, Flavio H F; Baptista, Rachel R; Kasai, Kiril E; Dos Anjos, Daniel M; Ferreira, Marcus C

    2017-10-11

    Well-vascularized composite tissue offers improved outcomes for complex head and neck reconstruction. Patients with vessel-depleted necks and failed reconstructions require alternative reconstructive options. We describe a pedicled internal mammary artery osteomyocutaneous chimeric flap (PIMOC) for salvage head and neck reconstruction. Bilateral dissections of 35 fresh cadavers were performed to study individual tissue components and vascular pedicles to develop the PIMOC technique. The flap was then utilized in a series of patients with vessel-depleted neck anatomy. The PIMOC was dissected bilaterally in all cadavers and there were no statistical differences in vascular pedicle caliber or length with regards to laterality or gender. Five patients subsequently underwent this procedure. The flaps included a vertical rectus abdominis myocutaneous component and a 6(th) or 7(th) rib with adjacent muscle and skin to restore bone defects, internal lining, and external coverage. All donor sites were closed primarily. There were no flap losses and all patients gained improvements in facial contour, speech and swallow. Although technically complex, the PIMOC is reproducible and provides a safe and reliable option for salvage head and neck reconstruction. The harvest of the 6(th) or 7(th) rib and rectus abdominis muscle renders an acceptable donor site.

  2. Phototheranostic Porphyrin Nanoparticles Enable Visualization and Targeted Treatment of Head and Neck Cancer in Clinically Relevant Models

    PubMed Central

    Muhanna, Nidal; Jin, Cheng S; Huynh, Elizabeth; Chan, Harley; Qiu, Yi; Jiang, Wenlei; Cui, Liyang; Burgess, Laura; Akens, Margarete K; Chen, Juan; Irish, Jonathan C; Zheng, Gang

    2015-01-01

    Head and neck cancer is the fifth most common type of cancer worldwide and remains challenging for effective treatment due to the proximity to critical anatomical structures in the head and neck region, which increases the probability of toxicity from surgery and radiotherapy, and therefore emphasizes the importance of maximizing the targeted ablation. We have assessed the effectiveness of porphysome nanoparticles to enhance fluorescence and photoacoustic imaging of head and neck tumors in rabbit and hamster models. In addition, we evaluated the effectiveness of this agent for localized photothermal ablative therapy of head and neck tumors. We have demonstrated that porphysomes not only enabled fluorescence and photoacoustic imaging of buccal and tongue carcinomas, but also allowed for complete targeted ablation of these tumors. The supremacy of porphysome-enabled photothermal therapy over surgery to completely eradicate primary tumors and metastatic regional lymph node while sparing the adjacent critical structures' function has been demonstrated for the first time. This study represents a novel breakthrough that has the potential to revolutionize our approach to tumor diagnosis and treatment in head and neck cancer and beyond. PMID:26681987

  3. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from thrust joint manipulation to the cervical spine.

    PubMed

    Puentedura, Emilio J; Cleland, Joshua A; Landers, Merrill R; Mintken, Paul E; Louw, Adriaan; Fernández-de-Las-Peñas, César

    2012-07-01

    Prospective cohort/predictive validity study. To determine the predictive validity of selected clinical examination items and to develop a clinical prediction rule to determine which patients with neck pain may benefit from cervical thrust joint manipulation (TJM) and exercise. TJM to the cervical spine has been shown to be effective in patients presenting with a primary report of neck pain. It would be useful for clinicians to have a decision-making tool, such as a clinical prediction rule, that could accurately identify which subgroup of patients would respond positively to cervical TJM. Consecutive patients who presented to physical therapy with a primary complaint of neck pain completed a series of self-report measures, then received a detailed standardized history and physical examination. After the clinical examination, all patients received a standardized treatment regimen consisting of cervical TJM and range-of-motion exercise. Depending on response to treatment, patients were treated for 1 or 2 sessions over approximately 1 week. At the end of their participation in the study, patients were classified as having experienced a successful outcome based on a score of +5 ("quite a bit better") or higher on the global rating of change scale. Sensitivity, specificity, and positive and negative likelihood ratios were calculated for all potential predictor variables. Univariate techniques and stepwise logistic regression were used to determine the most parsimonious set of variables for prediction of treatment success. Variables retained in the regression model were used to develop a multivariate clinical prediction rule. Eighty-two patients were included in data analysis, of whom 32 (39%) achieved a successful outcome. A clinical prediction rule with 4 attributes (symptom duration less than 38 days, positive expectation that manipulation will help, side-to-side difference in cervical rotation range of motion of 10° or greater, and pain with posteroanterior spring

  4. Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association.

    PubMed

    Childs, John D; Cleland, Joshua A; Elliott, James M; Teyhen, Deydre S; Wainner, Robert S; Whitman, Julie M; Sopky, Bernard J; Godges, Joseph J; Flynn, Timothy W

    2008-09-01

    The Orthopaedic Section of the American Physical Therapy Association presents this second set of clinical practice guidelines on neck pain, linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) prognosis, (3) interventions provided by physical therapists, and (4) assessment of outcome for common musculoskeletal disorders.

  5. Development of an attention-touch control for manual cervical distraction: a pilot randomized clinical trial for patients with neck pain.

    PubMed

    Gudavalli, M Ram; Salsbury, Stacie A; Vining, Robert D; Long, Cynthia R; Corber, Lance; Patwardhan, Avinash G; Goertz, Christine M

    2015-06-05

    Manual cervical distraction (MCD) is a traction-based therapy performed with a manual contact over the cervical region producing repeating cycles while patients lie prone. This study evaluated a traction force-based minimal intervention for use as an attention-touch control in clinical trials of MCD for patients with chronic neck pain. We conducted a mixed-methods, pilot randomized clinical trial in adults with chronic neck pain. Participants were allocated to three traction force ranges of MCD: low force/minimal intervention (0-20 N), medium force (21-50 N), or high force (51-100 N). Clinicians delivered five treatments over two weeks consisting of three sets of five cycles of MCD at the C5 vertebra and occiput. Traction forces were measured at each treatment. Patient-reported outcomes included a pain visual analogue scale (VAS), Neck Disability Index (NDI), Credibility and Expectancy Questionnaire (CEQ), and adverse effects. A qualitative interview evaluated treatment group allocation perceptions. We randomized 48 participants, allocating an average of five each month. Forty-five participants completed the trial with three participants lost to follow-up. Most participants were women (65%) and white (92%) with a mean (SD) age of 46.8 (12.5) years. Mean traction force values were within the prescribed force ranges for each group at the C5 and occiput levels. Neck pain VAS demonstrated a benefit for high traction force MCD compared to the low force group [adjusted mean difference 15.6; 95% confidence interval (CI) 1.6 to 29.7]. Participants in the medium traction force group demonstrated improvements in NDI compared to the low force group (adjusted mean difference 3.0; 95% CI 0.1 to 5.9), as did participants in the high traction force group (adjusted mean difference 2.7; 95% CI -0.1 to 5.6). CEQ favored the high force group. Most low force participants correctly identified their treatment allocation in the qualitative interview. No serious adverse events were

  6. Is behavioral graded activity cost-effective in comparison with manual therapy for patients with subacute neck pain? An economic evaluation alongside a randomized clinical trial.

    PubMed

    Bosmans, Judith E; Pool, Jan J M; de Vet, Henrica C W; van Tulder, Maurits W; Ostelo, Raymond W J G

    2011-08-15

    An economic evaluation alongside a randomized controlled trial comparing behavioral graded activity (BGA) with manual therapy (MT). To evaluate the cost-effectiveness of BGA in comparison with MT for patients with subacute neck pain from a societal perspective. Neck pain is common and poses an important socioeconomic burden to society. Data on the cost-effectiveness of treatments for neck pain are scarce. A randomized clinical trial was conducted, involving 146 patients with subacute nonspecific neck pain. The BGA program can be described as a time-contingent increase in activities from baseline toward predetermined goals. MT consists of specific spinal mobilization techniques and exercises. Clinical outcomes included recovery, pain, disability, and quality-adjusted life-years (QALYs). Costs were measured from a societal perspective using cost diaries. The follow-up period was 52 weeks. Multiple imputation was used for missing cost and effect data. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and cost-effectiveness acceptability (CEA) curves were estimated. BGA had no significant effect on recovery or QALYs gained in comparison with MT but pain and disability did improve significantly in the BGA group in comparison with the MT group. Total societal costs in the BGA group were nonsignificantly higher than in the MT group. Cost-effectiveness analyses showed that BGA is not cost-effective in comparison with MT for recovery and QALYs gained. Substantial investments are needed to reach a 0.95 probability that BGA is cost-effective in comparison with MT for pain and disability. On the basis of the data presented, we consider BGA not cost-effective in comparison with MT.

  7. Neck dissection: current concepts and future directions.

    PubMed

    Rigual, Nestor R; Wiseman, Sam M

    2004-01-01

    For individuals diagnosed with head and neck cancer, neck dissection may be performed for therapy or disease staging. The classification of neck dissection and the definition of precise anatomic landmarks have allowed for this operation, and its many variations, to become standardized world-wide. SLNBX shows promise in its ability to accurately stage NO head and neck cancer and may allow patients with no micro metastatic disease to avoid neck dissection. Before this technique becomes adopted into routine clinical practice, however, it must first be prospectively scrutinized in large patient populations. Regardless of the future role of SLNBX in the management of head and neck cancer, currently it is only through a complete understanding of the clinical, theoretic, and technical aspects of neck dis-section that surgeons may benefit individual patients and the head and neck cancer patient population as a whole.

  8. When, how and why to treat the neck in patients with esthesioneuroblastoma: a review.

    PubMed

    Zanation, Adam M; Ferlito, Alfio; Rinaldo, Alessandra; Gore, Mitchell R; Lund, Valerie J; McKinney, Kibwei A; Suárez, Carlos; Takes, Robert P; Devaiah, Anand K

    2010-11-01

    Esthesioneuroblastoma is an uncommon tumor that presents in the sinonasal cavity and anterior skull base. Cervical metastases are not frequently found on initial presentation but eventually occur in 20-25% of these patients. This presents the treating physician with the difficult decision as to how and when to treat the neck in this disease. The aims of this study were to provide a comprehensive review of the incidence of N+ disease at presentation, make recommendations about the optimal treatment strategy of patients with N+ disease, explain the role of elective neck treatment in patients with N0 disease, and comment on treatment of patients with late cervical metastases that require salvage therapy, using the literature review of the incidence and treatment of neck disease in patients with esthesioneuroblastoma. This review revealed an approximately 5-8% incidence of cervical nodal metastasis at the time of presentation. Combined modality therapy with surgery and radiotherapy is recommended to treat the N+ neck at the time of diagnosis and later. Chemotherapy may have a role combined with radiation treatment, but there are little data to support this. There is limited evidence to substantiate the use of elective neck dissection or elective radiotherapy in the clinically and radiologically N0 neck. Patients who have late cervical metastases have a clear survival advantage (59 vs. 14%) when treated with combined surgery and radiotherapy relative to single modality methods alone. The results indicate that the management of the neck in esthesioneuroblastoma continues to be a significant challenge in the treatment algorithm of these complex patients.

  9. Central neck dissection in differentiated thyroid cancer: technical notes.

    PubMed

    Giugliano, G; Proh, M; Gibelli, B; Grosso, E; Tagliabue, M; De Fiori, E; Maffini, F; Chiesa, F; Ansarin, M

    2014-02-01

    Differentiated thyroid cancers may be associated with regional lymph node metastases in 20-50% of cases. The central compartment (VIupper VII levels) is considered to be the first echelon of nodal metastases in all differentiated thyroid carcinomas. The indication for central neck dissection is still debated especially in patients with cN0 disease. For some authors, central neck dissection is recommended for lymph nodes that are suspect preoperatively (either clinically or with ultrasound) and/or for lymph node metastases detected intra-operatively with a positive frozen section. In need of a better definition, we divided the dissection in four different areas to map localization of metastases. In this study, we present the rationale for central neck dissection in the management of differentiated thyroid carcinoma, providing some anatomical reflections on surgical technique, oncological considerations and analysis of complications. Central neck dissection may be limited to the compartments that describe a predictable territory of regional recurrences in order to reduce associated morbidities.

  10. De-escalation of radiation dose for human papillomavirus-positive oropharyngeal head and neck squamous cell carcinoma: A case report and preclinical and clinical literature review.

    PubMed

    Wu, Cheng-Chia; Horowitz, David P; Deutsch, Israel; Rahmati, Rahmatullah; Schecter, Jordan M; Saqi, Anjali; Wang, Tony J C

    2016-01-01

    Traditionally, head and neck squamous cell carcinoma (HNSCC) has been considered to be a relatively homogeneous disease. However, recent data have demonstrated that human papillomavirus (HPV)-positive and HPV-negative disease are two different clinical entities associated with different outcomes. Preclinical and clinical studies have reported a divergence in treatment strategies as well as prognostic outcomes for HNSCCs that are HPV-positive versus HPV-negative. The present study describes the case of a 52-year-old man who presented with stage IVB cT2N3M0 right tonsillar HPV-positive squamous cell carcinoma. Induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF), followed by chemoradiation therapy with carboplatin and 70 Gray (Gy) radiation in daily fractions was recommended. The patient completed the TPF and carboplatin treatment; however, he was unable to tolerate the radiation course, receiving a final dose of 46 Gy. A 60-day follow-up right neck salvage dissection was subsequently performed. Despite having received a partial radiation treatment of 46 Gy, the patient had no pathological evidence of disease at 60 days post radiation treatment. Repeat positron emission tomography-computed tomography at 32 months after the right neck dissection revealed no evidence of disease. The present study also discusses the current preclinical in vitro and in vivo targets for HPV-positive HNSCC and the obstacles presented in advancing clinical treatment modalities. Previous preclinical models investigating radiation sensitivity have yielded mixed results. Thus, it is important to understand and establish representative preclinical models for studying HPV and HNSCC to improve clinical research and therapeutic development. This review may guide future understanding of the role of HPV in HNSCC.

  11. De-escalation of radiation dose for human papillomavirus-positive oropharyngeal head and neck squamous cell carcinoma: A case report and preclinical and clinical literature review

    PubMed Central

    WU, CHENG-CHIA; HOROWITZ, DAVID P.; DEUTSCH, ISRAEL; RAHMATI, RAHMATULLAH; SCHECTER, JORDAN M.; SAQI, ANJALI; WANG, TONY J. C.

    2016-01-01

    Traditionally, head and neck squamous cell carcinoma (HNSCC) has been considered to be a relatively homogeneous disease. However, recent data have demonstrated that human papillomavirus (HPV)-positive and HPV-negative disease are two different clinical entities associated with different outcomes. Preclinical and clinical studies have reported a divergence in treatment strategies as well as prognostic outcomes for HNSCCs that are HPV-positive versus HPV-negative. The present study describes the case of a 52-year-old man who presented with stage IVB cT2N3M0 right tonsillar HPV-positive squamous cell carcinoma. Induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF), followed by chemoradiation therapy with carboplatin and 70 Gray (Gy) radiation in daily fractions was recommended. The patient completed the TPF and carboplatin treatment; however, he was unable to tolerate the radiation course, receiving a final dose of 46 Gy. A 60-day follow-up right neck salvage dissection was subsequently performed. Despite having received a partial radiation treatment of 46 Gy, the patient had no pathological evidence of disease at 60 days post radiation treatment. Repeat positron emission tomography-computed tomography at 32 months after the right neck dissection revealed no evidence of disease. The present study also discusses the current preclinical in vitro and in vivo targets for HPV-positive HNSCC and the obstacles presented in advancing clinical treatment modalities. Previous preclinical models investigating radiation sensitivity have yielded mixed results. Thus, it is important to understand and establish representative preclinical models for studying HPV and HNSCC to improve clinical research and therapeutic development. This review may guide future understanding of the role of HPV in HNSCC. PMID:26870181

  12. Survivors' Experiences of Dysphagia-Related Services Following Head and Neck Cancer: Implications for Clinical Practice

    ERIC Educational Resources Information Center

    Nund, Rebecca L.; Ward, Elizabeth C.; Scarinci, Nerina A.; Cartmill, Bena; Kuipers, Pim; Porceddu, Sandro V.

    2014-01-01

    Background: It is known that people with dysphagia experience a number of negative consequences as a result of their swallowing difficulties following head and neck cancer management (HNC). However their perceptions and experiences of adjusting to dysphagia in the post-treatment phase, and the services received to assist this process, has not been…

  13. Survivors' Experiences of Dysphagia-Related Services Following Head and Neck Cancer: Implications for Clinical Practice

    ERIC Educational Resources Information Center

    Nund, Rebecca L.; Ward, Elizabeth C.; Scarinci, Nerina A.; Cartmill, Bena; Kuipers, Pim; Porceddu, Sandro V.

    2014-01-01

    Background: It is known that people with dysphagia experience a number of negative consequences as a result of their swallowing difficulties following head and neck cancer management (HNC). However their perceptions and experiences of adjusting to dysphagia in the post-treatment phase, and the services received to assist this process, has not been…

  14. Sprain of the neck in clinically treated patients in The Netherlands: an inventory of different categories of car accidents.

    PubMed

    Versteegen, G J; Kingma, J; ten Duis, H J

    2001-06-01

    Different categories of car accidents of victims with sprain of the neck were investigated for both drivers and passengers. The predominant category of the car crash was a collision with another car for drivers as well as for passengers. The second cause was unknown. The distribution of the accidents was statistically significantly different for drivers and passengers.

  15. On realizations of exterior calculus with dN = 0

    NASA Astrophysics Data System (ADS)

    Abramov, V.

    1998-11-01

    We study realizations of the q-exterior calculus with exterior differential d satisfying d N = 0, N > 2 on the free associative algebra with one generator and on the generalized Clifford algebras. Analogs of the notions of connection and curvature are discussed in the case of the q-exterior calculus on the generalized Clifford algebra. We show that the q-exterior calculus on the free associative algebra with one generator is related to q-calculus on the braided line.

  16. The application of a clinical prediction rule for patients with neck pain likely to benefit from cervical traction: A case report.

    PubMed

    Bernstetter, Andrew

    2016-10-01

    Cervical traction is a commonly utilized intervention in the treatment of patients with neck pain. In 2009, a clinical prediction rule (CPR) was developed as a way to assist clinicians in determining the patient population most likely to respond to cervical traction, though this CPR has yet to be validated. The purpose of this case report is to demonstrate the application of that CPR. The patient was a 46-year-old female with a four-week history of right-sided neck and shoulder pain, with numbness and tingling of her thumb and index finger. Treatment consisted of five sessions provided over 3 weeks. The plan of care included home mechanical cervical traction, exercise, and manual therapy. The patient achieved pain-free cervical range of motion. Neck disability index scores decreased from 28% to 6%, and the Patient-Specific Functional Scale average score improved from 5.5 to 10 out of 10. This case report demonstrates the application of a CPR to assist in deciding if cervical traction is an appropriate intervention. Further research is needed to validate the CPR and to establish the optimal mode of delivery for traction.

  17. Clinical decision making associated with an undetected odontoid fracture in an older individual referred to physical therapy for the treatment of neck pain.

    PubMed

    Ross, Michael D; Cheeks, John M

    2008-07-01

    Resident's case problem. The purpose of this paper is to provide the examination of and decision-making process for a patient referred to physical therapy for the treatment of neck pain following trauma. She was found to have an underlying odontoid fracture that precluded physical therapy intervention. This case involved a 73-year-old woman who had a sudden onset of neck and left upper extremity pain after a fall 15 days prior to her initial physical therapy visit. Conventional cervical spine radiographs completed 1 day prior to her initial physical therapy visit were negative for a fracture. However, several components of this patient's history and physical examination were consistent with a condition for which physical therapy intervention would not be indicated until more definitive cervical spine diagnostic imaging had been completed; more specifically, the physical therapist was primarily concerned about the possibility of an undetected fracture. The referring physician was contacted and immediate magnetic resonance imaging was requested, which revealed a type II fracture of the odontoid. Thirty-four days after her fall, the patient underwent a C1-C2 fusion. When evaluating patients with neck pain who have a history of cervical spine trauma, it is important that physical therapists understand the clinical findings associated with cervical spine fractures, as these findings provide guidance for the use of cervical spine diagnostic imaging and medical referral prior to implementing physical therapy interventions. Diagnosis, level 4.

  18. Malakoplakia of the neck.

    PubMed

    Schmerber, Sebastien; Lantuejoul, Sylvie; Lavieille, Jean-Pierre; Reyt, Emile

    2003-11-01

    Malakoplakia that presents in the head and neck is very rare. We describe a 76-year-old man who presented with an inflammatory mass in the lateral aspect of the neck that clinically mimicked a tumoral expansion and was consistent with a cervical malakoplakia. To our knowledge, this is the second case reported with manifestations of this chronic inflammatory disease localized in the neck. Malakoplakia is a rare granulomatous disease that most frequently involves the genitourinary tract and occurs in an immunodeficient host. The symptoms are nonspecific and the diagnosis is based on the histologic findings. In the present case, the biopsy specimen of the cervical mass revealed a collection of numerous von Hansemann cells containing Michaelis-Gutmann bodies, which are pathognomonic of malakoplakia. Bacteriologic analysis identified Escherichia coli. The evolution was favorable after surgical excision and prolonged antibiotic therapy with fluoroquinolones.

  19. Aspiration in head and neck cancer patients: a single centre experience of clinical profile, bacterial isolates and antibiotic sensitivity pattern.

    PubMed

    Lakshmaiah, K C; Sirsath, Nagesh T; Subramanyam, Jayshree R; Govind, Babu K; Lokanatha, D; Shenoy, Ashok M

    2013-07-01

    Most patients with head and neck cancer have dysphagia and are at increased risk of having aspiration and subsequent pneumonia. It can cause prolonged hospitalization, treatment delay and/or interruption and mortality in cancer patients. The treatment of these infections often relies on empirical antibiotics based on local microbiology and antibiotic sensitivity patterns. The aim of present study is to analyse respiratory tract pathogens isolated by sputum culture in head and neck cancer patients undergoing treatment at a tertiary cancer centre in South India who presented with features of aspiration. The study is carried out to establish empirical antibiotic policy for head and neck cancer patients who present with features of aspiration. This was a retrospective study. The study included sputum samples sent for culture and sensitivity from January 2011 to December 2012. Analysis of microbiologic species isolated in sputum specimen and the antibiotic sensitivity pattern of the bacterial isolates was performed. A detailed study of case files of all patients was done to find out which is the most common site prone for producing aspiration. There were 47 (31.54 %) gram positive isolates and 102 (68.45 %) gram negative isolates. The most common bacterial isolates were Klebsiella pneumoniae (25.50 %), Pseudomonas aeruginosa (16.77 %) and Haemophilus influenzae (15.43 %). Levofloxacin was the most effective antibiotic with excellent activity against both gram positive and gram negative isolates. Most patients with aspiration had laryngeal cancer (34.89 %). Aspiration pneumonia was present in 14 (9.39 %) patients. Gram negative bacteria are common etiologic agents in head and neck cancer patients presenting with features of aspiration. Levofloxacin should be started as empirical antibiotic in these patients while awaiting sputum culture sensitivity report. As aspiration in head and neck cancer is an underreported event such institutional antibiotic sensitivity

  20. Anomalies of minimal { N }=(0,1) and { N }=(0,2) sigma models on homogeneous spaces

    NASA Astrophysics Data System (ADS)

    Chen, Jin; Cui, Xiaoyi; Shifman, Mikhail; Vainshtein, Arkady

    2017-01-01

    We study chiral anomalies in { N }=(0,1) and (0,2) two-dimensional minimal sigma models defined on the generic homogeneous spaces G/H. Such minimal theories contain only (left) chiral fermions and in certain cases are inconsistent because of ‘incurable’ anomalies. We explicitly calculate the anomalous fermionic effective action and show how to remedy it by adding a series of local counterterms. In this procedure, we derive a local anomaly matching condition, which is demonstrated to be equivalent to the well-known global topological constraint on {p}1(G/H), the first Pontryagin class. More importantly, we show that these local counterterms further modify and constrain ‘curable’ chiral models, some of which, for example, flow to the nontrivial infrared superconformal fixed point. Finally, we also observe an interesting relation between { N }=(0,1) and (0,2) two-dimensional minimal sigma models and supersymmetric gauge theories.

  1. Primary extra-cranial meningioma of head and neck: clinical, histopathological and immunohistochemical study of three cases.

    PubMed

    Possanzini, P; Pipolo, C; Romagnoli, S; Falleni, M; Moneghini, L; Braidotti, P; Salvatori, P; Paradisi, S; Felisati, G

    2012-10-01

    Extracranial meningiomas of the head and neck region are rare neoplasms, the majority being a secondary location of a primary intracranial tumour. We herewith report three rare cases of extracranial meningiomas, located in the temporal muscle, parotid gland and nasal cavity, together with complete pathological, immunohistochemical and ultrastructural studies. Prognosis of this tumour is generally excellent. Surgical excision is the treatment of choice, with no need for further treatment; nevertheless, differential diagnosis must consider other more common tumours of the head and neck and be based on histopathologic examination and relative techniques, including examination of frozen sections. This procedure is particularly useful assessing surgical treatment and should be performed whenever possible to exclude the malignant nature of the lesion and avoid over-treatment. All three patients underwent surgery and are alive and disease-free.

  2. Fiddler's neck.

    PubMed

    Moreno, J C; Gata, I M; García-Bravo, B; Camacho, F M

    1997-03-01

    The dermatologic pathological condition of musicians is a rare medical problem. We would like to draw attention to what is called "Fiddler's neck," a process that is peculiar to violin, viola, or cello players and that may be caused by two different mechanisms: contact allergic reaction or a mechanical action.

  3. Turning the tide: Clinical utility of PD-L1 expression in squamous cell carcinoma of the head and neck.

    PubMed

    De Meulenaere, Astrid; Vermassen, Tijl; Aspeslagh, Sandrine; Huvenne, Wouter; Van Dorpe, Jo; Ferdinande, Liesbeth; Rottey, Sylvie

    2017-07-01

    The use of cytotoxic and/or targeted agents is the gold standard in first- and second-line treatment of metastatic head and neck cancer. Currently the focus of oncologic research is shifting to the implementation of immune checkpoint inhibitor regimens. Many trials are being performed evaluating the survival benefit of various PD-1/PD-L1 blocking antibodies in both solid and haematological malignancies. Also, evaluation of the predictive value of PD-L1 expression on tumour cells and immune cells is being explored. We first review the current knowledge and possible pitfalls for PD-L1 expression in squamous cell carcinoma of the head and neck. Next, we provide an update on the therapeutic use of PD-1/PD-L1 blocking antibodies as treatment modality for patients with squamous cell carcinoma of the head and neck and we assess the predictive value of tumour PD-L1 positivity. Finally, we elaborate on other promising predictive biomarkers of interest in this patient population. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Does structured patient education improve the recovery and clinical outcomes of patients with neck pain? A systematic review from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

    PubMed

    Yu, Hainan; Côté, Pierre; Southerst, Danielle; Wong, Jessica J; Varatharajan, Sharanya; Shearer, Heather M; Gross, Douglas P; van der Velde, Gabrielle M; Carroll, Linda J; Mior, Silvano A; Ameis, Arthur; Jacobs, Craig L; Taylor-Vaisey, Anne L

    2016-12-01

    or less effective than other conservative treatments including massage, supervised exercise, and physiotherapy. However, structured patient education may provide small benefits when combined with physiotherapy. Either mode of delivery (ie, oral or written education) provides similar results in patients with recent WAD. This review adds to the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders by defining more specifically the role of structured patient education in the management of WAD and NAD. Results suggest that structured patient education alone cannot be expected to yield large benefits in clinical effectiveness compared with other conservative interventions for patients with WAD or NAD. Moreover, structured patient education may be of benefit during the recovery of patients with WAD when used as an adjunct therapy to physiotherapy or emergency room care. These benefits are small and short lived. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Fully Automated Simultaneous Integrated Boosted-Intensity Modulated Radiation Therapy Treatment Planning Is Feasible for Head-and-Neck Cancer: A Prospective Clinical Study

    SciTech Connect

    Wu Binbin; McNutt, Todd; Zahurak, Marianna; Simari, Patricio; Pang, Dalong; Taylor, Russell; Sanguineti, Giuseppe

    2012-12-01

    Purpose: To prospectively determine whether overlap volume histogram (OVH)-driven, automated simultaneous integrated boosted (SIB)-intensity-modulated radiation therapy (IMRT) treatment planning for head-and-neck cancer can be implemented in clinics. Methods and Materials: A prospective study was designed to compare fully automated plans (APs) created by an OVH-driven, automated planning application with clinical plans (CPs) created by dosimetrists in a 3-dose-level (70 Gy, 63 Gy, and 58.1 Gy), head-and-neck SIB-IMRT planning. Because primary organ sparing (cord, brain, brainstem, mandible, and optic nerve/chiasm) always received the highest priority in clinical planning, the study aimed to show the noninferiority of APs with respect to PTV coverage and secondary organ sparing (parotid, brachial plexus, esophagus, larynx, inner ear, and oral mucosa). The sample size was determined a priori by a superiority hypothesis test that had 85% power to detect a 4% dose decrease in secondary organ sparing with a 2-sided alpha level of 0.05. A generalized estimating equation (GEE) regression model was used for statistical comparison. Results: Forty consecutive patients were accrued from July to December 2010. GEE analysis indicated that in APs, overall average dose to the secondary organs was reduced by 1.16 (95% CI = 0.09-2.33) with P=.04, overall average PTV coverage was increased by 0.26% (95% CI = 0.06-0.47) with P=.02 and overall average dose to the primary organs was reduced by 1.14 Gy (95% CI = 0.45-1.8) with P=.004. A physician determined that all APs could be delivered to patients, and APs were clinically superior in 27 of 40 cases. Conclusions: The application can be implemented in clinics as a fast, reliable, and consistent way of generating plans that need only minor adjustments to meet specific clinical needs.

  6. Effect of thoracic manipulation and deep craniocervical flexor training on pain, mobility, strength, and disability of the neck of patients with chronic nonspecific neck pain: a randomized clinical trial

    PubMed Central

    Lee, Kwan-Woo; Kim, Won-Ho

    2016-01-01

    [Purpose] To investigate the effects of thoracic manipulation and deep craniocervical flexor training on the muscle strength and endurance, range of motion, and the disability index of the neck of patients with chronic nonspecific neck pain. [Subjects and Methods] Forty-six patients with chronic neck pain participated. They received an intervention for 35 minutes a day, three times a week for 10 weeks. Subjects were randomly assigned to one control and two experimental groups: group A (thoracic manipulation combined with deep craniocervical flexor training, n=16), group B (deep craniocervical flexor training, n=15), and group C (active self-exercise as a control group, n=15). Muscle strength and endurance, pain, neck disability index, and range of motion of the cervical and thoracic spine were measured before and after the intervention. [Results] Group A showed significant increases in muscle strength, endurance, and cervical and thoracic range of motion, and significant decreases in the pain and neck disability index, compared with groups B and C. [Conclusion] Although deep craniocervical flexor training is effective at improving neck function, thoracic manipulation combined with deep craniocervical flexor training was a more effective intervention for pain relief and improving the range of motion, muscle function, and neck disability of patients with nonspecific chronic neck pain. PMID:26957752

  7. Neck muscle endurance and head posture: A comparison between adolescents with and without neck pain.

    PubMed

    Oliveira, Ana Carolina; Silva, Anabela G

    2016-04-01

    The main aims of this study were to compare the neck flexor and extensor endurance and forward head posture between adolescents with and without neck pain. The secondary aims were to explore potential associations between muscles endurance, head posture and neck pain characteristics and to assess intra-rater reliability of the measurements used. Adolescents with neck pain (n = 35) and age-matched asymptomatic adolescents (n = 35) had their forward head posture, neck flexor endurance and neck extensor endurance measured using clinical tests. Intra-rater reliability was also assessed. Forward head posture and neck flexor and extensor endurance tests showed moderate to almost perfect intra-rater reliability (ICC between 0.58 and 0.88). Adolescents with neck pain showed significantly less forward head posture (neck pain = 46.62 ± 4.92; asymptomatic = 44.18°± 3.64°, p > 0.05) and less neck flexor (neck pain = 24.50 ± 23.03s; asymptomatic = 35.89 ± 21.53s, p > 0.05) and extensor endurance (neck pain = 12.6.64 ± 77.94s; asymptomatic = 168.66 ± 74.77s, p > 0.05) than asymptomatic adolescents. Results suggest that changes in posture and neck muscle endurance are a feature of adolescents with neck pain. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Clinical evaluation of BIOXTRA in relieving signs and symptoms of dry mouth after head and neck radiotherapy of cancer patients at Seyed-al-Shohada Hospital, Isfahan, Iran

    PubMed Central

    Gookizadeh, Abbas; Emami, Hamid; Najafizadeh, Nadia; Roayaei, Mahnaz

    2012-01-01

    Background: Radiotherapy of head and neck cancers causes acute and chronic xerostomia and acute mucositis. Xerostomia increases risk of radiation caries and affects on oral comfort, fit of prostheses, speech, swallowing, and the growth of caries-producing organisms. Salivary flow rate can be measured by asking patients some questions. There are different types of commercial synthetic saliva such as BIOXTRA, but until now, no one can effectively relieve xerostomia. We tried to design a clinical research on BIOXTRA efficacy for treating xerostomia. Materials and Methods: In this research, 58 patients with head and neck cancer (except salivary gland cancers) treated in Seyed-al-Shohada Hospital. The patients received at least 40-50 GY; and after 2 months of compilation treatment, they were evaluated by asking about having xerostomia. Before and after treatment with the BIOXTRA, the PH of the oral cavity, candida albicans, and lactobacillus counts measured and documented in laboratory. We used BIOXTRA for 2 weeks, 3 times daily, and then re-evaluated patients with some questions. Results: The counts of candida albicans and lactobacilli statistically significant decreased. Conclusion: Xerostomia for most patients improved clinically during the day and night while PH of the oral cavity increased. PMID:23326802

  9. Adult Co-morbidity Evaluation 27 scores of head and neck cancer patients using touch-screen technology: patient satisfaction and clinical verification.

    PubMed

    Brammer, C; Dawson, D; Joseph, M; Tipper, J; Jemmet, T; Liew, L; Spinou, C; Grew, N; Pigadas, N; Rehman, K

    2017-05-01

    This study aimed to assess head and neck cancer patient satisfaction with the use of a touch-screen computer patient-completed questionnaire for assessing Adult Co-morbidity Evaluation 27 co-morbidity scores prior to treatment, along with its clinical reliability. A total of 96 head and neck cancer patients were included in the audit. An accurate Adult Co-morbidity Evaluation 27 co-morbidity score was achieved via patient-completed questionnaire assessment for 97 per cent of participants. In all, 96 per cent of patients found the use of a touch-screen computer acceptable and would be willing to use one again, and 62 per cent would be willing to do so without help. Patients were more likely to be willing to use the computer again without help if they were aged 65 years or younger (χ2 test; p = 0.0054) or had a performance status of 0 or 1 (χ2 test; p = 0.00034). Use of a touch-screen computer is an acceptable approach for assessing Adult Co-morbidity Evaluation 27 scores at pre-treatment assessment in a multidisciplinary joint surgical-oncology clinic.

  10. Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain.

    PubMed

    Evans, Roni; Bronfort, Gert; Nelson, Brian; Goldsmith, Charles H

    2002-11-01

    Randomized clinical trial. To compare the effects of spinal manipulation combined with low-tech rehabilitative exercise, MedX rehabilitative exercise, or spinal manipulation alone in patient self-reported outcomes over a two-year follow-up period. There have been few randomized clinical trials of spinal manipulation and rehabilitative exercise for patients with neck pain, and most have only reported short-term outcomes. One hundred ninety-one patients with chronic neck pain were randomized to 11 weeks of one of the three treatments. Patient self-report questionnaires measuring pain, disability, general health status, improvement, satisfaction, and OTC medication use were collected after 5 and 11 weeks of treatment and 3, 6, 12, and 24 months after treatment. Data were analyzed taking into account all time points using repeated measures analyses. Ninety-three percent (178) of randomized patients completed the 11-week intervention phase, and 76% (145) provided data at all evaluation time points over the two-year follow-up period. A difference in patient-rated pain with no group-time interaction was observed in favor of the two exercise groups [F(2141) = 3.2; P= 0.04]. There was also a group difference in satisfaction with care [F(2143) = 7.7; P= 0.001], with spinal manipulation combined with low-tech rehabilitative exercise superior to MedX rehabilitative exercise (P = 0.02) and spinal manipulation alone (P < 0.001). No significant group differences were found for neck disability, general health status, improvement, and OTC medication use, although the trend over time was in favor of the two exercise groups. The results of this study demonstrate an advantage of spinal manipulation combined with low-tech rehabilitative exercise and MedX rehabilitative exercise versus spinal manipulation alone over two years and are similar in magnitude to those observed after one-year follow-up. These results suggest that treatments including supervised rehabilitative exercise should

  11. [Cervical recurrence in the pathologically negative neck (pNO): finding a needle in a haystack].

    PubMed

    Lassaletta, L; Bernáldez, R; González, T; Gavilán, J

    2002-01-01

    Recurrence in the pathologically negative neck (pN0) is one of the most striking events occurring in head and neck tumors. It is not even mentioned in many neck dissection studies. The presence of micrometastases has been suggested as an explanation for this event. In accordance to a recent study performed in our institution, we bring up this controversial issue. A definitive explanation for recurrence in the pN0 has not yet been proposed.

  12. Spatiotemporal Optoacoustic Mapping of Tumor Hemodynamics in a Clinically Relevant Orthotopic Rabbit Model of Head and Neck Cancer.

    PubMed

    Rich, Laurie J; Sexton, Sandra; Curtin, Leslie; Seshadri, Mukund

    2017-10-01

    The purpose of this study was to investigate the usefulness of photoacoustic imaging (PAI) for spatiotemporal mapping of tumor hemodynamics in a rabbit model of head and neck carcinoma. Shope cottontail rabbit papilloma virus associated VX2 carcinomas were established in adult male New Zealand White rabbits (n = 9) by surgical transplantation of tumor tissue in the neck. Noninvasive PAI with co-registered ultrasound (US) was performed to longitudinally monitor tumor growth, oxygen saturation (%sO2), and hemoglobin concentration (HbT). PAI findings were validated with Doppler sonography measures of percent vascularity (PV). Differences in tumor volumes, %sO2, HbT, and PV values over time were analyzed using repeated-measures analysis of variance with multiple comparisons. Two-tailed Spearman correlation analysis was performed to determine the correlation coefficient (r) for comparisons between %sO2, HbT, and tumor volume. US revealed a significant (P < .0001) increase in tumor volume over the 3-week period from 549 ± 260 mm(3) on day 7 to 5055 ± 438 mm(3) at 21 days postimplantation. Consistent with this aggressive tumor growth, PAI revealed a significant (P < .05) and progressive reduction in %sO2 from day 7 (37.6 ± 7.4%) to day 21 (9.5 ± 2.1%). Corresponding Doppler images also showed a decrease in PV over time. PAI revealed considerable intratumoral spatial heterogeneity with the tumor rim showing two- to three-fold higher %sO2 values compared to the core. Noninvasive PAI based on endogenous contrast provides a label-free method for longitudinal monitoring of temporal changes and spatial heterogeneity in thick head and neck tumors. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  13. Clinical Practice Guidance for Radiotherapy Planning After Induction Chemotherapy in Locoregionally Advanced Head-and-Neck Cancer

    SciTech Connect

    Salama, Joseph K.; Haddad, Robert I.; Kies, Merril S.; Busse, Paul M.; Dong Lei; Brizel, David M.; Eisbruch, Avraham; Tishler, Roy B.; Trotti, Andy M.; Garden, Adam S.

    2009-11-01

    Purpose: The use of induction chemotherapy (IC) for locoregionally advanced head-and-neck cancer is increasing. The response to IC often causes significant alterations in tumor volume and location and shifts in normal anatomy. Proper determination of the radiotherapy (RT) targets after IC becomes challenging, especially with the use of conformal and precision RT techniques. Therefore, a consensus conference was convened to discuss issues related to RT planning and coordination of care for patients receiving IC. Methods and Materials: Ten participants with special expertise in the various aspects of integration of IC and RT for the treatment of locoregionally advanced head-and-neck cancer, including radiation oncologists, medical oncologists, and a medical physicist, participated. The individual members were assigned topics for focused, didactic presentations. Discussion was encouraged after each presentation, and recommendations were formulated. Results: Recommendations and guidelines emerged that emphasize up-front evaluation by all members of the head-and-neck management team, high-quality baseline and postinduction planning scans with the patient in the treatment position, the use of preinduction target volumes, and the use of full-dose RT, even in the face of a complete response. Conclusion: A multidisciplinary approach is strongly encouraged. Although these recommendations were provided primarily for patients treated with IC, many of these same principles apply to concurrent chemoradiotherapy without IC. A rapid response during RT is quite common, requiring the development of two or more plans in a sizeable fraction of patients, and suggesting the need for similar guidance in the rapidly evolving area of adaptive RT.

  14. Perioperative enteral nutrition and quality of life of severely malnourished head and neck cancer patients: a randomized clinical trial.

    PubMed

    Van Bokhorst-de Van der Schuer, M A; Langendoen, S I; Vondeling, H; Kuik, D J; Quak, J J; Van Leeuwen, P A

    2000-12-01

    This study evaluated the use of perioperative nutritional support on Quality of Life (QOL) in malnourished head and neck cancer patients undergoing surgery. 49 Malnourished (weight loss >10%) head and neck cancer patients who were included in a nutrition intervention trial were randomized to receive either no preoperative and standard postoperative tube-feeding (group I), standard preoperative and postoperative tube-feeding (group II) or arginine-supplemented preoperative and postoperative tube-feeding (group III). Of these patients, 31 completed a full QOL assessment on the first day of preoperative nutritional support, one day before surgery, and 6 months after surgery. Both a disease-specific (EORTC QLQ-C30) and a generic questionnaire (COOP-WONCA) were used. One way analysis of variance (ANOVA) and the Kruskal-Wallis test were applied for testing differences in scores between groups. Between baseline and the day before surgery, both preoperatively fed groups revealed a positive change for the dimensions physical and emotional functioning and dyspnea (with significance in group II, P=0.050,0.031,0.045 respectively). Group III showed a negative change in appetite (P=0.049). Between baseline and 6 months after surgery, there were no differences between group I and both pre-fed groups. There were no differences in favour of group III compared to group II. Enteral nutrition improves QOL of severely malnourished head and neck cancer patients in the period preceding surgery. No benefit of preoperative enteral feeding on QOL could be demonstrated 6 months after surgery. Copyright 2000 Harcourt Publishers Ltd.

  15. Clinical evaluation of dual-energy bone removal in CT angiography of the head and neck: comparison with conventional bone-subtraction CT angiography.

    PubMed

    Deng, K; Liu, C; Ma, R; Sun, C; Wang, X-m; Ma, Z-T; Sun, X-l

    2009-05-01

    To evaluate the bone-subtraction effect of dual-energy bone removal in computed tomography angiography (CTA) of the head and neck in comparison with conventional bone-subtraction CTA. The study comprised 52 patients who were divided into two groups at random, and examined using dual-source CT for head and neck CTA. Dual-energy bone removal CTA and conventional bone-subtraction CTA were applied to each of the two groups, respectively. The bone subtraction was performed automatically in both methods. Vascular structures, as well as brain tissue remained visible. The subtracted images were further processed with maximum intensity projection (MIP) and volume-rendering technique (VRT) for image evaluation. Two experienced radiologists reviewed the resulting subtracted and non-subtracted volume data with respect to the delineation and detection of image quality and vascular pathology. The means of the weighted CT dose index (CTDIvol) for bone-removal dual-energy CTA and conventional bone-subtraction CTA were 20.56+/-0.01 mGy and 25.57+/-0.56 mGy, respectively. There was a significant difference between them. The percentage of carotid and vertebral arteries and all other vessels that could be successfully assessed with these two methods were 87.8, 68, and 83%, and 93.5, 91.8, and 92.6%, respectively. There were no significant differences in the visualization of the carotid arteries; however, there were significant differences in the visualization of the vertebral arteries. Compared with conventional bone-subtraction CTA, dual-energy bone-removal CTA had a lower radiation dose. It eliminated most bones in the head and neck successfully; however, the bone subtraction effect around the vertebral artery was unsatisfactory. Dual-energy bone-removal CTA provides a new method for detecting vascular diseases in routine clinical work.

  16. The clinical utility of reduced-distortion readout-segmented echo-planar imaging in the head and neck region: initial experience.

    PubMed

    Koyasu, Sho; Iima, Mami; Umeoka, Shigeaki; Morisawa, Nobuko; Porter, David A; Ito, Juichi; Le Bihan, Denis; Togashi, Kaori

    2014-12-01

    To evaluate whether readout-segmented echo-planar imaging (RS-EPI) diffusion weighted image (DWI) can diminish image distortion in the head and neck area, compared with single-shot (SS)-EPI DWI. We conducted phantom and patient studies using 3 T magnetic resonance imaging (MRI) with a 16-channel coil. For the phantom study, we evaluated distortion and signal homogeneity in gel phantoms. For the patient study, 29 consecutive patients with clinically suspicious parotid lesions were prospectively enrolled. RS-EPI and SS-EPI DWI were evaluated by two independent readers for identification of organ/lesion and distortion, using semiquantitative scales and quantitative scores. Apparent diffusion coefficient (ADC) values and contrast-noise ratios of parotid tumours (if present; n = 15) were also compared. The phantom experiments showed that RS-EPI provided less distorted and more homogeneous ADC maps than SS-EPI. In the patient study, RS-EPI was found to provide significantly less distortion in almost all organs/lesions (p < 0.05), according to both semiquantitative scales and quantitative scores. There was no significant difference in ADC values and contrast-noise ratios between the two DWI techniques. The distortion in DWI was significantly reduced with RS-EPI in both phantom and patient studies. The RS-EPI technique provided more homogenous images than SS-EPI, and can potentially offer higher image quality in the head and neck area. The distortion in DWI is significantly reduced with RS-EPI compared with SS-EPI. Structures in the head and neck were identified more clearly using RS-EPI. No significant difference in ADC values was found between the techniques.

  17. The clinical impact of p16 status in fine-needle aspirates of cervical lymph node metastasis of head and neck squamous cell carcinomas.

    PubMed

    Jakscha, Jens; Zlobec, Inti; Storck, Claudio; Obermann, Ellen C; Tornillo, Luigi; Terracciano, Luigi M; Fischer, Claude A

    2013-02-01

    Lymph node involvement is prognostically the most determinant clinical factor for patients with head and neck squamous cell carcinomas (HNSCCs). Ultrasound of the neck and fine-needle aspiration (FNA) cytology is one of the first diagnostic procedures and the most accurate diagnostic staging tool for the neck. Patients with HPV-positive oropharyngeal carcinomas (OPSCC) show a significantly better prognosis when compared with HPV-negative OPSCC. P16 overexpression is accepted as surrogate marker for HPV-positive in OPSCC. These HPV/p16-positive OPSCC are localized either in the palatal tonsils or the base of tongue and frequently present with lymph node metastases. We analyzed the correlation and reliability of p16 expression of the FNA of the lymph node metastasis with the immunohistochemical expression of p16 of the same lymph node metastasis and its corresponding primary tumor, as it could be of importance for determining the localization and different prognosis of the primary tumor. 54 HNSCC patients were evaluated, p16 expression of the primary tumors and their lymph node metastases correlated precisely. In 25 of the 54 HNSCC patients, a FNA of the lymph node metastases was taken before the treatment. The positive cytological and immunohistochemical p16 staining correlated exactly. Of the 17 histologically p16-negative lymph node metastases 15 FNA were p16-negative, whereas two samples were p16-positive. In our view, a cytological p16 analysis of cervical lymph node metastasis can facilitate the correct localization of the primary tumor and discriminate reliably HPV-positive OPSCC from HPV-negative HNSCC with their significantly diverse prognosis.

  18. Imaging of pediatric neck masses.

    PubMed

    Friedman, Elliott R; John, Susan D

    2011-07-01

    Palpable neck masses are a common indication for pediatric imaging. Such lesions may be caused by infectious, inflammatory, tumoral, traumatic, lymphovascular, immunologic, or congenital etiologies. Radiological assessment of neck masses in young children should be tailored based on patient presentation and physical examination, as well as clinical suspicion. The goal of imaging should be to help arrive at a diagnosis or limited differential in an efficient manner while minimizing radiation exposure.

  19. Noninvasive treatment of the neck.

    PubMed

    Brobst, Robert W; Ferguson, Maria; Perkins, Stephen W

    2014-05-01

    Emerging trends in neck rejuvenation include the incorporation of nonsurgical treatment modalities as an offering to those patients desiring minimal downtime and accepting of mild results. Intense focused ultrasound is a promising technology for treatment of the neck. It is rapidly growing in clinical use and undergoing further investigation to determine optimum treatment parameters and make its outcomes more predictable. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Neck Surgery Under Local Anesthesia.

    PubMed

    Obradovic, Bojan

    2017-09-21

    The value of local anesthesia (LA) is widely recognized in oral and maxillofacial surgery. Many procedures can be performed with the use of local anesthetic alone, instilled at or near the site of surgery.The author presents a patient with neck tumor, where the tumor removal was managed under LA at outpatient clinic. Treatment and postoperative period was routine.Neck surgery under LA in outpatient environment shows a great potential in adequately selected patients.

  1. Laser Doppler flowmetry: an early diagnosis instrument in detecting the soft tissue changes that occur during radiotherapy to the head and neck area, clinical case report

    NASA Astrophysics Data System (ADS)

    Petre, L. C.; Miron, M. I.; Ianes, E.

    2016-03-01

    Aim of the study: Our goal was to monitor soft tissue changes occurring during radiotherapy - both through clinical examination and using LDF - in order to establish Laser Doppler as an early diagnosis instrument in this situation, and also to assess what kind of dental procedures could be provided during radiotherapy, in order to increase patients' quality of life. Material and Method: Our study included two male patients, who received head and neck radiotherapy. Patient A, 68 years old, underwent 31 radiotherapy exposures. Patient B, 52 years old, underwent 24 exposures. They received a thorough clinical examination, and a LDF evaluation of gingival blood flow in areas close to the irradiated site, after the first, the 18th, and the last radiotherapy exposure. Results: Patient A presented radiotherapy induced mucositis, after the 18th radiotherapy exposure. After the last exposure the mucositis worsened, additionally, radiodermitis appeared on the neck. LDF showed an increase in blood flow of the irradiated area, even after the first exposure, and it persisted throughout treatment. Patient B showed no clinical changes, besides a hyperkeratinisation of the gingiva in the irradiated area, after the last exposure. LDF showed an overall increase in vascularity of the area throughout treatment. Discussion: Even after the first radiotherapy exposure, and also when clinical changes were not apparent, LDF measurements revealed an increase in blood flow in the gingiva of irradiated patients. LDF might allow us to establish the most appropriate moment in time for each dental treatment, in order to increase the quality of life.

  2. Treatment referral before and after the introduction of the Liverpool Patients Concerns Inventory (PCI) into routine head and neck oncology outpatient clinics.

    PubMed

    Ghazali, Naseem; Kanatas, Anastasios; Langley, Daniel J R; Scott, Barry; Lowe, Derek; Rogers, Simon N

    2011-11-01

    Holistic needs assessment is a key recommendation in improving supportive and palliative care in adults with cancer. The Patients Concerns Inventory (PCI) is a holistic needs assessment tool designed for head and neck cancer survivors in outpatient setting. Routine screening of potential unmet needs in a clinic may result in increased onward referrals, thus placing a burden on existing healthcare services. The aim of this study was to compare the referral trends following consultation in the time periods before and after introduction of PCI in an oncology outpatient clinic. A cross-sectional cohort of disease-free survivors of oral/oropharyngeal cancers of a single consultant was prospectively exposed to PCI from July 2007 to April 2009. The PCI is a self-completed questionnaire consisting of 55 items of patient needs/concern and a list of multidisciplinary professionals, whom patients may wish to talk to or be referred to. Retrospective analysis of referral patterns from clinic letters in two periods in the pre-PCI and post-PCI exposure was performed. Prospective analysis of consultations was performed to determine the outcome of PCI-highlighted items. There was no change in the prevalence of onward referral with the introduction of PCI, i.e. 21 referrals per 100 patients seen in outpatients. However, the proportion of referrals to oral rehabilitation and psychological support increased. Referrals to certain services, e.g. speech and language and dentistry, remained consistently in demand. Many PCI-highlighted needs were dealt in a clinic with by the consultant and/or other professionals during a multidisciplinary consultation. Routine use of PCI promotes target efficiency by directing and apportioning appropriate services to meet the needs for supportive care of head and neck cancer survivors.

  3. Validation of clinical acceptability of an atlas-based segmentation algorithm for the delineation of organs at risk in head and neck cancer

    SciTech Connect

    Hoang Duc, Albert K. McClelland, Jamie; Modat, Marc; Cardoso, M. Jorge; Mendelson, Alex F.; Eminowicz, Gemma; Mendes, Ruheena; Wong, Swee-Ling; D’Souza, Derek; Veiga, Catarina; Kadir, Timor; Ourselin, Sebastien

    2015-09-15

    Purpose: The aim of this study was to assess whether clinically acceptable segmentations of organs at risk (OARs) in head and neck cancer can be obtained automatically and efficiently using the novel “similarity and truth estimation for propagated segmentations” (STEPS) compared to the traditional “simultaneous truth and performance level estimation” (STAPLE) algorithm. Methods: First, 6 OARs were contoured by 2 radiation oncologists in a dataset of 100 patients with head and neck cancer on planning computed tomography images. Each image in the dataset was then automatically segmented with STAPLE and STEPS using those manual contours. Dice similarity coefficient (DSC) was then used to compare the accuracy of these automatic methods. Second, in a blind experiment, three separate and distinct trained physicians graded manual and automatic segmentations into one of the following three grades: clinically acceptable as determined by universal delineation guidelines (grade A), reasonably acceptable for clinical practice upon manual editing (grade B), and not acceptable (grade C). Finally, STEPS segmentations graded B were selected and one of the physicians manually edited them to grade A. Editing time was recorded. Results: Significant improvements in DSC can be seen when using the STEPS algorithm on large structures such as the brainstem, spinal canal, and left/right parotid compared to the STAPLE algorithm (all p < 0.001). In addition, across all three trained physicians, manual and STEPS segmentation grades were not significantly different for the brainstem, spinal canal, parotid (right/left), and optic chiasm (all p > 0.100). In contrast, STEPS segmentation grades were lower for the eyes (p < 0.001). Across all OARs and all physicians, STEPS produced segmentations graded as well as manual contouring at a rate of 83%, giving a lower bound on this rate of 80% with 95% confidence. Reduction in manual interaction time was on average 61% and 93% when automatic

  4. Is one better than another?: A randomized clinical trial of manual therapy for patients with chronic neck pain.

    PubMed

    Izquierdo Pérez, Honorio; Alonso Perez, Jose Luis; Gil Martinez, Alfonso; La Touche, Roy; Lerma-Lara, Sergio; Commeaux Gonzalez, Noelia; Arribas Perez, Hector; Bishop, Mark D; Fernández-Carnero, Josue

    2014-06-01

    Our purpose was to compare the effectiveness of three manual therapy techniques: high velocity, low amplitude (HVLA), mobilization (Mob) and sustained natural apophyseal glide (SNAG) in patients with chronic neck pain (CNP). The randomized controlled trial included patients with mechanically reproducible CNP, who were randomized to the treatment group. Outcome measures were the Visual Analogue scale (VAS), Neck Disability Index (NDI), Global Rating of Change (GROC) and Cervical Range of Motion (CROM). Two-way repeated measures analysis of variance compared outcomes at baseline, at the end of treatment and 1, 2 and 3 months after treatment. A total of 51 subjects completed the trial. No significant differences were found between HVLA, Mob and SNAG at the end of treatment and during the follow-up in any of the analysed outcomes. There were no differences in satisfaction for all techniques. The results lead to the conclusion that there is no long-term difference between the application of HVLA, Mob and SNAG in pain, disability and cervical range of motion for patients with CNP.

  5. Prediction of clinical toxicity in locally advanced head and neck cancer patients by radio-induced apoptosis in peripheral blood lymphocytes (PBLs)

    PubMed Central

    2010-01-01

    Head and neck cancer is treated mainly by surgery and radiotherapy. Normal tissue toxicity due to x-ray exposure is a limiting factor for treatment success. Many efforts have been employed to develop predictive tests applied to clinical practice. Determination of lymphocyte radio-sensitivity by radio-induced apoptosis arises as a possible method to predict tissue toxicity due to radiotherapy. The aim of the present study was to analyze radio-induced apoptosis of peripheral blood lymphocytes in head and neck cancer patients and to explore their role in predicting radiation induced toxicity. Seventy nine consecutive patients suffering from head and neck cancer, diagnosed and treated in our institution, were included in the study. Toxicity was evaluated using the Radiation Therapy Oncology Group scale. Peripheral blood lymphocytes were isolated and irradiated at 0, 1, 2 and 8 Gy during 24 hours. Apoptosis was measured by flow cytometry using annexin V/propidium iodide. Lymphocytes were marked with CD45 APC-conjugated monoclonal antibody. Radiation-induced apoptosis increased in order to radiation dose and fitted to a semi logarithmic model defined by two constants: α and β. α, as the origin of the curve in the Y axis determining the percentage of spontaneous cell death, and β, as the slope of the curve determining the percentage of cell death induced at a determined radiation dose, were obtained. β value was statistically associated to normal tissue toxicity in terms of severe xerostomia, as higher levels of apoptosis were observed in patients with low toxicity (p = 0.035; Exp(B) 0.224, I.C.95% (0.060-0.904)). These data agree with our previous results and suggest that it is possible to estimate the radiosensitivity of peripheral blood lymphocytes from patients determining the radiation induced apoptosis with annexin V/propidium iodide staining. β values observed define an individual radiosensitivity profile that could predict late toxicity due to radiotherapy

  6. Oncologic safety of cervical nerve preservation in neck dissection for head and neck cancer.

    PubMed

    Honda, Keigo; Asato, Ryo; Tsuji, Jun; Miyazaki, Masakazu; Kada, Shinpei; Tsujimura, Takashi; Kataoka, Michiko

    2017-09-01

    Although the functional merits of preserving cervical nerves in neck dissection for head and neck cancer have been reported, the oncologic safety has not yet been determined. Therefore, the purpose of this study was to evaluate the safety of cervical nerve preservation. A retrospective chart review was performed on patients with head and neck cancer who had been treated by neck dissection between 2009 and 2014 at Kyoto Medical Center. Management of cervical nerves and clinical results were analyzed. A total of 335 sides of neck dissection had been performed in 222 patients. Cervical nerves were preserved in 175 neck sides and resected in 160 sides. The 5-year overall survival (OS) rate calculated by the Kaplan-Meier method was 71%. The 5-year neck control rate was 95% in cervical nerve preserved sides and 89% in cervical nerve resected sides. Preserving cervical nerves in neck dissection is oncologically safe in selected cases. © 2017 Wiley Periodicals, Inc.

  7. Expression of TP53 mutation-associated microRNAs predicts clinical outcome in head and neck squamous cell carcinoma patients

    PubMed Central

    Ganci, F.; Sacconi, A.; Bossel Ben-Moshe, N.; Manciocco, V.; Sperduti, I.; Strigari, L.; Covello, R.; Benevolo, M.; Pescarmona, E.; Domany, E.; Muti, P.; Strano, S.; Spriano, G.; Fontemaggi, G.; Blandino, G.

    2013-01-01

    Background TP53 mutation is associated with decreased survival rate in head and neck squamous cell carcinoma (HNSCC) patients. We set out to identify microRNAs (miRNAs) whose expression associates with TP53 mutation and survival in HNSCC. Patients and methods We analyzed TP53 status by direct sequencing of exons 2 through 11 of a prospective series of 121 HNSCC samples and assessed its association with outcome in 109 followed-up patients. We carried out miRNA expression profiling on 121 HNSCC samples and 66 normal counterparts. miRNA associations with TP53 mutations and outcome were evaluated. Results A TP53 mutation was present in 58% of the tumors and TP53 mutations were significantly associated with a shorter recurrence-free survival. This association was stronger in the clinical subgroup of patients subjected to adjuvant therapy after surgery. The expression of 49 miRNAs was significantly associated with TP53 status. Among these 49, we identified a group of 12 miRNAs whose expression correlates with recurrence-free survival and a group of 4 miRNAs that correlates with cancer-specific survival. The two groups share three miRNAs. Importantly, miRNAs that correlate with survival are independent prognostic factors either when considered individually or as signatures. Conclusions miRNAs expression associates with TP53 status and with reduced survival after surgical treatment of squamous cell carcinoma of the head and neck. PMID:24107801

  8. Expression and clinical significance of MAGE and NY-ESO-1 cancer-testis antigens in adenoid cystic carcinoma of the head and neck.

    PubMed

    Veit, Johannes A; Heine, Daniela; Thierauf, Julia; Lennerz, Jochen; Shetty, Subasch; Schuler, Patrick J; Whiteside, Theresa; Beutner, Dirk; Meyer, Moritz; Grünewald, Inga; Ritter, Gerd; Gnjatic, Sacha; Sikora, Andrew G; Hoffmann, Thomas K; Laban, Simon

    2016-07-01

    Adenoid cystic carcinoma (ACC) of the head and neck is a rare but highly malignant tumor. Cancer-testis antigens (CTAs) represent an immunogenic family of cancer-specific proteins and thus represent an attractive target for immunotherapy. Eighty-four cases of ACC were identified, the CTAs pan-Melanoma antigen (pan-MAGE; M3H67) and New York esophageal squamous cell carcinoma (NY-ESO-1; E978) were detected immunohistochemically (IHC) and correlated with clinical data. Expression of NY-ESO-1 was found in 48 of 84 patients (57.1%) and of pan-MAGE in 28 of 84 patients (31.2%). Median overall survival (OS) in NY-ESO-1 positive versus negative patients was 130.8 and 282.0 months (p = .223), respectively. OS in pan-MAGE positive versus negative patients was 105.3 and 190.5 months, respectively (p = .096). Patients expressing both NY-ESO-1 and pan-MAGE simultaneously had significantly reduced OS with a median of 90.5 months compared with 282.0 months in negative patients (p = .047). A significant fraction of patients with ACC show expression of the CTAs NY-ESO-1 and/or pan-MAGE with promising immunotherapeutic implications. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1008-1016, 2016. © 2016 Wiley Periodicals, Inc.

  9. Electrotherapy for neck pain.

    PubMed

    Kroeling, Peter; Gross, Anita; Goldsmith, Charles H; Burnie, Stephen J; Haines, Ted; Graham, Nadine; Brant, Aron

    2009-10-07

    Neck pain is common, disabling and costly. The effectiveness of electrotherapy as a physiotherapeutic option remains unclear. This update replaces our 2005 Cochrane review on this topic. To assess whether electrotherapy improves pain, disability, patient satisfaction, and global perceived effect in adults with neck pain. Computer-assisted searches of: CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL, without language restrictions, from their beginning to December 2008; handsearched relevant conference proceedings; consulted content experts. Randomised controlled trials in any language, investigating the effects of electrotherapy, used primarily as unimodal treatment for neck pain. Quasi-RCTs and controlled clinical trials were excluded. At least two authors independently conducted citation identification, study selection, data abstraction, and risk of bias assessment. We were unable to statistically pool any of the results, but assessed the quality of the evidence using an adapted GRADE approach. Eighteen small trials (1043 people with neck pain) with 23 comparisons were included. Analysis was limited by trials of varied quality, heterogeneous treatment subtypes and conflicting results. The main findings for reduction of neck pain by treatment with electrotherapeutic modalities are:Very low quality evidence that pulsed electromagnetic field therapy (PEMF), repetitive magnetic stimulation (rMS) and transcutaneous electrical nerve stimulation (TENS) are more effective than placebo.Low quality evidence that permanent magnets (necklace) are not more effective than placebo.Very low quality evidence that modulated galvanic current, iontophoresis and electric muscle stimulation (EMS) are not more effective than placebo.There were only four trials that reported on other outcomes such as function and global perceived effects, but none were of clinical importance. We cannot make any definite statements on the efficacy and clinical usefulness of electrotherapy modalities for

  10. [Targeting p16(INK4a) by therapeutic vaccination : Concept and status of clinical investigations in HPV-associated head and neck cancers].

    PubMed

    Reuschenbach, M

    2015-02-01

    Up to 70% of oropharyngeal cancers are attributable to human papillomavirus (HPV) infection; however, a therapy specific for patients with HPV-associated cancers is currently not available. Overexpression of the viral oncogenes E6 and E7 results in cellular alterations that represent interesting targets for novel therapies. One consequence of E6/E7 overexpression is strong expression of the cellular protein p16(INK4a). The elimination of p16(INK4a)-expressing tumor cells by the immune system could be achieved through a therapeutic p16(INK4a) vaccine. The current article provides an overview of HPV-associated head and neck cancers and the associated p16(INK4a) expression. Based on this overview, the concept and status of the clinical investigation of therapeutic p16(INK4a) vaccination is described. In addition to discussing published literature, a clinical study is described. In this phase I/IIa study, patients with advanced HPV-associated p16(INK4a)-expressing tumors were vaccinated with a p16(INK4a) peptide. HPV-associated head and neck cancers continuously display strong overexpression of the cellular protein p16(INK4a). Vaccination with p16(INK4a) could represent a novel therapy for patients with HPV-associated carcinomas. Further studies will evaluate the clinical efficacy of therapeutic p16(INK4a) vaccination. Combinations with other immunotherapeutic approaches are interesting considering the modulating role of the immune system, particularly in HPV-associated tumors.

  11. Acupuncture for neck disorders.

    PubMed

    Trinh, K V; Graham, N; Gross, A R; Goldsmith, C H; Wang, E; Cameron, I D; Kay, T

    2006-07-19

    Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are the perceptions of benefits. Acupuncture has been used as an alternative to more traditional treatments for musculoskeletal pain. This review summarizes the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain. To determine the effects of acupuncture for individuals with neck pain. We searched CENTRAL (2006, issue 1) and MEDLINE, EMBASE, MANTIS, CINAHL from their beginning to February 2006. We searched reference lists and the acupuncture database TCMLARS in China. Any published trial using randomized (RCT) or quasi-randomized (quasi-RCT) assignment to the intervention groups, either in full text or abstract form, were included. Two reviewers made independent decisions for each step of the review: article inclusion, data abstraction and assessment of trial methodological quality. Study quality was assessed using the Jadad criteria. Consensus was used to resolve disagreements. When clinical heterogeneity was absent, we combined studies using random-effects meta-analysis models. We did not find any trials that examined the effects of acupuncture for acute or subacute pain, but we found 10 trials that examined acupuncture treatments for chronic neck pain. Overall, methodological quality had a mean of 2.3/5 on the Jadad Scale. For chronic mechanical neck disorders, there was moderate evidence that acupuncture was more effective for pain relief than some types of sham controls, measured immediately post-treatment. There was moderate evidence that acupuncture was more effective than inactive, sham treatments measured immediately post-treatment and at short-term follow-up (pooled standardized mean difference (SMD) -0.37, 95% confidence interval (CI) -0.61 to -0.12). There was limited evidence that acupuncture was more effective than massage at short-term follow-up. For chronic

  12. D-IMRT verification with a 2D pixel ionization chamber: dosimetric and clinical results in head and neck cancer.

    PubMed

    Stasi, M; Giordanengo, S; Cirio, R; Boriano, A; Bourhaleb, F; Cornelius, I; Donetti, M; Garelli, E; Gomola, I; Marchetto, F; Porzio, M; Sanz Freire, C J; Sardo, A; Peroni, C

    2005-10-07

    Dynamic intensity-modulated radiotherapy (D-IMRT) using the sliding-window technique is currently applied for selected treatments of head and neck cancer at Institute for Cancer Research and Treatment of Candiolo (Turin, Italy). In the present work, a PiXel-segmented ionization Chamber (PXC) has been used for the verification of 19 fields used for four different head and neck cancers. The device consists of a 32x32 matrix of 1024 parallel-plate ionization chambers arranged in a square of 24x24 cm2 area. Each chamber has 0.4 cm diameter and 0.55 cm height; a distance of 0.75 cm separates the centre of adjacent chambers. The sensitive volume of each single ionization chamber is 0.07 cm3. Each of the 1024 independent ionization chambers is read out with a custom microelectronics chip.The output factors in water obtained with the PXC at a depth of 10 cm were compared to other detectors and the maximum difference was 1.9% for field sizes down to 3x3 cm2. Beam profiles for different field dimensions were measured with the PXC and two other types of ionization chambers; the maximum distance to agreement (DTA) in the 20-80% penumbra region of a 3x3 cm2 field was 0.09 cm. The leaf speed of the multileaf collimator was varied between 0.07 and 2 cm s-1 and the detector response was constant to better than 0.6%. The behaviour of the PXC was measured while varying the dose rate between 0.21 and 1.21 Gy min-1; the mean difference was 0.50% and the maximum difference was 0.96%. Using fields obtained with an enhanced dynamic wedge and a staircase-like (step) IMRT field, the PXC has been tested for simple 1D modulated beams; comparison with film gave a maximum DTA of 0.12 cm. The PXC was then used to check four different IMRT plans for head and neck cancer treatment: cervical chordoma, parotid, ethmoid and skull base. In the comparison of the PXC versus film and PXC versus treatment planning system, the number of pixels with gamma parameter

  13. D-IMRT verification with a 2D pixel ionization chamber: dosimetric and clinical results in head and neck cancer

    NASA Astrophysics Data System (ADS)

    Stasi, M.; Giordanengo, S.; Cirio, R.; Boriano, A.; Bourhaleb, F.; Cornelius, I.; Donetti, M.; Garelli, E.; Gomola, I.; Marchetto, F.; Porzio, M.; Sanz Freire, C. J.; Sardo, A.; Peroni, C.

    2005-10-01

    Dynamic intensity-modulated radiotherapy (D-IMRT) using the sliding-window technique is currently applied for selected treatments of head and neck cancer at Institute for Cancer Research and Treatment of Candiolo (Turin, Italy). In the present work, a PiXel-segmented ionization Chamber (PXC) has been used for the verification of 19 fields used for four different head and neck cancers. The device consists of a 32 × 32 matrix of 1024 parallel-plate ionization chambers arranged in a square of 24 × 24 cm2 area. Each chamber has 0.4 cm diameter and 0.55 cm height; a distance of 0.75 cm separates the centre of adjacent chambers. The sensitive volume of each single ionization chamber is 0.07 cm3. Each of the 1024 independent ionization chambers is read out with a custom microelectronics chip. The output factors in water obtained with the PXC at a depth of 10 cm were compared to other detectors and the maximum difference was 1.9% for field sizes down to 3 × 3 cm2. Beam profiles for different field dimensions were measured with the PXC and two other types of ionization chambers; the maximum distance to agreement (DTA) in the 20-80% penumbra region of a 3 × 3 cm2 field was 0.09 cm. The leaf speed of the multileaf collimator was varied between 0.07 and 2 cm s-1 and the detector response was constant to better than 0.6%. The behaviour of the PXC was measured while varying the dose rate between 0.21 and 1.21 Gy min-1; the mean difference was 0.50% and the maximum difference was 0.96%. Using fields obtained with an enhanced dynamic wedge and a staircase-like (step) IMRT field, the PXC has been tested for simple 1D modulated beams; comparison with film gave a maximum DTA of 0.12 cm. The PXC was then used to check four different IMRT plans for head and neck cancer treatment: cervical chordoma, parotid, ethmoid and skull base. In the comparison of the PXC versus film and PXC versus treatment planning system, the number of pixels with γ parameter <=1 was 97.7% and 97

  14. Detection of human papillomavirus (HPV) in clinical samples: Evolving methods and strategies for the accurate determination of HPV status of head and neck carcinomas

    PubMed Central

    Westra, William H.

    2015-01-01

    SUMMARY Much recent attention has highlighted a subset of head and neck squamous cell carcinomas (HNSCCs) related to human papillomavirus (HPV) that has an epidemiologic, demographic, molecular and clinical profile which is distinct from non-HPV-related HNSCC. The clinical significance of detecting HPV in a HNSCC has resulted in a growing expectation for HPV testing of HNSCCs. Although the growing demand for routine testing is understandable and appropriate, it has impelled an undisciplined approach that has been largely unsystematic. The current state of the art has now arrived at a point where a better understanding of HPV-related tumorigenesis and a growing experience with HPV testing can now move wide scale, indiscriminant and non-standardized testing towards a more directed, clinically relevant and standardized approach. This review will address the current state of HPV detection; and will focus on why HPV testing is important, when HPV testing is appropriate, and how to test for the presence of HPV in various clinical samples. As no single test has been universally accepted as a best method, this review will consider the strengths and weaknesses of some of the more commonly used assays, and will emphasize some emerging techniques that may improve the efficiency of HPV testing of clinical samples including cytologic specimens. PMID:24932529

  15. Phase II clinical trial of cisplatin, 5-fluorouracil, and ifosfamide as treatment for advanced locoregional head and neck carcinoma.

    PubMed

    Sánchez Parra, M; Churruca, C; Paredes, A; Lacasta, A; López de Argumedo, G; Alvárez, I; Abad, T; Egana, L; Guimón, E; Piera, J M

    1999-02-01

    The association of ifosfamide with cisplatin and 5-fluorouracil for the management of advanced squamous cell carcinoma of the head and neck was assessed in this trial. Ifosfamide was given initially to 12 patients in combination with standard fixed doses of cisplatin and 5-fluorouracil, at 1,000 mg/m2 daily on days 2, 3, and 4. Two patients died of neutropenia and severe infection, and the authors recruited seven more patients who were treated with a lower dose of ifosfamide, 800 mg/m2 daily on days 2, 3, and 4. One of the seven patients died of neutropenia and severe infection. Three complete remission were observed in 18 patients evaluable for efficacy. The study was closed early because of the severe toxicity profile demonstrated by this scheme and because of no clear advantage in efficacy versus cisplatin plus 5-fluorouracil combinations.

  16. Efficacy of Electrical Stimulation and Exercise for Dysphagia in Head and Neck Cancer Patients: A Randomized Clinical Trial

    PubMed Central

    Langmore, Susan E; McCulloch, Timothy M; Krisciunas, Gintas P; Lazarus, Cathy L.; Van Daele, Douglas J; Pauloski, Barbara Roa; Rybin, Denis; Doros, Gheorghe

    2015-01-01

    Background Electrical stimulation (NMES) is a highly sought after but poorly studied treatment for dysphagia among head and neck cancer (HNC) patients with dysphagia. This study investigated the efficacy of NMES in this patient population. Methods In this double-blinded, randomized controlled trial, 170 HNC patients experiencing post-treatment dysphagia were randomized into active NMES + swallow exercise versus sham NMES + swallow exercise groups. Outcomes after a 12-week program included changes in fluoroscopy measures, diet, and quality of life. Results After the 12-week program, the active NMES group had significantly worse Penetration Aspiration Scale scores than the sham group. Both groups reported significantly better diet and quality of life. No other measures were significant. Conclusions NMES did not add benefit to traditional swallow exercises. Unfortunately swallow exercises were not effective by themselves either. For HNC patients with moderate-severe dysphagia caused by radiation therapy, current behavioral therapies are of limited help in reversing long-term dysphagia. PMID:26469360

  17. Predictors of health-related quality of life in patients treated with neck dissection for head and neck cancer.

    PubMed

    Gane, Elise M; McPhail, Steven M; Hatton, Anna L; Panizza, Benedict J; O'Leary, Shaun P

    2017-09-22

    Patients with head and neck cancer can report reduced health-related quality of life several years after treatment. The aim of this study was to identify risk factors for reduced quality of life in patients up to 5 years following neck dissection. This cross-sectional study was conducted at two hospitals in Brisbane, Australia. Patients completed two measures of quality of life: the Neck Dissection Impairment Index (NDII), a region- and disease-specific tool, and the Assessment of Quality of Life-4 Domains, a general tool. Generalised linear modelling was used to determine which demographic and clinical variables were associated with quality of life. The cohort included n = 129 patients (71% male, median age 61, median 3 years since surgery). Positive nodal disease was associated with better quality of life on the NDII [e.g. N2 vs N0 coeff (95% CI) = 22.84 (7.33, 38.37)]. Worse quality of life was associated with adjuvant treatment [e.g. Independent Living domain model: surgery with chemoradiation vs surgery only coeff (95% CI) = -0.11 (-0.22, -0.01)]. Positive nodal disease was associated with better quality of life, which may be a reflection of response shift. Multimodality treatment leads to worse quality of life compared with surgery only.

  18. SU-E-T-593: Clinical Evaluation of Direct Aperture Optimization in Head/Neck and Prostate IMRT Treatment

    SciTech Connect

    Hosini, M; GALAL, M; Emam, I; Kamal, G; Algohary, M

    2014-06-01

    Purpose: To investigate the planning and dosimetric advantages of direct aperture optimization (DAO) over beam-let optimization in IMRT treatment of head and neck (H/N) and prostate cancers. Methods: Five Head and Neck as well as five prostate patients were planned using the beamlet optimizer in Elekta-Xio ver 4.6 IMRT treatment planning system. Based on our experience in beamlet IMRT optimization, PTVs in H/N plans were prescribed to 70 Gy delivered by 7 fields. While prostate PTVs were prescribed to 76 Gy with 9 fields. In all plans, fields were set to be equally spaced. All cases were re-planed using Direct Aperture optimizer in Prowess Panther ver 5.01 IMRT planning system at same configurations and dose constraints. Plans were evaluated according to ICRU criteria, number of segments, number of monitor units and planning time. Results: For H/N plans, the near maximum dose (D2) and the dose that covers 95% D95 of PTV has improved by 4% in DAO. For organs at risk (OAR), DAO reduced the volume covered by 30% (V30) in spinal cord, right parotid, and left parotid by 60%, 54%, and 53% respectively. This considerable dosimetric quality improvement achieved using 25% less planning time and lower number of segments and monitor units by 46% and 51% respectively. In DAO prostate plans, Both D2 and D95 for the PTV were improved by only 2%. The V30 of the right femur, left femur and bladder were improved by 35%, 15% and 3% respectively. On the contrary, the rectum V30 got even worse by 9%. However, number of monitor units, and number of segments decreased by 20% and 25% respectively. Moreover the planning time reduced significantly too. Conclusion: DAO introduces considerable advantages over the beamlet optimization in regards to organs at risk sparing. However, no significant improvement occurred in most studied PTVs.

  19. Selected clinical features of the head and neck in women with Turner syndrome and the 45,X/46,XY karyotype.

    PubMed

    Frelich, Agnieszka; Frelich, Jakub; Jeż, Wacław; Irzyniec, Tomasz

    2017-01-01

    A 45,X/46,XY karyotype in women with Turner syndrome (TS) is very rare. The presence of a Y chromosome in the karyotype causes phenotypic differences and increased risk for neoplastic disease, compared to TS-women with other karyotypes. Our study addresses an issue: non-genital phenotypic differences between TS-patients with a Y-chromosome of their karyotype and TS-women without it. Results from patient history/physical examinations of the head and neck of eight TS-women and the 45,X/46,XY karyotype were compared with those observed in 164 TS-women and 30 controls. The heights of TS-groups: 142.5 ± 7.2 and 144.9 ± 7.2 cm were lower than controls (165.2 ± 6.6 cm). Participants were examined from 1995 to 2014. Among 28 study parameters, 15 were more frequently observed in TS women with the 45,X/46,XY karyotype compared to controls. Only abnormalities in the oral cavity and a history of childhood lymphoedema, differed significantly in the TS groups. With respect to the head and neck, the patient history and physical examination results of TS-women and the 45,X/46,XY karyotype and TS and other karyotypes revealed similar differences compared to controls. Compared to others TS patients, 45,X/46,XY individuals might more frequently have oral cavity soft tissue abnormalities and more rarely a history of childhood lymphoedema. (Endokrynol Pol 2017; 68 (1): 47-52).

  20. Clinical Utility of Multimodality Imaging with Dynamic Contrast-Enhanced MRI, Diffusion-Weighted MRI, and 18F-FDG PET/CT for the Prediction of Neck Control in Oropharyngeal or Hypopharyngeal Squamous Cell Carcinoma Treated with Chemoradiation

    PubMed Central

    Chan, Sheng-Chieh; Lin, Yu-Chun; Yen, Tzu-Chen; Liao, Chun-Ta; Chang, Joseph Tung-Chieh; Ko, Sheung-Fat; Wang, Hung- Ming; Chang, Chee-Jen; Wang, Jiun-Jie

    2014-01-01

    The clinical usefulness of pretreatment imaging techniques for predicting neck control in patients with oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) treated with chemoradiation remains unclear. In this prospective study, we investigated the role of pretreatment dynamic contrast-enhanced perfusion MR imaging (DCE-PWI), diffusion-weighted MR imaging (DWI), and [18F]fluorodeoxyglucose-positron emission tomography (18F-FDG PET)/CT derived imaging markers for the prediction of neck control in OHSCC patients treated with chemoradiation. Patients with untreated OHSCC scheduled for chemoradiation between August, 2010 and July, 2012 were eligible for the study. Clinical variables and the following imaging parameters of metastatic neck lymph nodes were examined in relation to neck control: transfer constant, volume of blood plasma, and volume of extracellular extravascular space (Ve) on DCE-PWI; apparent diffusion coefficient (ADC) on DWI; maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis on 18F-FDG PET/CT. There were 69 patients (37 with oropharynx SCC and 32 with hypopharynx SCC) with successful pretreatment DCE-PWI and DWI available for analysis. After a median follow-up of 31 months, 25 (36.2%) participants had neck failure. Multivariate analysis identified hemoglobin level <14.3 g/dL (P = 0.019), Ve <0.23 (P = 0.040), and ADC >1.14×10−3 mm2/s (P = 0.003) as independent prognostic factors for 3-year neck control. A prognostic scoring system was formulated by summing up the three significant predictors of neck control. Patients with scores of 2–3 had significantly poorer neck control and overall survival rates than patients with scores of 0–1. We conclude that hemoglobin levels, Ve, and ADC are independent pretreatment prognostic factors for neck control in OHSCC treated with chemoradiation. Their combination may identify a subgroup of patients at high risk of developing neck failure. PMID:25531391

  1. Acupuncture for neck disorders.

    PubMed

    Trinh, Kien; Graham, Nadine; Irnich, Dominik; Cameron, Ian D; Forget, Mario

    2016-05-04

    Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are perceptions of benefit. Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain. This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain. This update replaces our 2006 Cochrane review update on this topic. To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Manual, Alternative and Natural Therapy Index System (MANTIS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Index to Chiropractic Literature (ICL) from their beginning to August 2015. We searched reference lists, two trial registers and the acupuncture database Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) in China to 2005. We included published trials that used random assignment to intervention groups, in full text or abstract form. We excluded quasi-randomised controlled trials (RCTs). Two review authors made independent decisions for each step of the review: article inclusion, data abstraction and assessment of quality of trial methods. We assessed study quality by using the Cochrane Back Review Group 'Risk of bias' tool. We used consensus to resolve disagreements, and when clinical heterogeneity was absent, we combined studies by using random-effects meta-analysis models. Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non

  2. The effects of tumor size, degree of differentiation, and depth of invasion on the risk of neck node metastasis in squamous cell carcinoma of the oral cavity.

    PubMed

    Haksever, Mehmet; Inançlı, Hasan Mete; Tunçel, Umit; Kürkçüoğlu, Sefik Sinan; Uyar, Melek; Genç, Omer; Irkkan, Ciğdem

    2012-03-01

    Cervical lymph node metastasis is the most important prognostic factor in patients with head and neck carcinoma. We retrospectively analyzed the effects of three different variables-tumor size, degree of differentiation, and depth of invasion-on the risk of neck node metastasis in 50 adults who had been treated with surgery for primary squamous cell carcinoma of the oral cavity. Primary tumor depth and other pathologic features were determined by reviewing the pathology specimens. Preoperatively, 36 of the 50 patients were clinically N0; however, occult lymph node metastasis was found in 13 of these patients (36.1%). The prevalence of neck node metastasis in patients with T1/T2 and T3/T4 category tumors was 51.5 and 58.8%, respectively. The associations between the prevalence of neck node metastasis and both the degree of differentiation and the depth of invasion were statistically significant, but there was no significant association between neck node metastasis and tumor size. We conclude that the prevalence of neck lymph node metastasis in patients with squamous cell carcinoma of the oral cavity increases as the tumor depth increases and as the degree of tumor differentiation decreases from well to poor, as has been shown in previous studies. It is interesting that tumor size, which is the most important component of the TNM system, was not significantly associated with neck node involvement.

  3. A clinic-supported group exercise program for head and neck cancer survivors: managing cancer and treatment side effects to improve quality of life.

    PubMed

    Capozzi, Lauren C; Boldt, Kevin R; Lau, Harold; Shirt, Lisa; Bultz, Barry; Culos-Reed, S Nicole

    2015-04-01

    The purpose of the evaluation of this clinic-supported 12-week progressive strength-training program was to assess the feasibility and impact of an exercise intervention for head and neck cancer (HNC) survivors. Recruitment and adherence feasibility, as well as health-related fitness measures and patient-reported symptom management were assessed on the 21 HNC survivors in the exercise program. Overall, this program was feasible, as indicated by recruitment, adherence, and safety outcomes. Survivors experienced improved acute symptom management over the period of one exercise class for tiredness, depression, anxiety, drowsiness, and overall wellbeing. Over the course of the program, survivors experienced significant improvements in physical functioning outcomes and improved management of tiredness and fatigue. A progressive strength-training program is feasible for HNC survivors on and following treatment and is associated with improved acute and chronic fitness outcomes and symptom management.

  4. 5-year clinical and radiostereometric analysis (RSA) follow-up of 39 CUT femoral neck total hip prostheses in young osteoarthritis patients

    PubMed Central

    2012-01-01

    Background As the number of young patients receiving total hip arthroplasty increases, bone-saving implantations facilitating possible future revision, such as the CUT femoral neck prosthesis, are gaining importance. There have been few medium-term results reported for this prosthesis, however, and its migration pattern has not been analyzed. Patients and methods 39 consecutive CUT femoral neck prostheses were implanted in 32 patients, mean age 37 (17–58) years, with symptomatic osteoarthritis and either less than 55 years of age or with an anatomic anomaly preventing implantation of a diaphyseal stem (n = 1). Patients were followed prospectively using routine clinical examination and radiostereometric analysis (RSA) at 6, 12, 26, and 52 weeks postoperatively and annually thereafter. This study evaluated the 5-year follow-up results. Results The mean Harris hip score increased from 26 (3–51) points preoperatively to 84 (66–98), 86 (55–98), and 87 (47–98) points at 3, 12, and 60 months. 3 stems were revised: 1 after luxation following excessive subsidence due to an undersized component and 2 due to persistent strong thigh pain. 5-year survival was 95% (95% CI: 87–100). Initial migration varied widely in magnitude; median total tip migration was 0.42 mm (0.09–9.4) at 6 weeks, 0.92 mm (0.18–5.9) at 1 year, and 1.10 mm (0.13–6.4) at 5 years. Even after high initial migration, stabilization was achieved in 31 of the 35 RSA-evaluable implants. 3 prostheses showed progressive continuous migration throughout the entire follow-up period, and were considered to be loose, suggesting reduced long-term survival. Interpretation Currently, we cannot recommend the CUT femoral neck prosthesis as a routine treatment option in (young) patients requiring THA. The CUT prosthesis may not reach the 90% survival benchmark at 10 years, and the prosthesis is difficult to implant. If initial stabilization is achieved, however, aseptic loosening is unlikely. A good clinical

  5. Fractures of the neck of the fifth metacarpal bone, treated by percutaneous intramedullary nailing: surgical technique, radiological and clinical results study (28 cases)

    PubMed Central

    Boussakri, Hassan; Elidrissi, Mohamad; Azarkane, Mohamad; Bensaad, Soufiane; Bachiri, Mohammed; Shimi, Mohamed; Elibrahimi, Abdelhalim; Elmrini, Abdelmajid

    2014-01-01

    This study report the results in 28 patients affected by closed fractures of the neck of the fifth metacarpal bone (boxer's fracture), treated with percutaneous elastic intramedullary nailing using a single wire, to verify the effectiveness of this surgical treatment. We reviewed the results of 28 patients treated with A single Kirschner wire (K-wire) pre-bent in a lazy-S fashion with a mild bend at approximately 5 millimeters, The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic. The follow-up period averaged of 20,75 months. The parameters evaluated included angulation, rotational alignment, postoperative metacarpophalangeal (MCP) range of motion, and time to union. We opted for this treatment in all cases, regardless volar angulation of the metacarpal head, malrotation of the fifth finger and associated or/no with a severe swelling of the hand. All the patients were reviewed clinically and radiologically at an average of 20,75 months after surgery. At the final follow-up, no patient reported residual pain and All fractures proceeded to bony union but we have one fracture had to be revised for failed fixation and three superficial wound infections needed antibiotic treatment. We recommend that this minimally invasive: percutaneous intramedullary nailing using a single k-wire in all metacarpal neck fracture( boxers’ fractures), especially when severe swelling of the hand is present, with good functional results and low morbidity. PMID:25419314

  6. Fractures of the neck of the fifth metacarpal bone, treated by percutaneous intramedullary nailing: surgical technique, radiological and clinical results study (28 cases).

    PubMed

    Boussakri, Hassan; Elidrissi, Mohamad; Azarkane, Mohamad; Bensaad, Soufiane; Bachiri, Mohammed; Shimi, Mohamed; Elibrahimi, Abdelhalim; Elmrini, Abdelmajid

    2014-01-01

    This study report the results in 28 patients affected by closed fractures of the neck of the fifth metacarpal bone (boxer's fracture), treated with percutaneous elastic intramedullary nailing using a single wire, to verify the effectiveness of this surgical treatment. We reviewed the results of 28 patients treated with A single Kirschner wire (K-wire) pre-bent in a lazy-S fashion with a mild bend at approximately 5 millimeters, The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic. The follow-up period averaged of 20,75 months. The parameters evaluated included angulation, rotational alignment, postoperative metacarpophalangeal (MCP) range of motion, and time to union. We opted for this treatment in all cases, regardless volar angulation of the metacarpal head, malrotation of the fifth finger and associated or/no with a severe swelling of the hand. All the patients were reviewed clinically and radiologically at an average of 20,75 months after surgery. At the final follow-up, no patient reported residual pain and All fractures proceeded to bony union but we have one fracture had to be revised for failed fixation and three superficial wound infections needed antibiotic treatment. We recommend that this minimally invasive: percutaneous intramedullary nailing using a single k-wire in all metacarpal neck fracture (boxers' fractures), especially when severe swelling of the hand is present, with good functional results and low morbidity.

  7. Clinical application of computed tomography-guided (125)I seed interstitial implantation for head and neck cancer patients with unmanageable cervical lymph node metastases.

    PubMed

    Huang, Hai; Xu, Shaonian; Li, Fusheng; Du, Zhenguang; Wang, Liang

    2016-04-27

    To assess clinical application of computed tomography (CT)-guided (125)I seed implantation for patients who cannot endure or unwillingly receive repeated surgery, chemotherapy, or radiotherapy for unmanageable cervical lymph node metastases in head and neck cancer (HNC). Thirty-one consecutive patients received CT-guided (125)I seed implantation between February 2010 and December 2013. To evaluate the clinical efficiency, karnofsky performance score (KPS), numeric rating scale (NRS), and tumor volume at 3-, and 6-month post-implantation were compared with pre-implantation, along with local control rate (LCR), overall survival rate (OSR), and complications at 3, 6 months, 1, and 2 years. The tumor volume was obviously decreased at 3-, and 6-month post-implantation (21.23 ± 8.83 versus 9.19 ± 7.52 cm(2); 21.23 ± 8.83 versus 6.42 ± 9.79 cm(2); P < 0.05) compared with pre-implantation. The NRS was statistically reduced (3.06 ± 1.06 versus 7.77 ± 0.92; 2.39 ± 1.15 versus 7.77 ± 0.92; P < 0.05), while KPS was significantly improved (83.18 ± 5.97 versus 73.60 ± 7.90; 82.86 ± 5.43 versus 73.60 ± 7.90; P < 0.05) postoperatively at 3 and 6 months, respectively. The LCR at 3, 6 months, 1, and 2 years was 96.30, 83.87, 64.51, and 45.16%, respectively. The OSR was 100, 100, 67.74, and 45.16%, respectively. Three cases experienced grade I and two had grade II acute radiation toxicity. CT-guided seed implantation may be feasible and safe for HNC patients whose neck nodes are not manageable by routine strategies with fewer complications, higher LCR, and significant pain relief.

  8. Economic analysis of amifostine as adjunctive support for patients with advanced head and neck cancer: preliminary results from a randomized phase II clinical trial from Germany.

    PubMed

    Bennett, C L; Lane, D; Stinson, T; Glatzel, M; Buntzel, J

    2001-01-01

    In a randomized phase II trial in Germany, we investigated the clinical and economic impact of amifostine protection against the hematological and oral toxicities of carboplatin administered concurrently with standard fractions of radiotherapy. 28 patients with squamous cell carcinomas of the head and neck received adjunctive or primary radiotherapy (5 days per week with daily fractions of 2 Gy, up to a total dose of 60 Gy) in conjunction with carboplatin (70 mg/m2) on days 1-5 and days 21-26. All patients received radiation encompassing at least 75% of the major salivary glands. Patients were randomized to receive radiation and carboplatin (RCT) alone or RCT preceded by rapid infusion of amifostine (500 mg) on days carboplatin was administered. The 14 patients who received amifostine, in comparison to 14 patients in the control arm, had significantly fewer episodes of grade 3 or 4 thrombocytopenia (p = 0.001), mucositis (p = 0.001), and xerostomia (p = 0.001). The patients receiving amifostine accrued significantly lower supportive care costs for resources related to infection ($241 vs. $1,275, p < 0.01), red blood cell and platelet support ($286 vs. $1,276 p = 0.06) alimentation ($343 vs. $894, p = .01), and hospitalization ($286 vs. $2,429, p < 0.01). Overall, including the costs of amifostine, mean per patient supportive care costs were $4,401 for the amifostine group and $5,873 (p = .02) for the control group. Our results from a randomized phase II trial indicate that selective cytoprotection with amifostine potentially offers clinical and economic benefits in patients with advanced head and neck cancer receiving radiochemotherapy. Additional economic studies alongside randomized phase III trials and from other countries are needed.

  9. Outcome of an uncemented hydroxyapatite coated hemiarthroplasty for displaced femoral neck fractures: a clinical and radiographic 2-year follow-up study.

    PubMed

    Eschen, Jacob; Kring, Søren; Brix, Michael; Ban, Ilija; Troelsen, Anders

    2012-01-01

    Hemiarthroplasty is the preferred treatment for displaced femoral neck fractures (DFNF) in elderly patients. The use of uncemented stems remains controversial and issues regarding inferior fixation in osteoporotic bone, implant-related pain and decreased mobility have discouraged their use. There is limited evidence for the use of modern uncemented femoral stems in the treatment of DFNF, and we wished to investigate the clinical and radiographic performance of an uncemented hydroxyapatite coated hemiarthroplasty at 2-year follow-up. We included 97 consecutive patients who had an uncemented, hydroxyapatite coated hemiarthroplasty (Corail, Depuy) inserted during a 1-year period. Due to unwillingness or cognitive impairment (n = 6) and death before follow-up (n = 44), a total of 47 patients (39 females) with a mean age of 81 years were available. At two year follow-up 38 of 47 patients lived in their own homes and the median New Mobility Score was 6 (range: 2-9). The median Visual Analogue Scale pain score was 0 (range: 0-5) at rest and 0 (range: 0-8) when walking. Patient satisfaction was a score of 9 (range: 2-10) on the VAS. Anterior or lateral thigh pain or groin pain was reported by 15 patients. The EQ-5D index score at follow-up was 0.72 (range: 0.16-1.00) and the EQ-5D Visual Analogue Score was 70 (range: 15-100). There were no signs of implant loosening in any of the 37 hips undergoing radiographic evaluation at follow-up. The results suggest that an uncemented hydroxyapatite coated hemiarthroplasty can be used to treat displaced intracupsular femoral neck fractures with good clinical and radiographic outcomes at short term follow-up.

  10. Fusobacterial head and neck infections in children.

    PubMed

    Brook, Itzhak

    2015-07-01

    Fusobacterium species are increasingly recognized as a cause of head and neck infections in children. These infections include acute and chronic otitis, sinusitis, mastoiditis, and tonsillitis; peritonsillar and retropharyngeal abscesses; Lemierre syndrome; post-anginal cervical lymphadenitis; and periodontitis. They can also be involved in brain abscess and bacteremia associated with head and neck infections. This review describes the clinical spectrum of head and neck fusobacterial infection in children and their management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Prophylactic feeding tubes for patients with locally advanced head-and-neck cancer undergoing combined chemotherapy and radiotherapy—systematic review and recommendations for clinical practice

    PubMed Central

    Orphanidou, C.; Biggs, K.; Johnston, M.E.; Wright, J.R.; Bowman, A.; Hotte, S.J.; Esau, A.; Myers, C.; Blunt, V.; Lafleur, M.; Sheehan, B.; Griffin, M.A.

    2011-01-01

    Goals This work aimed to determine the benefits and risks of prophylactic feeding tubes for adult patients with squamous cell carcinoma of the head and neck who receive combined chemotherapy and radiotherapy with curative intent and to make recommendations on the use of prophylactic feeding tubes and the provision of adequate nutrition to this patient population. Methods A national multidisciplinary panel conducted a systematic review of the evidence and formulated recommendations to guide clinical decision-making. The draft evidence summary and recommendations were distributed to clinicians across Canada for their input. Main Results No randomized controlled trials have directly addressed this question. Evidence from studies in the target population was limited to seven descriptive studies: two with control groups (one prospective, one retrospective) and five without control groups. Results from ten controlled studies in patients treated with radiotherapy alone were also reviewed. Conclusions The available evidence was insufficient to draw definitive conclusions about the effectiveness of prophylactic feeding tubes in the target patient population or to support an evidence-based practice guideline. After review of the evidence, of guidelines from other groups, and of current clinical practice in Canada, the multidisciplinary panel made consensus-based recommendations regarding comprehensive interdisciplinary clinical care before, during, and after cancer treatment. The recommendations are based on the expert opinion of the panel members and on their understanding of best clinical practice. PMID:21874110

  12. Neck abscess: 79 cases

    PubMed Central

    Bulgurcu, Suphi; Arslan, Ilker Burak; Demirhan, Erhan; Kozcu, Sureyya Hikmet; Cukurova, Ibrahim

    2015-01-01

    OBJECTIVE: Neck abscess is a disease that might cause mortality and severe morbidity, if it is not treated urgently. In our study, patients with diagnosis of neck abscess in our clinic were analyzed retrospectively and presented in the light of the literature. METHODS: In our clinic, age distribution, source of infection, systemic disease, imaging methods that were used in diagnosis, preferred anaesthesia during drainage, abscess sites, culture results of abscess material, complications during treatment procedure, any antibiotherapy before admission and duration of hospitalization of 79 cases with neck abscess who were treated in the hospital between January 2008 and January 2015 were assessed. RESULTS: Cases in our study were aged between 1–79 (mean 28.3) years and 43 of them were female and 36 were male patients. Systemic diseases were determined in 19 of the cases. The most common systemic disease was diabetes mellitus. Abscesses were localized mostly at peritonsillar region and 13 of the cases were operated when abscess were in multipl localizations. In 74 of the cases, drainage was performed under local anaesthesia and in 5 cases under general anaesthesia. Four of these 5 cases, abscesses were localized within retropharyngeal region and 1 of them had multiple abscesses at various regions. Staphylococcus aereus was the most detected microorganism based on culture results. Three adult cases were followed up in the intensive care unit because of development of mediastinitis. One of these 3 cases exited because of sepsis. Hospitalization periods of 79 cases ranged between 2–21 days (mean 7.64 days). Hospitalization period of 19 cases with systemic diseases were 9.47 days (p<0.05) and statistically which were statistically significantly longer when compared with those without any systemic disease. CONCLUSION: Neck abscess must be diagnosed early and treated with surgical drainage and parenteral therapy because it might cause severe complications. PMID:28058371

  13. Validated assessment scale for neck volume.

    PubMed

    Sattler, Gerhard; Carruthers, Alastair; Carruthers, Jean; Flynn, Timothy C; Geister, Thorin L; Görtelmeyer, Roman; Hardas, Bhushan; Himmrich, Silvia; Jones, Derek; Kerscher, Martina; Mohrmann, Cornelia; Narins, Rhoda S; Pooth, Rainer; Rzany, Berthold; Buchner, Larry; Benter, Ursula; Breitscheidel, Lusine; de Maio, Maurício

    2012-02-01

    Sagging of the neck aesthetic area is an important indicator of age. The development of complex and globally accepted tools for proper assessment of the change in neck volume is an essential contribution to aesthetic research and the routine clinical setting. To develop a grading scale for the objective assessment of the neck volume and to establish the reliability of this scale for clinical research and practice. A 5-point rating scale was developed to assess neck volume objectively. Twelve experts rated frontal and lateral neck photographs of 50 subjects in two separate rating cycles using the neck volume scale. Responses of raters were analyzed to assess inter- and intrarater reliability. Interrater reliability for the neck volume scale was almost perfect, with intraclass correlation coefficients for the first and second rating cycles of 0.85 and 0.84, respectively. Intrarater reliability for the neck volume scale was high (0.90) and Pearson correlation coefficients ranged between 0.88 and 0.95 and were statistically significant. The neck volume scale demonstrates optimal reliability for clinical research and practice. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

  14. Systemic therapy in the curative treatment of head-and-neck squamous cell cancer: Cancer Care Ontario clinical practice guideline.

    PubMed

    Winquist, E; Agbassi, C; Meyers, B M; Yoo, J; Chan, K K W

    2017-04-01

    The aim of the present work was to make recommendations about the use of systemically administered drugs in combination or in sequence with radiation (rt) or surgery, or both, for cure or organ preservation, or both, in patients with locally advanced nonmetastatic (stages iii-ivb) squamous cell carcinoma of the head and neck (lascchn). The Meta-analysis of Chemotherapy in Head and Neck Cancer (mach-nc) reports have, de facto, guided practice since 2000, and so we searched the literature for systematic reviews published from January 2000 to February 2015 in reference to five research questions. A search was also conducted up to February 2015 for randomized trials (rcts) not included in the meta-analyses. Recommendations were constructed using the Cancer Care Ontario Program in Evidence-Based Care practice guidelines development cycle. In addition to updated mach-nc reports, five additional meta-analyses and thirty rcts were identified. Five recommendations for lascchn treatment were generated based on those data. Concurrent chemoradiation (ccrt) is recommended to maximize the chance of cure in patients less than 71 years of age when rt is used as definitive treatment. The same recommendation also applies to patients with resected lascchn considered to be at high risk for locoregional recurrence. For lascchn patients who are candidates for organ preservation strategies and would otherwise require total laryngectomy, either ccrt or induction chemotherapy, followed by rt or surgery based on tumour response is recommended. The addition of cetuximab to intensified rt (concomitant boost or hyperfractionated schedule) is an alternative to ccrt. Routine use of induction chemotherapy to improve overall survival is not recommended. We were able to use high-level evidence from patients receiving rt as definitive or postoperative treatment to generate recommendations for the use of systemic therapy in the treatment of lascchn. A limitation is a lack of stratification for human

  15. Peri-implant bone loss clinical and radiographic evaluation around rough neck and microthread implants: a 5-year study.

    PubMed

    Calvo-Guirado, José Luis; López-López, Patricia J; Pérez-Albacete Martínez, Carlos; Javed, Fawad; Granero-Marín, José Manuel; Maté Sánchez de Val, José Eduardo; Ramírez Fernández, Maria Piedad

    2016-01-07

    To evaluate marginal bone loss over 5 years around microthreaded implants placed in the maxillary anterior/esthetic zone and immediate restored with non-occlusal loading. Seventy-one implants (with microthreads up to the platform-rough surface body and neck, internal connection and platform switching) were placed in healed bone in the maxillary arches of 30 men and 23 women (mean age 37.85 ± 7.09 years, range 27-60). All subjects had at least 3 mm of soft tissue to allow the establishment of adequate biologic width and to reduce bone resorption. Each patient received a provisional restoration immediately after implant placement with slight occlusal contact. Mesial and distal bone height was evaluated using digital radiography on the day following implant placement (baseline) and after 1, 2, 3, 4 and 5 years. Primary stability was measured with resonance frequency analysis. No implants failed, resulting in a cumulative survival rate of 100% after 3 years. Marginal bone loss from implant collar to bone crest measured at baseline (peri-implant bone defect at the fresh extraction socket) and after 5 years was 0.90 mm ± 0.26 mm. Mesial and distal site crestal bone loss ranged from 3.42 ± 1.2 mm at baseline to 3.51 ± 1.5 mm after 5 years and from 3.38 ± 0.9 mm at baseline to 3.49 ± 0.9 mm after 5 years, respectively (P = 0.086). The results of this study showed limited implant crestal bone loss 0.90 mm ± 0.26 mm and 100% of implant survival rate at 5-year follow-up of immediate restored implants with rough surface neck and microthreads. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Expression and clinical significance of connective tissue growth factor in advanced head and neck squamous cell cancer.

    PubMed

    Kikuchi, Ryoko; Kikuchi, Yoshihiro; Tsuda, Hitoshi; Maekawa, Hitoshi; Kozaki, Ken-Ichi; Imoto, Issei; Tamai, Seiichi; Shiotani, Akihiro; Iwaya, Keiichi; Sakamoto, Masaru; Sekiya, Takao; Matsubara, Osamu

    2014-07-01

    Connective tissue growth factor (CTGF) has been reported to play critical roles in the tumorigenesis of several human malignancies. This study was performed to evaluate CTGF protein expression in head and neck squamous cell carcinoma (HNSCC). Surgical specimens from 76 primary HNSCC were obtained with written informed consents and the expression level of CTGF was immunohistochemically evaluated. The cytoplasmic immunoreactivity of CTGF in cancer cells was semiquantitatively classified into low and high expression. Among all 76 cases with or without neoadjuvant therapy, low CTGF showed significantly longer (P = 0.0282) overall survival (OS), but not disease-free survival (DFS) than high CTGF. Although low CTGF in patients with stage I, II and III did not result in any significant difference of the OS and DFS, stage IV HNSCC patients with low CTGF showed significantly longer OS (P = 0.032) and DFS (P = 0.0107) than those with high CTGF. These differences in stage IV cases were also confirmed using multivariate analyses. These results suggest that low CTGF in stage IV HNSCC is an independent prognostic factor, despite with or without neoadjuvant therapy.

  17. Investigating Clinical Failure of Bone Grafting through a Window at the Femoral Head Neck Junction Surgery for the Treatment of Osteonecrosis of the Femoral Head

    PubMed Central

    Sun, Wei; Zhao, Dingyan; Gao, Fuqiang; Su, Yangming; Li, Zirong

    2016-01-01

    Aims This study aimed to analyze the clinical factors related to the failure of bone grafting through a window at the femoral head-neck junction. Methods In total, 119 patients (158 hips) underwent bone grafting for treatment of avascular necrosis of the femoral head. The patients were classified by their ARCO staging and CJFH classification. All patients were clinically and radiographically followed up every three months during the first year and every six months in the following year. The clinical follow-up comprised determination of pre- and postoperative Harris hip scores, while serial AP, frog lateral radiographs, and CT scan were used for the radiographic follow-up. Results The clinical failure of bone grafting was observed in 40 patients. The clinical failure rates in patients belonging to ARCO stage II period, IIIa, and III (b + c) were 25.9%, 16.2%, and 61.5%, respectively, while those in patients belonging to (C + M + L1) type and L2, L3 type disease groups were 1.7%, 38.9%, and 39%, respectively. The clinical failure rates in patients aged below 40 and those aged 40 and over were 20.5% and 39.0%, respectively (all P < 0.05). Conclusion Disease type, disease stage, and patient age are risk factors for failure of bone graft surgery. Patients belonging to ARCO stage II and IIIa showed a good overall response rate, while patients belonging to ARCO stage IIIb and IIIc and those with necrotic lesions involving the lateral pillar (L2 and L3 type) showed high surgical failure rates. PMID:27285821

  18. (18)F-FDG PET/CT quantification in head and neck squamous cell cancer: principles, technical issues and clinical applications.

    PubMed

    Manca, Gianpiero; Vanzi, Eleonora; Rubello, Domenico; Giammarile, Francesco; Grassetto, Gaia; Wong, Ka Kit; Perkins, Alan C; Colletti, Patrick M; Volterrani, Duccio

    2016-07-01

    (18)F-FDG PET/CT plays a crucial role in the diagnosis and management of patients with head and neck squamous cell cancer (HNSCC). The major clinical applications of this method include diagnosing an unknown primary tumour, identifying regional lymph node involvement and distant metastases, and providing prognostic information. (18)F-FDG PET/CT is also used for precise delineation of the tumour volume for radiation therapy planning and dose painting, and for treatment response monitoring, by detecting residual or recurrent disease. Most of these applications would benefit from a quantitative approach to the disease, but the quantitative capability of (18)F-FDG PET/CT is still underused in HNSCC. Innovations in PET/CT technology promise to overcome the issues that until now have hindered the employment of dynamic procedures in clinical practice and have limited "quantification" to the evaluation of standardized uptake values (SUV), de facto a semiquantitative parameter, the limits of which are well known to the nuclear medicine community. In this paper the principles of quantitative imaging and the related technical issues are reviewed so that professionals involved in HNSCC management can reflect on the advantages of "true" quantification. A discussion is then presented on how semiquantitative information is currently used in clinical (18)F-FDG PET/CT applications in HNSCC, by discussing the improvements that could be obtained with more advanced and "personalized" quantification techniques.

  19. Skin Cancer of the Head and Neck With Perineural Invasion: Defining the Clinical Target Volumes Based on the Pattern of Failure

    SciTech Connect

    Gluck, Iris; Ibrahim, Mohannad; Popovtzer, Aron; Teknos, Theodoros N.; Chepeha, Douglas B.; Prince, Mark E.; Moyer, Jeffrey S.; Bradford, Carol R.; Eisbruch, Avraham

    2009-05-01

    Purpose: To analyze patterns of failure in patients with head-and-neck cutaneous squamous cell carcinoma (HNCSCC) and clinical/radiologic evidence of perineural invasion (CPNI), in order to define neural clinical target volume (CTV) for treatment planning. Methods and Materials: Patients treated with three-dimensional (3D) conformal or intensity-modulated radiotherapy (IMRT) for HNCSCC with CPNI were included in the study. A retrospective review of the clinical charts, radiotherapy (RT) plans and radiologic studies has been conducted. Results: Eleven consecutive patients with HNCSCCs with CPNI were treated from 2000 through 2007. Most patients underwent multiple surgical procedures and RT courses. The most prevalent failure pattern was along cranial nerves (CNs), and multiple CNs were ultimately involved in the majority of cases. In all cases the involved CNs at recurrence were the main nerves innervating the primary tumor sites, as well as their major communicating nerves. We have found several distinct patterns of disease spread along specific CNs depending on the skin regions harboring the primary tumors, including multiple branches of CN V and VII. These patterns and the pertinent anatomy are detailed in the this article. Conclusions: Predictable disease spread patterns along cranial nerves supplying the primary tumor sites were found in this study. Awareness of these patterns, as well as knowledge of the relevant cranial nerve anatomy, should be the basis for CTV definition and delineation for RT treatment planning.

  20. [Meta-analysis of the clinical significance of thyroidectomy combined with central neck dissection in differentiated thyroid carcinoma at the first treatment].

    PubMed

    Sun, Ronghao; Li, Chao; Fan, Jinchuan; Liu, Jifeng; Chen, Jianchao; Zhang, Bing

    2014-02-01

    To compare the differences in recurrence rates and surgical complications between thyroidectomy alone and thyroidectomy combined with central neck dissection as initial treatments to differentiated thyroid cancer and evaluate the clinic significance of central neck dissection for these patients. The literatures published in 1998-2013 were searched in Wanfang database, Chongqing VIP database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Pubmed, Medline and Beijing Kangjian foreign medical journal full text service. According to the inclusion and deletion criteria, 30 articles were included. Of them 26 articles involved in complications, hypocalcemia and recurrent laryngeal nerve palsy as two major complications were involved in 26 articles and 24 articles respectively, and 26 articles involved in recurrence rate. RevMan5.0 software package was used to perform meta-analysis. Total complication rate in experimental group (plus central neck dissection) was 13.08% higher than that in control group (thyroidectomy only), the odds ratio (OR) [95% confidence interval (95%CI)] was 2.32[2.02, 2.67], Z value was 11.80, P < 0.01. Hypocalcemia in the experimental group was 11.80% higher than that in control group, OR value [95%CI] was 2.58[2.21, 3.02], Z was 11.98, P < 0.01. The rates of recurrent laryngeal nerve paralysis were low in both experimental group (5.26%) and control group(3.95%), and OR value [95%CI] was 1.22 [0.94, 1.58], Z was 1.48, P = 0.14. Recurrence rate in experimental group was 2.23% lower than that in control group, OR value [95%CI] was 0.78 [0.63,0.97], Z was 2.35, P = 0.03. Central compartment dissection as initial treatment to differentiated thyroid cancer may reduce the risk of recurrence, but increases the incidence of total complications and hypocalcemia, and has no significant effect on the rate of the recurrent laryngeal nerve paralysis.

  1. Near-Infrared Fluorescence Sentinel Lymph Node Mapping of the Oral Cavity in Head and Neck Cancer Patients

    PubMed Central

    van der Vorst, Joost R.; Schaafsma, Boudewijn E.; Verbeek, Floris P.R.; Keereweer, Stijn; Jansen, Jeroen C.; van der Velden, Lilly-Ann; Langeveld, Antonius; Hutteman, Merlijn; Löwik, Clemens; van de Velde, Cornelis J.H.; Frangioni, John V.; Vahrmeijer, Alexander L.

    2013-01-01

    Objectives Elective neck dissection is frequently performed during surgery in head and neck cancer patients. The sentinel lymph node (SLN) procedure can prevent the morbidity of a neck dissection and improve lymph node staging by fine pathology. Near-infrared (NIR) fluorescence imaging is a promising technique to identify the sentinel lymph node (SLN) intraoperatively. This feasibility study explored the use of indocyanine green adsorbed to human serum albumin (ICG:HSA) for SLN mapping in head and neck cancer patients. Materials and Methods A total of 10 consecutive patients with oral cavity or oropharyngeal cancer and a clinical N0 neck were included. After exposure of the neck, 1.6 mL of ICG:HSA (500 μM) was injected at 4 quadrants around the tumor. During the neck dissection, levels I, II, III and IV were measured for fluorescence using the Mini-FLARE imaging system. Results In all 10 patients, NIR fluorescence imaging enabled visualization of one or more SLNs. A total of 17 SLNs were identified. The mean contrast between the fluorescent signal of the lymph nodes and of the surrounding tissue was 8.7 ± 6.4. In 3 patients, of which 1 was false-negative, lymph node metastases were found. After administration of ICG:HSA, the average number of fluorescent lymph nodes significantly increased over time (P < 0.001). Conclusion This study demonstrated feasibility to detect draining lymph nodes in head and neck cancer patients using NIR fluorescence imaging. However, the fluorescent tracer quickly migrated beyond the SLN to higher tier nodes. PMID:22939692

  2. Smartphone Application WeChat for Clinical Follow-up of Discharged Patients with Head and Neck Tumors: A Randomized Controlled Trial

    PubMed Central

    Lyu, Ke-Xing; Zhao, Jing; Wang, Bin; Xiong, Guan-Xia; Yang, Wei-Qiang; Liu, Qi-Hong; Zhu, Xiao-Lin; Sun, Wei; Jiang, Ai-Yun; Wen, Wei-Ping; Lei, Wen-Bin

    2016-01-01

    Background: Nowadays, social media tools such as short message service, Twitter, video, and web-based systems are more and more used in clinical follow-up, making clinical follow-up much more time- and cost-effective than ever before. However, as the most popular social media in China, little is known about the utility of smartphone WeChat application in follow-up. In this study, we aimed to investigate the feasibility and superiority of WeChat application in clinical follow-up. Methods: A total of 108 patients diagnosed with head and neck tumor were randomized to WeChat follow-up (WFU) group or telephone follow-up (TFU) group for 6-month follow-up. The follow-ups were delivered by WeChat or telephone at 2 weeks, 1, 2, 3, and 6 months to the patients after being discharged. The study measurements were time consumption for follow-up delivery, total economic cost, lost-to-follow-up rate, and overall satisfaction for the follow-up method. Results: Time consumption in WFU group for each patient (23.36 ± 6.16 min) was significantly shorter than that in TFU group (42.89 ± 7.15 min) (P < 0.001); total economic cost in WFU group (RMB 90 Yuan) was much lower than that in TFU group (RMB 196 Yuan). Lost-to-follow-up rate in the WFU group was 7.02% (4/57) compared with TFU group, 9.80% (5/51), while no significance was observed (95% confidence interval [CI]: 0.176–2.740; P = 0.732). The overall satisfaction rate in WFU group was 94.34% (50/53) compared with 80.43% (37/46) in TFU group (95% CI: 0.057–0.067; P = 0.034). Conclusions: The smartphone WeChat application was found to be a viable option for follow-up in discharged patients with head and neck tumors. WFU was time-effective, cost-effective, and convenient in communication. This doctor-led follow-up model has the potential to establish a good physician-patient relationship by enhancing dynamic communications and providing individual health instructions. Trial Registration: Chinese Clinical Trial Registry, Chi

  3. Esthesioneuroblastoma: Is There a Need for Elective Neck Treatment?

    SciTech Connect

    Demiroz, Candan; Gutfeld, Orit; Aboziada, Mohamed; Brown, Doris; Marentette, Lawrence J.; Eisbruch, Avraham

    2011-11-15

    Purpose: To assess the risk of cervical lymph node metastases after definitive treatment for esthesioneuroblastoma (ENB) that did not include elective neck therapy. Methods and Materials: This was a retrospective analysis of 26 ENB patients treated at University of Michigan between 1995 and 2007. Tumor stage was Kadish A in 1 patient, B in 19, C in 5, and unknown in 1. Craniofacial or subcranial resection was performed in 24 patients (92%), with negative margins in 22 (92%). Postoperative radiotherapy (RT) to the primary site was given in 12 patients (46%), and 14 patients (54%) had surgery alone. All patients had clinically N0 disease, and no patient underwent elective neck dissection or radiation. Median follow-up was 72 months. Results: Local relapse-free survival was significantly better for patients who received postoperative RT compared with those who had surgery alone: 100% vs. 29% at 5 years, respectively (p = 0.005). Five-year disease-free survival was 87.5% in the RT group vs. 31% in the surgery-alone group (p = 0.05). Regional failure was observed in 7 patients (27%), 6 with Kadish Stage B and 1 with Stage C disease. The most common site of nodal failure was Level II, and 3 patients failed in the contralateral neck. Only 3 patients with regional failure were successfully salvaged. Conclusion: The high rate of regional failures when the neck is not electively treated justifies elective nodal RT in patients with both Kadish Stages B and C. In addition, our experience confirms the beneficial effect on local control of adjuvant RT to the tumor bed.

  4. Antioxidant capacity of calendula officinalis flowers extract and prevention of radiation induced oropharyngeal mucositis in patients with head and neck cancers: a randomized controlled clinical study

    PubMed Central

    2013-01-01

    This study was designed to determine the effect of Calendula officinalis flowers extract mouthwash as oral gel on radiation-induced oropharyngeal mucositis (OM) in patients with head-and-neck cancer. Forty patients with neck and head cancers under radiotherapy or concurrent chemoradiotherapy protocols were randomly assigned to receive either 2% calendula extract mouthwash or placebo (20 patients in each group). Patients were treated with telecobalt radiotherapy at conventional fractionation (200 cGy/fraction, five fractions weekly, 30–35 fractions within 4–7 weeks). The oropharyngeal mucositis was evaluated by two clinical investigators (a radiation oncologist and a dentist), using the oral mucositis assessment scale (OMAS). Trying to find out the possible mechanism of action of the treatment, total antioxidant, polyphenol and flavonoid contents, and quercetin concentration of the mouth wash were measured. Calendula mouthwash significantly decreased the intensity of OM compared to placebo at week 2 (score: 5.5 vs. 6.8, p = 0.019), week 3 (score: 8.25 vs. 10.95, p < 0.0001) and week 6 (score: 11.4 vs. 13.35, p = 0.031). Total antioxidant, polyphenol and flavonoid contents and quercetin concentration of the 2% extract were 2353.4 ± 56.5 μM, 313.40 ± 6.52 mg/g, 76.66 ± 23.24 mg/g, and 19.41 ± 4.34 mg/l, respectively. Calendula extract gel could be effective on decreasing the intensity of radiotherapy- induced OM during the treatment and antioxidant capacity may be partly responsible for the effect. PMID:23497687

  5. Treatment of Femoral Neck Fracture with a Minimal Invasive Surgical Approach for Hemiarthroplasty – Clinical and Radiological Results in 180 Geriatric Patients

    PubMed Central

    Unger, A.C; Dirksen, B; Renken, F. G; Wilde, E; Willkomm, M; Schulz, A.P

    2014-01-01

    Purpose : The Direct Anterior Approach (DAA) is well established as a minimal access approach in elective orthopaedic hip surgery. For the growing number of elderly patients with femoral neck fractures treated with Bipolar Hip Hemiarthroplasty (BHH), only a few results do exist. The study shows the clinical and radiological outcome for 180 patients treated by a modified DAA with BHH. Materials and Methods : The data of 180 geriatric patients with medial femoral neck fractures were evaluated retrospectively. The general and surgical complications, mobilisation using the Timed Up and Go test (TUG), the social environment pre- and postoperative and the radiological results have been compared with established approaches for geriatric hip surgery. Results : After joint replacement, 18 (10%) patients were developed pneumonia, of which 3 (1.7%) died during hospitalisation. In 7 cases (4%), surgical revision had to be carried out: three times (1.7%) because of a seroma, three times (1.7%) because of subcutaneous infection, and one time (0.6%) because the BHH was removed, owing to deep wound infection. One dislocation (0.6%) occurred, as well as one femoral nerve lesion (0.6%) occured. 88.3% of patients were mobilised on walkers or crutches; the Timed Up and Go Test showed a significant improvement during inpatient rehabilitation. 83% were discharged to their usual social environment, 10% were transferred to a short-term care facility and 7% were relocated permanently to a nursing home. 3/4 of patients had a cemented stem alignment in the range between -5° and 5°, while 2/3 of patients had a maximum difference of 1 cm in leg length. Conclusion : Using the modified DAA, a high patient satisfaction is achieved after implantation of a BHH. The rate of major complications is just as low as in conventional approaches, and rapid mobilisation is possible. PMID:25136389

  6. Antioxidant capacity of calendula officinalis flowers extract and prevention of radiation induced oropharyngeal mucositis in patients with head and neck cancers: a randomized controlled clinical study.

    PubMed

    Babaee, Neda; Moslemi, Dariush; Khalilpour, Mohammad; Vejdani, Fatemeh; Moghadamnia, Yasaman; Bijani, Ali; Baradaran, Mahmoud; Kazemi, Mohammad Taghi; Khalilpour, Asieh; Pouramir, Mahdi; Moghadamnia, Ali Akbar

    2013-03-07

    This study was designed to determine the effect of Calendula officinalis flowers extract mouthwash as oral gel on radiation-induced oropharyngeal mucositis (OM) in patients with head-and-neck cancer. Forty patients with neck and head cancers under radiotherapy or concurrent chemoradiotherapy protocols were randomly assigned to receive either 2% calendula extract mouthwash or placebo (20 patients in each group). Patients were treated with telecobalt radiotherapy at conventional fractionation (200 cGy/fraction, five fractions weekly, 30-35 fractions within 4-7 weeks). The oropharyngeal mucositis was evaluated by two clinical investigators (a radiation oncologist and a dentist), using the oral mucositis assessment scale (OMAS). Trying to find out the possible mechanism of action of the treatment, total antioxidant, polyphenol and flavonoid contents, and quercetin concentration of the mouth wash were measured. Calendula mouthwash significantly decreased the intensity of OM compared to placebo at week 2 (score: 5.5 vs. 6.8, p = 0.019), week 3 (score: 8.25 vs. 10.95, p < 0.0001) and week 6 (score: 11.4 vs. 13.35, p = 0.031). Total antioxidant, polyphenol and flavonoid contents and quercetin concentration of the 2% extract were 2353.4 ± 56.5 μM, 313.40 ± 6.52 mg/g, 76.66 ± 23.24 mg/g, and 19.41 ± 4.34 mg/l, respectively. Calendula extract gel could be effective on decreasing the intensity of radiotherapy- induced OM during the treatment and antioxidant capacity may be partly responsible for the effect.

  7. Radiation therapy for head and neck neoplasms

    SciTech Connect

    Wang, C.C.

    1990-01-01

    This book presents the clinical manifestations of disease, applied anatomy pertaining to the management of head and neck tumors, and results of conventional radiation therapy for uncommon tumors have been explored. It also contains an additional chapter on altered fractionation radiation therapy pertaining to irradiation of major head and neck tumors.

  8. K-line (-) in the Neck-Flexed Position in Patients With Ossification of the Posterior Longitudinal Ligament Is a Risk Factor for Poor Clinical Outcome After Cervical Laminoplasty.

    PubMed

    Takeuchi, Kazunari; Yokoyama, Toru; Numasawa, Takuya; Yamasaki, Yoshihito; Kudo, Hitoshi; Itabashi, Taito; Chin, Shunfu; Wada, Kan-Ichiro

    2016-12-15

    Retrospective study comparing postoperative clinical outcomes after cervical laminoplasty between K-line (-) ossification of the posterior longitudinal ligament (OPLL) and K-line (+) OPLL in the neck-flexed position. To investigate postoperative outcomes using Japanese Orthopedic Association (JOA) scores, and grip-and-release (GR) and foot-tap (FT) test scores after laminoplasty in patients with K-line (-) OPLL in the neck-flexed position. Cervical laminoplasty has been reported to lead to poor outcomes in K-line (-) OPLL and good outcomes in K-line (+) OPLL. The cervical spine, however, continues moving in the extension and flexion direction after laminoplasty. Patients with cervical myelopathy were divided into K-line (+) and (-) in the neck-flexed position. We compared postoperative outcomes after cervical laminoplasty using recovery rate, as assessed by the JOA score and degree of improvement in the six JOA score items, and performance, as assessed by GR and (FT) tests, between patients with K-line (+) OPLL (n = 18) and K-line (-) OPLL (n = 23) in the neck-flexed position. Recovery rate of JOA score (23.8%) of patients in the K-line (-) group was significantly lower (P = 0.028) than that (46.3%) of K-line (+) group in the neck-flexed position. In the K-line (+) group, significant improvements were seen in all JOA-score items except bladder function; however, in the K-line (-) group, improvements were seen only in upper- and the lower-extremity sensory functions. In the K-line (+) group, mean GR and FT tests significantly improved, but in the K-line (-) group, only mean FT test significantly improved. The K-line (-) OPLL in the neck-flexed position is a risk factor for poor clinical outcome after cervical laminoplasty. 4.

  9. [Clinical analysis of nimotuzumab plus cisplatin and fluorouracil regimen as induction treatment in resectable head and neck squamous cell carcinoma].

    PubMed

    Zhao, Xiao-ying; Guo, Ye; Zhu, Yong-xue; Wang, Yu; Zhu, Guo-pei; Hu, Chao-su; Ji, Qing-hai

    2012-07-01

    A phase II study was conducted to test the efficacy and toxicity of the combination of cisplatin, 5-Fu and nimotuzumab, as induction treatment of resectable head and neck squamous cell carcinoma (HNSCC). Forty cases of resectable HNSCC were treated with nimotuzumab (400 mg on day 1) combined with PF regimens (cisplatin 75 mg/m² on days 1 and 5-Fu 750 mg/m² on days 1-5 q3wks). After 2 cycles, an organ-preservation local therapy (surgery or radiotherapy) was recommended. The primary endpoints of this study were overall response rate, pathologic complete response and safety of the induction treatment. Mean age of 40 patients was 54 years old, of them 9 patients with oropharyngeal cancer (22.5%), 16 hypopharyngeal cancer (40.0%), 10 laryngeal cancer (25.0%), and 5 oral cancer (12.5%). With a 2-cycle induction treatment, 34 (85.0%) patients achieved complete or partial response. Twenty-four patients (60.0%) got downstage, with T downstage in 21 (52.5%) patients and N downstage in 8 (20.0%) patients. Totally 27 patients got surgery after the induction treatment, of them 20 patients (74.1%) preserved organ functions. Four patients' primary tumors (10.0% in all 40 patients and 14.8% in operated 27 patients) showed pathologically complete responses. The toxicity was mild and manageable. The most common grade 3/4 toxicities were neutropenia (5.0%), nausea/vomiting (2.5%), stomatitis (2.5%) and thrombocytopenia (2.5%). One patient got grade 2 renal insufficiency and one patient got grade 1 skin rash. For resectable HNSCC, nimotuzumab plus PF regimen as induction treatment is highly effective for preserving the organ function and the toxicities are well tolerable.

  10. Orgasm-associated incontinence (climacturia) after bladder neck-sparing radical prostatectomy: clinical and video-urodynamic evaluation.

    PubMed

    Manassero, Francesca; Di Paola, Giuseppe; Paperini, Davide; Mogorovich, Andrea; Pistolesi, Donatella; Valent, Francesca; Selli, Cesare

    2012-08-01

    Orgasm-Associated Incontinence (OAI) or climacturia has been observed in male patients maintaining sexual potency after radical prostatectomy and cystectomy. We investigated the incidence and video-urodynamic aspects of this event in continent and potent patients after bladder neck-sparing (BNS) radical prostatectomy (RP). Comparing functional and morphological aspects between climacturic and non-climacturic patients to identify a possible explanation of this unusual kind of leakage that could seriously impact the sexual life after surgery. In a pool of 84 men, potent and continent at least 1 year after BNS RP, 24 (28.6%) reported climacturia and 7 agreed to undergo video-urodynamic evaluation (group 1), which was performed also in 5 controls (group 2). Those 12 men were also evaluated with 24-hour pad test, 5-item International Index of Erectile Function and International Prostate Symptom Score questionnaires. Functional urethral length (FUL) was significantly lower in the climacturia group (P=0.02) and time to continence recovery was significantly longer (P=0.05). No other significant differences were found between the two groups. The radiological appearance of the vesicourethral junction at voiding cystourethrography was similar. To the best of our knowledge, this is the first functional and morphological evaluation of climacturia after RP. In our experience, this event is indirectly associated with a reduced FUL in the sphincter area, although both patients and controls were continent during daily activities. BNS technique seems to reduce time to continence recovery, although climacturic patients need longer time than control patients. Since in our series no rigidity of the vesicourethral anastomosis was radiographically evident, we believe that differences in FUL could explain OAI. Anatomical difference in membranous urethra length could explain the occurrence of this symptom in patients treated with the same surgical technique. © 2012 International Society

  11. The development of an ICF-based clinical guideline and screening tool for the standardized assessment and evaluation of functioning after head and neck cancer treatment.

    PubMed

    Kisser, Ulrich; Adderson-Kisser, Christine; Coenen, Michaela; Stier-Jarmer, Marita; Becker, Sven; Sabariego, Carla; Harréus, Ulrich

    2017-02-01

    The assessment and evaluation of functioning and quality of life after tumor treatment in head and neck cancer (HNC) are considered as essential aspects of clinical routine and studies. A huge number of instruments are available that have been designed to evaluate functioning and quality of life after HNC treatment. The diversity of these instruments in terms of content, response options and administration hinders the comparability of available studies and the performance of meta-analyses. The objective of this paper is to inform about the development of a screening tool for the standardized assessment and evaluation of functioning based on the International Classification of Functioning, Disability and Health (ICF) Core Set for HNC. We followed a multi-step approach including (1) preparatory studies to identify and preselect suitable instruments for the assessment of functioning, (2) a decision-making process to agree on an ICF-based clinical guideline including instruments assessing functioning and (3) the development of a computer-based standardized screening tool to assess and evaluate functioning based on this guideline in clinical routine. Twenty-one experts participated in a consensus meeting and decided on instruments to be included in an ICF-based clinical guideline and screening tool for the assessment and evaluation of functioning in HNC patients in cancer treatment. The chosen instruments cover all aspects of the ICF Core Set for HNC addressing therapy control, pain, food intake/swallowing, voice/speech/breathing, other somatic complaints and psychosocial aspects. The screening tool contains patient-reported outcome measures and a clinician's checklist. It has to be further tested in clinical practice.

  12. Neck Pain: Revision 2017.

    PubMed

    Blanpied, Peter R; Gross, Anita R; Elliott, James M; Devaney, Laurie Lee; Clewley, Derek; Walton, David M; Sparks, Cheryl; Robertson, Eric K

    2017-07-01

    The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to neck pain. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. doi:10.2519/jospt.2017.0302.

  13. Stabilization of p21 by mTORC1/4E-BP1 predicts clinical outcome of head and neck cancers

    PubMed Central

    Llanos, Susana; García-Pedrero, Juana M.; Morgado-Palacin, Lucia; Rodrigo, Juan P.; Serrano, Manuel

    2016-01-01

    The levels, regulation and prognostic value of p21 in head and neck squamous cell carcinomas (HNSCC) has been puzzling for years. Here, we report a new mechanism of regulation of p21 by the mTORC1/4E-BP1 pathway. We find that non-phosphorylated 4E-BP1 interacts with p21 and induces its degradation. Accordingly, hyper-activation of mTORC1 results in phosphorylation of 4E-BP1 and stabilization of p21. In HNSCC, p21 levels strongly correlate with mTORC1 activity but not with p53 status. Finally, clinical data indicate that HNSCC patients with p21 and phospho-S6-double-positive tumours present a better disease-specific survival. We conclude that over-activation of the mTORC1/4E-BP1/p21 pathway is a frequent and clinically relevant alteration in HNSCC. PMID:26832959

  14. Clinical significance of Anoctamin-1 gene at 11q13 in the development and progression of head and neck squamous cell carcinomas

    PubMed Central

    Rodrigo, Juan P.; Menéndez, Sofía Tirados; Hermida-Prado, Francisco; Álvarez-Teijeiro, Saúl; Villaronga, M. Ángeles; Alonso-Durán, Laura; Vallina, Aitana; Martínez-Camblor, Pablo; Astudillo, Aurora; Suárez, Carlos; María García-Pedrero, Juana

    2015-01-01

    This study investigates the clinical significance of Anoctamin-1 gene mapping at 11q13 amplicon in both the development and progression of head and neck squamous cell carcinomas (HNSCC). ANO1 protein expression was evaluated by immunohistochemistry in a cohort of 372 surgically treated HNSCC patients and also in 35 laryngeal precancerous lesions. ANO1 gene amplification was determined by real-time PCR in all the laryngeal premalignancies and 60 of the HNSCCs, and molecular data correlated with clinical outcome. ANO1 gene amplification was frequently detected in both premalignant lesions (63%) and HNSCC tumours (58%), whereas concomitant ANO1 expression occurred at a much lower frequency (20 and 22%). Interestingly, laryngeal dysplasias harbouring ANO1 gene amplification showed a higher risk of malignant transformation (HR = 3.62; 95% CI 0.79–16.57; P = 0.097; Cox regression). ANO1 expression and gene amplification showed no significant associations with clinicopathological parameters in HNSCC. However, remarkably ANO1 expression differentially influenced patient survival depending on the tumour site. Collectively, this study provides original evidence demonstrating the distinctive impact of ANO1 expression on HNSCC prognosis depending on the tumour site. PMID:26498851

  15. Clinical significance of Anoctamin-1 gene at 11q13 in the development and progression of head and neck squamous cell carcinomas.

    PubMed

    Rodrigo, Juan P; Menéndez, Sofía Tirados; Hermida-Prado, Francisco; Álvarez-Teijeiro, Saúl; Villaronga, M Ángeles; Alonso-Durán, Laura; Vallina, Aitana; Martínez-Camblor, Pablo; Astudillo, Aurora; Suárez, Carlos; María García-Pedrero, Juana

    2015-10-26

    This study investigates the clinical significance of Anoctamin-1 gene mapping at 11q13 amplicon in both the development and progression of head and neck squamous cell carcinomas (HNSCC). ANO1 protein expression was evaluated by immunohistochemistry in a cohort of 372 surgically treated HNSCC patients and also in 35 laryngeal precancerous lesions. ANO1 gene amplification was determined by real-time PCR in all the laryngeal premalignancies and 60 of the HNSCCs, and molecular data correlated with clinical outcome. ANO1 gene amplification was frequently detected in both premalignant lesions (63%) and HNSCC tumours (58%), whereas concomitant ANO1 expression occurred at a much lower frequency (20 and 22%). Interestingly, laryngeal dysplasias harbouring ANO1 gene amplification showed a higher risk of malignant transformation (HR = 3.62; 95% CI 0.79-16.57; P = 0.097; Cox regression). ANO1 expression and gene amplification showed no significant associations with clinicopathological parameters in HNSCC. However, remarkably ANO1 expression differentially influenced patient survival depending on the tumour site. Collectively, this study provides original evidence demonstrating the distinctive impact of ANO1 expression on HNSCC prognosis depending on the tumour site.

  16. Symptoms and Needs of Head and Neck Cancer Patients at Diagnosis of Incurability - Prevalences, Clinical Implications, and Feasibility of a Prospective Longitudinal Multicenter Cohort Study.

    PubMed

    Alt-Epping, Bernd; Seidel, Wiebke; Vogt, Jeannette; Mehnert, Anja; Thomas, Michael; van Oorschot, Birgitt; Wolff, Hendrik; Schliephake, Henning; Canis, Martin; Dröge, Leif H; Nauck, Friedemann; Lordick, Florian

    2016-01-01

    Little is known about the physical symptoms and psychosocial burden of patients at the time of diagnosis of an incurable situation, although cancer treatment guidelines demand early assessment and integration of palliative care concepts, beginning from the diagnosis of incurability. Therefore, we initiated a prospective longitudinal multicenter cohort study assessing the symptoms and needs of patients suffering from incurable cancer (various entities), from the time of diagnosing incurability (i.e., before palliative anticancer treatment was initiated) and in 3-monthly intervals thereafter, by using validated self-reporting tools. Here, we focus on patients with head and neck cancer and present preliminary results on symptoms and need prevalences, on clinical implications, and on the feasibility of a methodologically complex assessment procedure in a particularly vulnerable study population. 22 patients completed the first visit. The Eastern Cooperative Oncology Group (ECOG) performance scores and most physical symptoms and psychosocial items varied between the extremes, from a virtually uncompromised condition to extremely perceived symptoms and needs. If intense face-to-face study support was provided, the study concept proved to be feasible, despite the complexity of assessment, problems in interdisciplinary and patient communication, comorbidities, and early death from complications. The striking variability in the perceived symptom and need intensities requires a highly individualized approach. For clinical purposes, a less complex screening procedure would be desirable, in order to enable a routine, early and comprehensive support, including palliative care services. © 2016 S. Karger GmbH, Freiburg.

  17. Human papillomavirus/p16 positive head and neck cancer in India: Prevalence, clinical impact, and influence of tobacco use.

    PubMed

    Murthy, V; Swain, M; Teni, T; Pawar, S; Kalkar, P; Patil, A; Chande, A; Ghonge, S; Laskar, S G; Gupta, T; Budrukkar, A; Agrawal, J

    2016-01-01

    Limited data are available on the prevalence and prognostic significance of human papillomavirus (HPV) in squamous cell carcinoma of head and neck (SCCHN) in the Indian population. The present study aimed to determine the prevalence of HPV and p16 in an Indian cohort of SCCHN and assess their correlation and influence of tobacco use on patient outcomes. The p16 and HPV status of 170 patients of SCCHN treated with curative chemoradiotherapy was determined using immunohistochemistry and polymerase chain reaction, respectively, and further correlated with their demographic characteristics. In addition, genotyping of HPV-positive samples was performed. Survival outcomes were analyzed and compared for both p16 positive (p16 +ve) and p16 negative (p16 -ve) population. The influence of tobacco use on outcomes was assessed. p16 expression was observed in 20% (34/170) cases whereas HPV positivity was detected in 39.4% (67/170) of SCCHN patients with HPV16 being the most common (91%) subtype. About 73.5% patients were p16 +ve among the tobacco users in this cohort (83.5%). Interestingly, p16 positivity was significantly associated with nonusers of tobacco (P = 0.02) and younger females (P = 0.06). The p16 +ve and p16 -ve groups did not exhibit a significant difference in the 5-year cause-specific survival (CSS) (79% vs. 72.2%), disease-free survival (DFS) (78.3% vs. 68.3%, P = 0.5), and locoregional control (LRC) (82.2% vs. 71.5%, P = 0.4). However, the outcome analyses in tobacco nonusers revealed a definite large improvement in CSS (P = 0.08) and a trend toward improvement in DFS (P = 0.15) and LRC (P = 0.11) in the p16 +ve versus the p16 -ve groups. The low prevalence of p16 positivity (20%) and dual HPV and p16 positivity (38.8%) in the studied Indian cohort indicates the low utility of p16 as a surrogate for HPV in the background of high tobacco burden. The outcomes are largely improved in a small subset of SCCHN cases comprising p16 +ve tobacco nonusers.

  18. [Clinical effects of different modes of ultra pulse carbon dioxide fractional laser used in combination on the treatment of hypertrophic scar on face and neck].

    PubMed

    Lei, Y; Li, S F; Yu, Y L; Tan, J

    2016-08-20

    To explore the clinical effects of ultra pulse mode of ultra pulse carbon dioxide fractional laser combined with Deep FX mode or Scaar FX mode on the treatment of patients with hypertrophic scars on face and neck. One hundred and fifty-eight patients with hypertrophic scars on face and neck who met the inclusion criteria were admitted to Hunan Provincial People's Hospital from January 2012 to January 2015. Firstly, the scar areas were cleaned and given compound lidocaine cream for surface anesthesia. Then the scar areas were treated with ultra pulse mode of ultra pulse carbon dioxide fractional laser, with energy from 150 to 175 mJ, frequency of 40 Hz, hole to hole distance of 4 mm or 5 mm, and the treatment time of each hole of 2 s or 3 s. For mild scar, Deep FX mode was added for treatment with energy from 30 to 50 mJ, frequency of 300 Hz, and density of 5%; for moderate and severe scar, Scaar FX mode was additionally used for therapy, with energy from 80 to 150 mJ, frequency of 300 Hz, and density of 3%. The above-mentioned treatments were performed per three months, totally for 3 times, 10-15 min per treatment. After each treatment, wounds were moisturized and given sun protection. Before the first treatment and 6 months after treatment of 3 times, the curative effect was assessed by Vancouver Scar Scale (VSS) and University of North Carolina Scar Scale. Six months after treatment of 3 times, satisfaction degree of patient and loss of working time were recorded. The adverse effects of whole treatment course were recorded. Data were processed with t test. (1) Six months after treatment of 3 times, VSS score of patients was (3.1±1.0) points, which was significantly lower than that before the first treatment [(9.4±1.8) points, t=53.096, P<0.05]; University of North Carolina Scar Scale score of patients was (1.6±0.7) points, which was significantly lower than that before the first treatment[(8.0±1.4) points, t=63.730, P<0.05]. (2) Six months after treatment of

  19. Integrating Epidermal Growth Factor Receptor Assay With Clinical Parameters Improves Risk Classification for Relapse and Survival in Head-and-Neck Squamous Cell Carcinoma

    SciTech Connect

    Chung, Christine H.; Hammond, Elizabeth M.; Trotti, Andy M.; Wang Huijun; Spencer, Sharon; Zhang Huazhong; Cooper, Jay; Jordan, Richard; Rotman, Marvin H.; Ang, K. Kian

    2011-10-01

    Purpose: Epidermal growth factor receptor (EGFR) overexpression has been consistently found to be an independent predictor of local-regional relapse (LRR) after radiotherapy. We assessed the extent by which it can refine risk classification for overall survival (OS) and LRR in patients with head-and-neck squamous cell carcinoma (HNSCC). Methods and Materials: EGFR expression in locally advanced HNSCC was measured by immunohistochemistry in a series of patients randomized to receive accelerated or conventional radiation regimens in a Phase III trial. Subsequently, data of the two series were pooled (N = 533) for conducting a recursive partitioning analysis that incorporated clinical parameters (e.g., performance status, primary site, T and N categories) and four molecular markers (EGFR, p53, Ki-67, and microvessel density). Results: This study confirmed that patients with higher than median levels of tumor EGFR expression had a lower OS (relative risk [RR]: 1.90, p = 0.0010) and a higher LRR (RR: 1.91, p = 0.0163). Of the four markers analyzed, only EGFR was found to contribute to refining classification of patients into three risk classes with distinct OS and LRR outcomes. The addition of EGFR to three clinical parameters could identify patients having up to a fivefold difference in the risk of LRR. Conclusions: Adding pretreatment EGFR expression data to known robust clinical prognostic variables improved the estimation of the probability for OS and LRR after radiotherapy. Its use for stratifying or selecting patients with defined tumor feature and pattern of relapse for enrollment into clinical trials testing specific therapeutic strategy warrants further investigation.

  20. The evolving role of selective neck dissection for head and neck squamous cell carcinoma.

    PubMed

    Robbins, K Thomas; Ferlito, Alfio; Shah, Jatin P; Hamoir, Marc; Takes, Robert P; Strojan, Primož; Khafif, Avi; Silver, Carl E; Rinaldo, Alessandra; Medina, Jesus E

    2013-03-01

    Neck dissection is an important part of the surgical treatment of head and neck squamous cell carcinoma (HNSCC). The historical concept of neck dissection implied the removal of all lymph node-bearing tissue in the neck, which began in the late nineteenth century. However, more conservative variations of neck dissection have been performed and promoted as well. Anatomic, pathologic, clinical investigations, and prospective studies have demonstrated that the lymphatic dissemination of HNSCC occurs in predictable patterns. Supported by these studies, selective neck dissection (SND), which consists of the removal of select levels of lymph nodes in the neck that have the highest risk of harboring undetected metastases, has become widely accepted in the treatment of the clinically uninvolved neck. More recently, evidence supports using SND in a therapeutic setting in selected cases of HNSCC with limited metastatic disease. Additionally, even more targeted dissections referred to as super-selective neck dissection have been explored for selected patients undergoing elective node dissection for supraglottic cancer and as an adjuvant therapy for salvage of residual lymphadenopathy confined to a single neck level following chemoradiation. In the future, the trend to tailor treatment to individual patients and to limit toxicity and morbidity may further increase the use of SND. The indications have to be guided by further research, in relation with non-surgical treatment options while optimizing oncological effectiveness.

  1. Lymph Node Metastasis in Cutaneous Head and Neck Squamous Cell Carcinoma.

    PubMed

    Silberstein, Eldad; Sofrin, Efrat; Bogdanov-Berezovsky, Alexander; Nash, Michael; Segal, Nili

    2015-10-01

    Cutaneous squamous cell carcinoma (CSCC), the second most common cancer in whites, may result in nodal metastasis in 4% of patients. In the last decade, sentinel lymph node biopsy (SLNB) became the common practice for treating patients with invasive skin cancers such as melanoma, although its use in patients with CSCC is still under debate. To find the rate of cervical lymph node metastasis in the series of patients with CSCC of the head and neck and to identify those who may need SLNB. A retrospective data collection on all patients diagnosed with CSCC of head and neck during the years 1998 to 2005. A total of 572 patients with 725 head and neck CSCC were included in the study group. During the follow-up period, 10 (1.3%) patients developed lymph node metastases and no patient developed distant metastases. The probability of lymph node metastasis within 6 years for T1 and T2 tumors was 1.09% and 5.46%, respectively (p = .0387). Because of the relatively low incidence of cervical lymph node metastases in patients with CSCC of the head and neck, SLNB for clinically N0 patients is not justified.

  2. Comparison of King Vision and Truview Laryngoscope for Postextubation Visualization of Vocal Cord Mobility in Patients Undergoing Thyroid and Major Neck Surgeries: A Randomized Clinical Trial

    PubMed Central

    Priyanka, Anto Sahaya; Nag, Kusha; Hemanth Kumar, V. R.; Singh, Dewan Roshan; Kumar, Senthil; Sivashanmugam, T.

    2017-01-01

    Background: Visualization of vocal cords following extubation after thyroid and major neck surgeries is highly desirable for the surgeon as well as the anaesthesiologist to rule out vocal cord palsy or oedema. As the patient is emerging from general anaesthesia, it may be challenging for the anaesthesiologist to optimally visualise and grade vocal cord movement following extubation. Setting: Randomized clinical trial at a tertiary care centre. Methodology: After obtaining institutional ethics committee approval, 60 patients posted for thyroid and major neck surgeries under American Society of Anesthesiologists (ASA) grade I and II were recruited for the study. Written informed consent was obtained. Pre-operatively indirect laryngoscopy was performed in all the patients to assess baseline vocal cord function. All patients were premedicated and induced and maintained as per standardized anaesthesia protocol. Patients were randomized using a sealed envelope technique to either Group K where intubation was performed using Kings vision laryngoscope or Group T where intubation was performed using True view laryngoscope. Glottis visualization was graded in all patients and intubated. Ten minutes prior to extubation injection. dexmedetomidine 1 μg/kg was administered. Once patients satisfied extubation criteria, laryngoscopy was performed using respective video-laryngoscope in each group, patient extubated under vision and assessed for vocal cord visualization and mobility grade (VMG) and patient reactivity score (PRS). Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure was also noted. Total intraoperative morphine consumption was recorded. Vocal cord function was assessed again before the day of discharge by indirect laryngoscopy. Results: Age (P = 0.27), sex (P = 0.08), body mass index (P = 0.70), ASA (P = 0.39), mallampati class (P = 0.72) and morphine used (P = 0.39) were comparable in both groups. There was no statistically

  3. Comparison of King Vision and Truview Laryngoscope for Postextubation Visualization of Vocal Cord Mobility in Patients Undergoing Thyroid and Major Neck Surgeries: A Randomized Clinical Trial.

    PubMed

    Priyanka, Anto Sahaya; Nag, Kusha; Hemanth Kumar, V R; Singh, Dewan Roshan; Kumar, Senthil; Sivashanmugam, T

    2017-01-01

    Visualization of vocal cords following extubation after thyroid and major neck surgeries is highly desirable for the surgeon as well as the anaesthesiologist to rule out vocal cord palsy or oedema. As the patient is emerging from general anaesthesia, it may be challenging for the anaesthesiologist to optimally visualise and grade vocal cord movement following extubation. Randomized clinical trial at a tertiary care centre. After obtaining institutional ethics committee approval, 60 patients posted for thyroid and major neck surgeries under American Society of Anesthesiologists (ASA) grade I and II were recruited for the study. Written informed consent was obtained. Pre-operatively indirect laryngoscopy was performed in all the patients to assess baseline vocal cord function. All patients were premedicated and induced and maintained as per standardized anaesthesia protocol. Patients were randomized using a sealed envelope technique to either Group K where intubation was performed using Kings vision laryngoscope or Group T where intubation was performed using True view laryngoscope. Glottis visualization was graded in all patients and intubated. Ten minutes prior to extubation injection. dexmedetomidine 1 μg/kg was administered. Once patients satisfied extubation criteria, laryngoscopy was performed using respective video-laryngoscope in each group, patient extubated under vision and assessed for vocal cord visualization and mobility grade (VMG) and patient reactivity score (PRS). Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure was also noted. Total intraoperative morphine consumption was recorded. Vocal cord function was assessed again before the day of discharge by indirect laryngoscopy. Age (P = 0.27), sex (P = 0.08), body mass index (P = 0.70), ASA (P = 0.39), mallampati class (P = 0.72) and morphine used (P = 0.39) were comparable in both groups. There was no statistically significant difference among the two groups with

  4. Preoperative Lymph Node Staging by FDG PET/CT With Contrast Enhancement for Thyroid Cancer: A Multicenter Study and Comparison With Neck CT

    PubMed Central

    Chong, Ari; Ha, Jung-Min; Han, Yeon-Hee; Kong, Eunjung; Choi, Yunjung; Hong, Ki Hwan; Park, Jun-Hee; Kim, Sung Hoon; Park, Jung Mi

    2017-01-01

    Objectives The purpose of this study was to compare lymph node (LN) staging using 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) with contrast-enhancement (CE) PET/CT and contrast-enhanced neck CT (neck CT) in patients with thyroid cancer with level-by-level comparison with various factors. Methods This was a retrospective multicenter study. A total of 85 patients were enrolled. Patients who underwent a preoperative evaluation by CE PET/CT and neck CT for thyroid cancer were enrolled. The gold standard for LN was the combination of surgical pathology and clinical follow-up. We compared CE PET/CT with neck CT using a level-by-level method. Factors, including age, sex, camera, arm position, tumor size, extra-thyroidal extension, tumor location, number of primary tumors, primary tumor maximum standardized uptake value, and the interval from scan to operation were also analyzed. Results Overall accuracy was 81.2% for CE PET/CT and 68.2% for neck CT. CE PET/CT was more sensitive than neck CT (65.8% vs. 44.7%). Also, CE PET/CT showed higher negative predictive value (77.2% vs. 66.1%). CE PET/CT showed good agreement with the gold standard (weighted kappa [κ], 0.7) for differentiating N0, N1a, and N1b, whereas neck CT showed moderate agreement (weighted κ, 0.5). CE PET/CT showed better agreement for the number of levels involved with the gold standard (weighted κ, 0.7) than that of neck CT with the gold standard (weighted κ, 0.5). The accuracies for differentiating N0, N1a, and N1b were 81.2% for CE PET/CT and 68.2% for neck CT. Level-by-level analysis showed that CE PET/CT was more sensitive and has higher negative predictive value for detecting ipsilateral level IV and level VI LNs than neck CT. Other analyzed factors were not related to accuracies of both modalities. Conclusion CE PET/CT was more sensitive and reliable than neck CT for preoperative LN staging in patients with thyroid cancer. PMID:27334517

  5. Submandibular gland sparing in intensity-modulated radiotherapy for N0-stage nasopharyngeal carcinoma

    PubMed Central

    Huang, L; Zhang, W; Zhuang, T; Wu, F; Li, D; Zheng, M; Lin, B; Zhuang, M

    2014-01-01

    Objective: This study evaluated and quantified the feasibility of submandibular gland (SMG) sparing in intensity-modulated radiotherapy (IMRT) for N0-stage nasopharyngeal carcinoma (NPC). Methods: Ten patients with N0-stage NPC were enrolled in the study. Four IMRT plans were produced for each, with different limiting conditions. In plan A, SMG sparing was ignored; in plans B, C and D, the mean dose to SMGs was restricted to 39 Gy. In addition, at least 95% of planning target volume (PTV)-IIa (PTV of clinical target volume involving level IIa lymph node) in plan C and 90% of PTV-IIa in plan D were required to have a 60 Gy covering. Results: The average mean dose to SMGs was 54.6 ± 3.6 Gy in plan A and was lower 39.3 ± 0.3, 49.3 ± 1.9 and 46.7 ± 2.8 Gy in plans B, C and D, respectively. The volume of PTV-IIa covered by 60 Gy was 98.9%, 81.6%, 95.2% and 90.8% in plans A, B, C and D, respectively, and showed a parallel association between dose reduction to SMGs and the covering deficit of PTV-IIa. Conclusion: Reducing the mean dose received by SMG to 39 Gy or less in IMRT for N0-stage NPC is feasible. PMID:24620926

  6. Phase II clinical study of valproic acid plus cisplatin and cetuximab in recurrent and/or metastatic squamous cell carcinoma of Head and Neck-V-CHANCE trial.

    PubMed

    Caponigro, Francesco; Di Gennaro, Elena; Ionna, Franco; Longo, Francesco; Aversa, Corrado; Pavone, Ettore; Maglione, Maria Grazia; Di Marzo, Massimiliano; Muto, Paolo; Cavalcanti, Ernesta; Petrillo, Antonella; Sandomenico, Fabio; Maiolino, Piera; D'Aniello, Roberta; Botti, Gerardo; De Cecio, Rossella; Losito, Nunzia Simona; Scala, Stefania; Trotta, Annamaria; Zotti, Andrea Ilaria; Bruzzese, Francesca; Daponte, Antonio; Calogero, Ester; Montano, Massimo; Pontone, Monica; De Feo, Gianfranco; Perri, Francesco; Budillon, Alfredo

    2016-11-25

    Recurrent/metastatic squamous cell carcinoma of the head and neck (SCCHN) has a poor prognosis and the combination of cisplatin and cetuximab, with or without 5-fluorouracil, is the gold standard treatment in this stage. Thus, the concomitant use of novel compounds represents a critical strategy to improve treatment results. Histone deacetylase inhibitors (HDACi) enhance the activity of several anticancer drugs including cisplatin and anti-Epidermal Growth Factor Receptor (anti-EGFR) compounds. Preclinical studies in models have shown that vorinostat is able to down regulate Epidermal Growth Factor Receptor (EGFR) expression and to revert epithelial to mesenchimal transition (EMT). Due to its histone deacetylase (HDAC) inhibiting activity and its safe use as a chronic therapy for epileptic disorders, valproic acid (VPA) has been considered a good candidate for anticancer therapy. A reasonable option may be to employ the combination of cisplatin, cetuximab and VPA in recurrent/metastatic SCCHN taking advantage of the possible positive interaction between histone deacetylase inhibitors, cisplatin and/or anti-EGFR. V-CHANCE is a phase 2 clinical trial evaluating, in patients with recurrent/metastatic squamous cell carcinoma of the head and neck never treated with first-line chemotherapy, the concomitant standard administration of cisplatin (on day 1, every 3 weeks) and cetuximab (on day 1, weekly), in combination with oral VPA given daily from day -14 with a titration strategy in each patient (target serum level of 50-100 μg/ml). Primary end point is the objective response rate measured according to Response Evaluation Criteria in Solid Tumors (RECIST). Sample size, calculated according to Simon 2 stage minimax design will include 21 patients in the first stage with upper limit for rejection being 8 responses, and 39 patients in the second stage, with upper limit for rejection being 18 responses. Secondary endpoints are time to progression, duration of response

  7. Clinical potential of boron neutron capture therapy for locally recurrent inoperable previously irradiated head and neck cancer.

    PubMed

    Lim, Diana; Quah, Daniel S C; Leech, Michelle; Marignol, Laure

    2015-12-01

    This review compares the safety and efficacy of boron neutron capture therapy (BNCT) in the treatment of previously irradiated, inoperable locoregional recurrent HNC patients and compares BNCT against the standard treatment of platinum-based chemotherapy. Our analysis of published clinical trials highlights efficacy of BNCT associated with mild side effects. However, the use of BNCT should be explored in stratified randomised trials.

  8. Electrotherapy for neck pain.

    PubMed

    Kroeling, Peter; Gross, Anita; Graham, Nadine; Burnie, Stephen J; Szeto, Grace; Goldsmith, Charles H; Haines, Ted; Forget, Mario

    2013-08-26

    Neck pain is common, disabling and costly. The effectiveness of electrotherapy as a physiotherapeutic option remains unclear. This is an update of a Cochrane review first published in 2005 and previously updated in 2009. This systematic review assessed the short, intermediate and long-term effects of electrotherapy on pain, function, disability, patient satisfaction, global perceived effect, and quality of life in adults with neck pain with and without radiculopathy or cervicogenic headache. We searched CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL, without language restrictions, from their beginning to August 2012; handsearched relevant conference proceedings; and consulted content experts. Randomized controlled trials (RCTs), in any language, investigating the effects of electrotherapy used primarily as unimodal treatment for neck pain. Quasi-RCTs and controlled clinical trials were excluded. We used standard methodological procedures expected by The Cochrane Collaboration. We were unable to statistically pool any of the results, but we assessed the quality of the evidence using an adapted GRADE approach. Twenty small trials (1239 people with neck pain) containing 38 comparisons were included. Analysis was limited by trials of varied quality, heterogeneous treatment subtypes and conflicting results. The main findings for reduction of neck pain by treatment with electrotherapeutic modalities were as follows.Very low quality evidence determined that pulsed electromagnetic field therapy (PEMF) and repetitive magnetic stimulation (rMS) were more effective than placebo, while transcutaneous electrical nerve stimulation (TENS) showed inconsistent results.Very low quality evidence determined that PEMF, rMS and TENS were more effective than placebo.Low quality evidence (1 trial, 52 participants) determined that permanent magnets (necklace) were no more effective than placebo (standardized mean difference (SMD) 0.27, 95% CI -0.27 to 0.82, random-effects model

  9. Grading Dysphagia as a Toxicity of Head and Neck Cancer: Differences in Severity Classification Based on MBS DIGEST and Clinical CTCAE Grades.

    PubMed

    Goepfert, Ryan P; Lewin, Jan S; Barrow, Martha P; Warneke, Carla L; Fuller, Clifton D; Lai, Stephen Y; Weber, Randal S; Hutcheson, Katherine A

    2017-08-23

    Clinician-reported toxicity grading through common terminology criteria for adverse events (CTCAE) stages dysphagia based on symptoms, diet, and tube dependence. The new dynamic imaging grade of swallowing toxicity (DIGEST) tool offers a similarly scaled five-point ordinal summary grade of pharyngeal swallowing as determined through results of a modified barium swallow (MBS) study. This study aims to inform clinicians on the similarities and differences between dysphagia severity according to clinical CTCAE and MBS-derived DIGEST grading. A cross-sectional sample of 95 MBS studies was randomly selected from a prospectively-acquired MBS database among patients treated with organ preservation strategies for head and neck cancer. MBS DIGEST and clinical CTCAE dysphagia grades were compared. DIGEST and CTCAE dysphagia grades had "fair" agreement per weighted κ of 0.358 (95% CI .231-.485). Using a threshold of DIGEST ≥ 3 as reference, CTCAE had an overall sensitivity of 0.50, specificity of 0.84, and area under the curve (AUC) of 0.67 to identify severe MBS-detected dysphagia. At less than 6 months, sensitivity was 0.72, specificity was 0.76, and AUC was 0.75 while at greater than 6 months, sensitivity was 0.22, specificity was 0.90, and AUC was 0.56 for CTCAE to detect dysphagia as determined by DIGEST. Classification of pharyngeal dysphagia on MBS using DIGEST augments our understanding of dysphagia severity according to the clinically-derived CTCAE while maintaining the simplicity of an ordinal scale. DIGEST likely complements CTCAE toxicity grading through improved specificity for physiologic dysphagia in the acute phase and improved sensitivity for dysphagia in the late-phase.

  10. Clinical benefit of nanoparticle albumin-bound-paclitaxel in recurrent/metastatic head and neck squamous cell carcinoma resistant to cremophor-based paclitaxel or docetaxel.

    PubMed

    Ley, Jessica; Wildes, Tanya M; Daly, Kristin; Oppelt, Peter; Adkins, Douglas

    2017-02-01

    The clinical benefit of nab-paclitaxel monotherapy for recurrent/metastatic head and neck squamous cell carcinoma (RM-HNSCC) that progressed on other taxanes (cremophor-based paclitaxel or docetaxel) is unknown. A retrospective analysis of patients treated at a single institution with nab-paclitaxel for taxane-resistant RM-HNSCC. The exploratory hypothesis was that nab-paclitaxel would result in clinical benefit (tumor response) in patients with taxane-resistant RM-HNSCC. Twelve patients who were treated with nab-paclitaxel monotherapy for taxane-resistant RM-HNSCC and met all eligibility criteria were identified. The majority of patients (n = 9; 75%) received three or more lines of therapy for RM-HNSCC. All patients had platin-resistant, and ten patients (83%) had cetuximab-resistant disease. Patients had RM-HNSCC that progressed on cremophor-based paclitaxel (8), docetaxel (1), or both (3). With prior taxane, the best tumor response was partial (PR) in 4 patients (33%), stable (SD) in 3 (25%), and progression in 5 (42%). The median time-to-progression (TTP) with prior taxane was 1.7 (range 0.7-9.0) months. The median interval from last dose of taxane to first dose of nab-paclitaxel was 3 (0.7-31.3) months. With nab-paclitaxel, tumor response occurred in two patients (17%; PR in both) and disease control (PR and SD) occurred in five (42%). Median TTP with nab-paclitaxel was 2.1 months (range 0.6-6.2), and median overall survival was 4.9 months (range 1.9-13.5). nab-Paclitaxel provided clinical benefit in some patients with taxane-resistant RM-HNSCC. The median TTP with nab-paclitaxel and with prior taxane were similar. This exploratory observation warrants further investigation in prospective studies.

  11. The possibility of clinical application of the solid state lasers: Nd:YAG, Ho:YAG, and Er:YAG in otolaryngology - head and neck surgery

    NASA Astrophysics Data System (ADS)

    Tomaszewska, M.; Kukwa, A.; Tulibacki, M.; Wójtowicz, P.; Olędzka, I.; Jeżewska, E.

    2007-02-01

    The purpose of this study was to summarize our experiences in clinical application of Nd:YAG, Ho:YAG and Er:YAG in otolaryngology- head and neck surgery. Choosing the laser type and parameters for the particular procedures was based on our previous research on tissue effects of those lasers. During the period of 1993-2006 we performed 3988 surgical procedures with the Nd:YAG laser. Over 87% of those were made for the nasal cavity pathologies as polyps, hyperplasia of inferior nasal turbinate, granulation tissue, postoperative adhesions, vascular malformations, under the local anesthesia conditions. In our experience Nd:YAG laser gives the possibility of good clinical control and low risk of side effects for disorders of high recurrence and frequent interventions necessity, as nasal polyps or respiratory papillomatosis. Nd:YAG assisted uvulopalatoplasty gives an interesting alternative for surgical procedures for snoring and slight/mild OSA-recognized patients. Due to its good hemostatic properties, it is a perfect tool for removal of the chemodectoma from meddle ear. During the period of 1995-2006 we performed 229 surgical procedures with the Ho:YAG laser, mostly for larynx pathologies (adhesion and scar tissue removal). In our experience Ho:YAG laser can serve as a precise laser knife for both soft and bony tissue. The ER:YAG laser still remain under clinical trial. Since 2001 year we performed 24 procedures of removing stone deposits from salivary glands. We believe it may become a promising method to cope with sialolithiasis which allows for glandule function preservation. All of the laser types mentioned above, can be easily coupled with endoscopes, what makes them available for all of the head and necklocalized disorders.

  12. Japanese Board Certification System for head and neck surgeons.

    PubMed

    Yoshimoto, Seiichi; Nakashima, Torahiko; Fujii, Takashi; Matsuura, Kazuto; Otsuki, Naoki; Asakage, Takahiro; Fujimoto, Yasushi; Hanai, Nobuhiro; Homma, Akihiro; Monden, Nobuya; Okami, Kenji; Sugasawa, Masashi; Hasegawa, Yasuhisa; Nibu, Ken-ichi; Kamata, Shin-etsu; Kishimoto, Seiji; Kohno, Naoyuki; Fukuda, Satoshi; Hisa, Yasuo

    2014-08-01

    The Japan Society for Head and Neck Surgery (JSHNS) started a board certification system for head and neck surgeons in 2010. To become certified, the following qualification and experiences are required: (1) board certification as otorhinolaryngologist, (2) 2 years of clinical experience in a board-certified training facility, (3) clinical care of 100 patients with head and neck cancer under the supervision of board-certified faculty and (4) surgical experience in 50 major head and neck surgical procedures, including 20 neck dissections, under the supervision of board-certified faculty. The following scientific activities are also required during the preceding 5 years: (1) two clinical papers on head and neck cancers presented at major scientific meetings, (2) one clinical paper on head and neck cancer published in a major journal, (3) attendance at two annual meetings of JSHNS and (4) enrolment in three educational programs approved by JSHNS. The qualifying examination consists of multiple choice tests and oral examinations. A total of 151 head and neck surgeons were certified in 2010 followed by 43 in 2011 and 34 in 2012, while the membership of JSHNS dramatically increased from 1201 in 2007 to 1748 in 2013. Although the board certification system for head and neck surgeons was started only recently, it has encouraged many residents and fellows as well as established head and neck surgeons. We believe that this system will contribute to further advancement in the clinical practice for head and neck cancers in Japan.

  13. Reliability of a measurement of neck flexor muscle endurance.

    PubMed

    Harris, Kevin D; Heer, Darren M; Roy, Tanja C; Santos, Diane M; Whitman, Julie M; Wainner, Robert S

    2005-12-01

    Neck flexor muscle endurance has been negatively correlated with cervical pain and dysfunction. The purposes of this study were to determine rater reliability in subjects both with and without neck pain and to determine whether there was a difference in neck flexor muscle endurance between the 2 groups. Forty-one subjects with and without neck pain were enrolled in this repeated-measures reliability study. Two raters used an isometric neck retraction test to assess neck flexor muscle endurance for all subjects during an initial session, and subjects without neck pain returned for testing 1 week later. For the group without neck pain, intrarater reliability was good to excellent (intraclass correlation coefficient [ICC(3,1)]=.82-.91), and interrater reliability was moderate to good (ICC[2,1]=.67-.78). The associated standard error of measurement (SEM) ranged from 8.0 to 11.0 seconds and from 12.6 to 15.3 seconds, respectively. For the group with neck pain, interrater reliability was moderate (ICC[2,1]=.67, SEM=11.5). Neck flexor muscle endurance test results for the group without neck pain (mean=38.95 seconds, SD=26.4) and the group with neck pain (mean=24.1 seconds, SD=12.8) were significantly different. Reliability coefficients differed between the 2 groups and ranged from moderate to excellent and improved after the first test session. The interrater reliability of data obtained with the neck flexor muscle endurance test in people with neck pain must be improved in order for clinicians to distinguish a clinically meaningful change from measurement error. Neck flexor muscle endurance was both statistically and clinically greater for subjects without neck pain than for those with neck pain.

  14. Phase I/II clinical study on safety and antivascular effects of paclitaxel encapsulated in cationic liposomes for targeted therapy in advanced head and neck cancer.

    PubMed

    Strieth, Sebastian; Dunau, Christoph; Michaelis, Uwe; Jäger, Lorenz; Gellrich, Donata; Wollenberg, Barbara; Dellian, Marc

    2014-07-01

    The purpose of this phase I/II clinical trial was to test safety and effectiveness of 2 doses of vascular targeting cationic liposomes encapsulating paclitaxel (EndoTAG-1 [ET]) in human head and neck squamous cell carcinoma (HNSCC). Patients with nonresectable therapy-refractory HNSCC were recruited for both ET treatment groups (3 or 4 patients per group). In cutaneous metastases, laser Doppler blood flow measurements were conducted during infusions. Only adverse events of grade 1 or 2 according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE version 3.0) - in particular fatigue, chills, and hypertension - occurred. Follow-up tumor volume measurements revealed stable disease in 4 of 5 cases. Reproducible dose-dependent blood flow reductions in skin metastases during ET infusions provide evidence of biological effectiveness. Infusions of ET seem to be safe and further phase II and III studies are warranted to prove efficacy in the treatment of HNSCC. Copyright © 2013 Wiley Periodicals, Inc.

  15. Serum Levels of IGF-1 and IGFBP-3 in Relation to Clinical and Pathobiological Aspects of Head and Neck Squamous Cell Carcinomas.

    PubMed

    Kalfert, David; Ludvikova, Marie; Topolcan, Ondrej; Celakovsky, Petr; Kucera, Radek; Windrichova, Jindra; Ludvik, Jaroslav; Skalova, Katerina; Kulda, Vlastimil; Pesta, Martin; Plzak, Jan

    2017-06-01

    Head and neck squamous cell carcinoma (HNSCC) includes tumors of various anatomical sites sharing multifactorial etiopathogenesis and generally dismal response to conventional treatment. The objective of this study was to determine the clinical significance of serum levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) in HNSCC. A total of 46 patients, with histologically-confirmed diagnosis of HNSCC (21 oropharyngeal, 21 laryngeal, and 4 hypopharyngeal cancers) were enrolled in this study. IGF-1 and IGFBP-3 serum levels were measured by an immunoradiometric assay using commercial kits. The adjustment of serum levels at 60 years of age was performed. Significant differences were found in IGF-1 serum concentrations between patients with p16 positive and p16 negative HNSCC (p=0.0062), with higher IGF-1 levels in p16 positive tumors, between low-grade and high-grade cancers (p=0.0323) only in larynx, with elevated IGF-1 concentrations associated with high-grade and between recurrent and non-recurrent HNSCC (p=0.0354), with lower IGF-1 levels in recurrent tumors. The conflicting results of this study may reflect some abnormality of IGF axis regulation in HNSCC, as well as the influence of other etiological factors (e.g. smoking, HPV infection). Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  16. Adaptive radiation therapy in head and neck cancer for clinical practice: state of the art and practical challenges.

    PubMed

    Veresezan, Ovidiu; Troussier, Idriss; Lacout, Alexis; Kreps, Sarah; Maillard, Sophie; Toulemonde, Aude; Marcy, Pierre-Yves; Huguet, Florence; Thariat, Juliette

    2017-02-01

    Modern radiation therapy techniques are characterized by high conformality to tumor volumes and steep dose gradients to spare normal organs. These techniques require accurate clinical target volume definitions and rigorous assessment of set up uncertainties using image guidance, a concept called image-guided radiation therapy. Due to alteration of patient anatomy, changes in tissue density/volumes and tumor shrinkage over the course of treatment, treatment accuracy may be challenged. This may result in excessive irradiation of organs at risk/healthy tissues and undercoverage of target volumes with a significant risk of locoregional failure. Adaptive radiation therapy (ART) is a concept allowing the clinician to reconsider the planned dose based on potential changes to accurately delivering the remaining radiation dose to the tumor while optimally minimizing irradiation of healthy tissues. There is little consensus on how to apply this concept in clinical practice. The current review investigates the current ART issues, including patient selection, clinical/dosimetric criteria and timing for re-planning, and practical technical issues. A practical algorithm is proposed for patient management in cases where ART is required.

  17. Neck-shoulder crossover: how often do neck and shoulder pathology masquerade as each other?

    PubMed

    Sembrano, Jonathan N; Yson, Sharon C; Kanu, Okezika C; Braman, Jonathan P; Santos, Edward Rainier G; Harrison, Alicia K; Polly, David W

    2013-09-01

    Cases of consecutive new patients seen at orthopedic spine and shoulder clinics were reviewed. Four percent of spine patients had significant shoulder pathology, and 3.6% of shoulder patients had significant spine pathology. Identification of the correct pain generator is a prerequisite for effective treatment in patients with neck and/or shoulder problems. However, distinguishing between the two can be difficult. Relative frequencies of how often one is mistaken for the other have not been well established. Six hundred ninety-four new patients were seen at the orthopedic shoulder clinic (n = 452) or spine clinic (n = 242) at an academic institution during a 2-year period. One hundred seven patients had previous shoulder surgery, and 39 had previous neck surgery. The 548 patients (shoulder clinic, 345; spine clinic, 203) who had no previous surgery were reviewed with respect to workup performed, final diagnosis, subsequent operative procedures, and incidence of referral from the shoulder clinic to the spine clinic and vice versa. Among the patients seen at the shoulder clinic, 325 (94.2%) had shoulder pathology, 6 (1.7%) had neck but no shoulder pathology, 6 (1.7%) had shoulder and neck pathology, and 8 (2.3%) had an unidentifiable cause of pain. Of the 12 patients with neck pathology, none underwent neck surgery. Among the patients seen at the spine clinic, 182 (89.7%) had neck pathology, 5 (2.5%) had shoulder but no neck pathology, 3 (1.5%) had neck and shoulder pathology, and 13 (6.4%) had an unidentifiable cause of pain. Of the 8 patients with shoulder pathology, 1 (12.5%) underwent shoulder surgery. Our analysis suggests that for patients who present to a shoulder surgeon's clinic for shoulder pain, 3.6% will turn out to have neck pathology. For patients who present to a spine surgeon's clinic for neck pain, 4% may turn out to have shoulder pathology. Thus, approximately 1 in 25 patients seen at a surgeon's clinic for a presumed shoulder or neck problem may

  18. Head-to-head comparison between (18)F-FDOPA PET/CT and MR/CT angiography in clinically recurrent head and neck paragangliomas.

    PubMed

    Heimburger, Céline; Veillon, Francis; Taïeb, David; Goichot, Bernard; Riehm, Sophie; Petit-Thomas, Julie; Averous, Gerlinde; Cavalcanti, Marcela; Hubelé, Fabrice; Chabrier, Gerard; Namer, Izzie Jacques; Charpiot, Anne; Imperiale, Alessio

    2017-06-01

    Head and neck paragangliomas (HNPGLs) can relapse after primary treatment. Optimal imaging protocols have not yet been established for posttreatment evaluation. The aim of the present study was to assess the diagnostic value of (18)F-FDOPA PET/CT and MR/CT angiography (MRA/CTA) in HNPGL patients with clinical relapse during their follow-up. Sixteen consecutive patients presenting with local pain, tinnitus, dysphagia, hoarse voice, cranial nerve involvement, deafness, or retrotympanic mass appearing during follow-up after the initial treatment of HNPGLs were retrospectively evaluated. Patients underwent both (18)F-FDOPA PET/CT and MRA (15 patents) or CTA (1 patent). Both methods were first assessed under blinded conditions and afterwards correlated. Head and neck imaging abnormalities without histological confirmation were considered true-positive results based on a consensus between radiologists and nuclear physicians and on further (18)F-FDOPA PET/CT and/or MRA. (18)F-FDOPA PET/CT and MRA/CTA were concordant in 14 patients and in disagreement in 2 patients. (18)F-FDOPA PET/CT and MRA/CTA identified, respectively, 12 and 10 presumed recurrent HNPGLs in 12 patients. The two lesions diagnosed by PET/CT only were confirmed during follow-up by otoscopic examination and MRA performed 29 and 17 months later. (18)F-FDOPA PET/CT images were only slightly influenced by the posttreatment sequelae, showing a better interobserver reproducibility than MRA/CTA. Finally, in 2 of the 16 studied patients, (18)F-FDOPA PET/CT detected two additional synchronous primary HNPGLs. (18)F-FDOPA PET/CT is highly sensitive in posttreatment evaluation of patients with HNPGLs, and also offers better interobserver reproducibility than MRA/CTA and whole-body examination. We therefore suggest that (18)F-FDOPA PET/CT is performed as the first diagnostic imaging modality in symptomatic patients with suspicion of HNPGL relapse after primary treatment when (68)Ga-labeled somatostatin analogues are

  19. DICOM for quantitative imaging biomarker development: a standards based approach to sharing clinical data and structured PET/CT analysis results in head and neck cancer research.

    PubMed

    Fedorov, Andriy; Clunie, David; Ulrich, Ethan; Bauer, Christian; Wahle, Andreas; Brown, Bartley; Onken, Michael; Riesmeier, Jörg; Pieper, Steve; Kikinis, Ron; Buatti, John; Beichel, Reinhard R

    2016-01-01

    Background. Imaging biomarkers hold tremendous promise for precision medicine clinical applications. Development of such biomarkers relies heavily on image post-processing tools for automated image quantitation. Their deployment in the context of clinical research necessitates interoperability with the clinical systems. Comparison with the established outcomes and evaluation tasks motivate integration of the clinical and imaging data, and the use of standardized approaches to support annotation and sharing of the analysis results and semantics. We developed the methodology and tools to support these tasks in Positron Emission Tomography and Computed Tomography (PET/CT) quantitative imaging (QI) biomarker development applied to head and neck cancer (HNC) treatment response assessment, using the Digital Imaging and Communications in Medicine (DICOM(®)) international standard and free open-source software. Methods. Quantitative analysis of PET/CT imaging data collected on patients undergoing treatment for HNC was conducted. Processing steps included Standardized Uptake Value (SUV) normalization of the images, segmentation of the tumor using manual and semi-automatic approaches, automatic segmentation of the reference regions, and extraction of the volumetric segmentation-based measurements. Suitable components of the DICOM standard were identified to model the various types of data produced by the analysis. A developer toolkit of conversion routines and an Application Programming Interface (API) were contributed and applied to create a standards-based representation of the data. Results. DICOM Real World Value Mapping, Segmentation and Structured Reporting objects were utilized for standards-compliant representation of the PET/CT QI analysis results and relevant clinical data. A number of correction proposals to the standard were developed. The open-source DICOM toolkit (DCMTK) was improved to simplify the task of DICOM encoding by introducing new API abstractions

  20. DICOM for quantitative imaging biomarker development: a standards based approach to sharing clinical data and structured PET/CT analysis results in head and neck cancer research

    PubMed Central

    Clunie, David; Ulrich, Ethan; Bauer, Christian; Wahle, Andreas; Brown, Bartley; Onken, Michael; Riesmeier, Jörg; Pieper, Steve; Kikinis, Ron; Buatti, John; Beichel, Reinhard R.

    2016-01-01

    Background. Imaging biomarkers hold tremendous promise for precision medicine clinical applications. Development of such biomarkers relies heavily on image post-processing tools for automated image quantitation. Their deployment in the context of clinical research necessitates interoperability with the clinical systems. Comparison with the established outcomes and evaluation tasks motivate integration of the clinical and imaging data, and the use of standardized approaches to support annotation and sharing of the analysis results and semantics. We developed the methodology and tools to support these tasks in Positron Emission Tomography and Computed Tomography (PET/CT) quantitative imaging (QI) biomarker development applied to head and neck cancer (HNC) treatment response assessment, using the Digital Imaging and Communications in Medicine (DICOM®) international standard and free open-source software. Methods. Quantitative analysis of PET/CT imaging data collected on patients undergoing treatment for HNC was conducted. Processing steps included Standardized Uptake Value (SUV) normalization of the images, segmentation of the tumor using manual and semi-automatic approaches, automatic segmentation of the reference regions, and extraction of the volumetric segmentation-based measurements. Suitable components of the DICOM standard were identified to model the various types of data produced by the analysis. A developer toolkit of conversion routines and an Application Programming Interface (API) were contributed and applied to create a standards-based representation of the data. Results. DICOM Real World Value Mapping, Segmentation and Structured Reporting objects were utilized for standards-compliant representation of the PET/CT QI analysis results and relevant clinical data. A number of correction proposals to the standard were developed. The open-source DICOM toolkit (DCMTK) was improved to simplify the task of DICOM encoding by introducing new API abstractions

  1. Expression of prion protein is closely associated with pathological and clinical progression and abnormalities of p53 in head and neck squamous cell carcinomas.

    PubMed

    Wei, Wei; Shi, Qi; Zhang, Nai-Song; Xiao, Kang; Chen, Li-Na; Yang, Xiao-Dong; Ji, Jia-Fu; Dong, Xiao-Ping

    2016-02-01

    Prion protein (PrP) is a glycosyl-phosphatidylinositol (GPI)-anchored membrane protein that functions as a unique pathogenic agent in transmissible spongiform encephalopathy (TSE). In the past decade, overexpression of PrP was observed in a number of human malignant tumors, such as gastric, breast and pancreatic cancer. However, the role of PrP expression in squamous cell carcinoma is rarely documented. To screen PrP expression in head and neck squamous cell carcinoma (HNSCCs), the paraffin-embedded specimens of 92 pathologically diagnosed HNSCCs were assessed by PrP-specific immunohistochemistry (IHC). A total of 55.43% (51/92) of the tested carcinoma tissues were PrP-positive. The rate of positivity and the staining intensity of PrP were closely related with the pathological degree of the HNSCCs; a higher rate of PrP expression was noted in the group of poorly differentiated cancers. PrP-positivity rates increased along with the progression of the clinical grade of the carcinomas. Further evaluation of the associations between PrP expression and the data concerning p53 abnormalities and human papillomavirus (HPV) infection in these samples as previously described, revealed that PrP-positive staining was more frequently detected in the tissues with p53-positive accumulation and the wild-type TP53 gene. The patients with a proline (Pro) polymorphism in SNP72 of TP53 showed significantly higher PrP-positive rates than those with arginine (Arg). No notable difference in PrP expression was identified between the HPV-positive and HPV-negative group. These data indicate a close association of PrP expression with clinical and histological differentiation of HNSCCs, as well as abnormalities of p53.

  2. Two-year clinical performance of glass ionomer and resin composite restorations in xerostomic head- and neck-irradiated cancer patients.

    PubMed

    De Moor, Roeland J G; Stassen, Inge G; van 't Veldt, Yoke; Torbeyns, Dries; Hommez, Geert M G

    2011-02-01

    The aim of this study was to evaluate the clinical performance of adhesive filling materials in class V cavities in xerostomic head- and neck-irradiated cancer patients, in terms of marginal adaptation, anatomical form and recurrent caries. We selected 35 high-caries-risk, post-radiation, xerostomic adults with ≥3 cervical carious lesions in the same arch. Every patient received a KetacFil (KF), PhotacFil (PF) and Herculite XRV (HX) restoration. Patients were instructed to use a neutral 1% sodium fluoride gel in custom trays, on a daily basis. After 6, 12, 18 and 24 months, the restorations were examined for material loss, marginal integrity and recurrent caries. Fluoride compliance was determined at each recall appointment and recorded as the percentage of recommended use during that interval [compliance of ≤50% = NFUs, >50% = FUs]. Only 30 patients were available for recall at 6 months, with 28 patients at 12 and 18 months, and 27 patients at 24 months. In the NFU group, differences in recurrent caries were found between KF and HX at all observation times (p < 0.05). Differences (p < 0.05) in adaptation and/or anatomical form were found between KF and PF in NFUs after 18 and 24 months. In FUs, significant differences were observed between KF and PF, and KF and HX after 6 and 12 months, between KF and HX, PF and HX after 18 and 24 months. In summary, glass ionomers (especially the conventionally setting formulation) provide clinical caries inhibition but erode easily, while composite resin provides greater structural integrity.

  3. High RAB25 expression is associated with good clinical outcome in patients with locally advanced head and neck squamous cell carcinoma

    PubMed Central

    Téllez-Gabriel, Marta; Arroyo-Solera, Irene; León, Xavier; Gallardo, Alberto; López, Montserrat; Céspedes, Maria V; Casanova, Isolda; López-Pousa, Antonio; Quer, Miquel; Mangues, Maria A; Barnadas, Agustí; Mangues, Ramón; Pavón, Miguel A

    2013-01-01

    Currently there are no molecular markers able to predict clinical outcome in locally advanced head and neck squamous cell carcinoma (HNSCC). In a previous microarray study, RAB25 was identified as a potential prognostic marker. The aim of this study was to analyze the association between RAB25 expression and clinical outcome in patients with locally advanced HNSCC treated with standard therapy. In a retrospective immunohistochemical study (n = 97), we observed that RAB25-negative tumors had lower survival (log-rank, P = 0.01) than patients bearing positive tumors. In an independent prospective mRNA study (n = 117), low RAB25 mRNA expression was associated with poor prognosis. Using classification and regression tree analysis (CART) we established two groups of patients according to their RAB25 mRNA level and their risk of death. Low mRNA level was associated with poor local recurrence-free (log-rank, P = 0.005), progression-free (log-rank, P = 0.002) and cancer-specific (log-rank, P < 0.001) survival. Multivariate Cox model analysis showed that low expression of RAB25 was an independent poor prognostic factor for survival (hazard ratio: 3.84, 95% confidence interval: 1.93–7.62, P < 0.001). Patients whose tumors showed high RAB25 expression had a low probability of death after treatment. We also found lower RAB25 expression in tumors than in normal tissue (Mann–Whitney U, P < 0.001). Moreover, overexpression of RAB25 in the UM-SCC-74B HNSCC cell line increased cisplatin sensitivity, and reduced cell migration and invasion. Our findings support a tumor suppressor role for RAB25 in HNSCC and its potential use to identify locally advanced patients with a high probability of survival after genotoxic treatment. PMID:24403269

  4. Chemoprevention of Head and Neck Cancer by Simultaneous Blocking of Epidermal Growth Factor Receptor and Cyclooxygenase-2 Signaling Pathways: Preclinical and Clinical Studies

    PubMed Central

    Shin, Dong M.; Zhang, Hongzheng; Saba, Nabil; Chen, Amy; Nannapaneni, Sreenivas; Amin, A.R.M. Ruhul; Müller, Susan; Lewis, Melinda; Sica, Gabriel; Kono, Scott; Brandes, Johann C.; Grist, William; Moreno-Williams, Rachel; Beitler, Jonathan J.; Thomas, Sufi M.; Chen, Zhengjia; Shin, Hyung Ju C.; Grandis, Jennifer R.; Khuri, Fadlo R.; Chen, Zhuo Georgia

    2013-01-01

    Purpose We investigated the efficacy and underlying molecular mechanism of a novel chemopreventive strategy combining epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) with cyclooxygenase-2 inhibitor (COX-2I). Experimental Design We examined the inhibition of tumor cell growth by combined EGFR-TKI (erlotinib) and COX-2I (celecoxib) treatment using head and neck cancer (HNC) cell lines and a preventive xenograft model. We studied the antiangiogenic activity of these agents and examined the affected signaling pathways by immunoblotting analysis in tumor cell lysates and immunohistochemistry (IHC) and enzyme immunoassay (EIA) analyses on the mouse xenograft tissues and blood, respectively. Biomarkers in these signaling pathways were studied by IHC, EIA, and an antibody array analysis in samples collected from participants in a phase I chemoprevention trial of erlotinib and celecoxib. Results The combined treatment inhibited HNC cell growth significantly more potently than either single agent alone in cell line and xenograft models, and resulted in greater inhibition of cell cycle progression at G1 phase than either single drug. The combined treatment modulated the EGFR and mTOR signaling pathways. A phase I chemoprevention trial of combined erlotinib and celecoxib revealed an overall pathologic response rate of 71% at time of data analysis. Analysis of tissue samples from participants consistently showed downregulation of EGFR, pERK and pS6 levels after treatment, which correlated with clinical response. Conclusion Treatment with erlotinib combined with celecoxib offers an effective chemopreventive approach through inhibition of EGFR and mTOR pathways, which may serve as potential biomarkers to monitor the intervention of this combination in the clinic. PMID:23422093

  5. Head and Neck Cancer

    MedlinePlus

    Head and neck cancer includes cancers of the mouth, nose, sinuses, salivary glands, throat, and lymph nodes in the ... swallowing A change or hoarseness in the voice Head and neck cancers are twice as common in men. Using ...

  6. Frequent screening with serial neck ultrasound is more likely to identify false-positive abnormalities than clinically significant disease in the surveillance of intermediate risk papillary thyroid cancer patients without suspicious findings on follow-up ultrasound evaluation.

    PubMed

    Peiling Yang, Samantha; Bach, Ariadne M; Tuttle, R Michael; Fish, Stephanie A

    2015-04-01

    American Thyroid Association (ATA) intermediate-risk thyroid cancer patients who achieve an excellent treatment response demonstrate a low risk of structural disease recurrence. Despite this fact, most patients undergo frequent surveillance neck ultrasound (US) during follow-up. The objective of the study was to evaluate the clinical utility of routine screening neck US in ATA intermediate-risk patients documented to have a nonstimulated thyroglobulin less than 1.0 ng/mL and a neck US without suspicious findings after therapy. Retrospective review of 90 ATA intermediate-risk papillary thyroid carcinoma patients treated with total thyroidectomy and radioactive iodine ablation in a tertiary referral center. A comparison between the frequency of finding false-positive US abnormalities and the frequency of identifying structural disease recurrence in the study cohort was measured. Over a median of 10 years, 90 patients had a median of six US (range 2-16). Structural disease recurrence was identified in 10% (9 of 90) at a median of 6.3 years. Recurrence was associated with other clinical indicators of disease in 5 of the 90 patients (5.6%, 5 of 90) and was detected without other signs of recurrence in four patients (4.8%, 4 of 84). False-positive US abnormalities were identified in 57% (51 of 90), leading to additional testing, which failed to identify clinically significant disease. In ATA intermediate-risk patients who have a nonstimulated thyroglobulin less than 1.0 ng/mL and a neck US without suspicious findings after therapy, frequent US screening during follow-up is more likely to identify false-positive abnormalities than clinically significant structural disease recurrence.

  7. Opportunistic actinomycosis in osteoradionecrosis of the jaws in patients affected by head and neck cancer: incidence and clinical significance.

    PubMed

    Curi, M M; Dib, L L; Kowalski, L P; Landman, G; Mangini, C

    2000-05-01

    Actinomycosis is occasionally an opportunistic infection occurrence in patients with osteoradionecrosis (ORN). A retrospective study (1992-97) of 50 patients with ORN of the jaws was done to evaluate the incidence and its clinical significance in the management of ORN. Actinomycosis was diagnosed in 12% of ORN cases. In 36 of the 50 patients including five cases of actinomycosis, the ORN was considered to be resolved after treatment. The median treatment duration of ORN was significantly longer (P<0.007) in patients with actinomycosis (29.7 months) than those without the disease (13.4 months). In conclusion, bone biopsy should be considered in cases of ORN with unsatisfactory response to its specific therapies, aiming to identify possible opportunistic actinomycosis infection.

  8. Clinical application of the Nd-YAG and Ho-YAG lasers in otolaryngology: head and neck surgery

    NASA Astrophysics Data System (ADS)

    Kukwa, Andrzej; Tulibacki, Marek P.; Dudziec, Katarzyna; Wojtowicz, Piotr

    1997-10-01

    The authors present their clinical experience regarding the possibilities of application of Nd:YAG and Ho:YAG lasers for the treatment of disorders in the area of the upper respiratory tract sinuses and ears. This technique makes it possible to perform a number of procedures in local anesthesia which considerably improves the economic effectiveness of the treatment. In case of the Nd:YAG laser they have also utilized the effect of deep coagulation of the soft tissues, whereas the Ho:YAG laser energy was applied for the surgery of bone tissue. The surgeries performed using laser beam enabled very good effect of treatment. They are competitive compared wit the methods used by traditional surgery.

  9. Neck and Upper Limb Dysfunction in Patients following Neck Dissection: Looking beyond the Shoulder.

    PubMed

    Gane, Elise M; O'Leary, Shaun P; Hatton, Anna L; Panizza, Benedict J; McPhail, Steven M

    2017-10-01

    Objective To measure patient-perceived upper limb and neck function following neck dissection and to investigate potential associations between clinical factors, symptoms, and function. Study Design Cross-sectional. Setting Two tertiary hospitals in Brisbane, Australia. Subjects and Methods Inclusion criteria: patients treated with neck dissection (2009-2014). aged <18 years, accessory nerve or sternocleidomastoid sacrifice, previous neck dissection, preexisting shoulder/neck injury, and inability to provide informed consent (cognition, insufficient English). Primary outcomes were self-reported function of the upper limb (Quick Disabilities of the Arm, Shoulder, and Hand) and neck (Neck Disability Index). Secondary outcomes included demographics, oncological management, self-efficacy, and pain. Generalized linear models were prepared to examine relationships between explanatory variables and self-reported function. Results Eighty-nine participants (male n = 63, 71%; median age, 62 years; median 3 years since surgery) reported mild upper limb and neck dysfunction (median [quartile 1, quartile 3] scores of 11 [3, 32] and 12 [4, 28], respectively). Significant associations were found between worse upper limb function and longer time since surgery (coefficient, 1.76; 95% confidence interval [CI], 0.01-3.51), having disease within the thyroid (17.40; 2.37-32.44), postoperative radiation therapy (vs surgery only) (13.90; 6.67-21.14), and shoulder pain (0.65; 0.44-0.85). Worse neck function was associated with metastatic cervical lymph nodes (coefficient, 6.61; 95% CI, 1.14-12.08), shoulder pain (0.19; 0.04-0.34), neck pain (0.34; 0.21-0.47), and symptoms of neuropathic pain (0.61; 0.25-0.98). Conclusion Patients can experience upper limb and neck dysfunction following nerve-preserving neck dissection. The upper quadrant as a whole should be considered when assessing rehabilitation priorities after neck dissection.

  10. Photoelectron spectroscopic study of the hydrated nucleoside anions: Uridine(-)(H(2)O)(n=0-2), cytidine(-)(H(2)O)(n=0-2), and thymidine(-)(H(2)O)(n=0,1).

    PubMed

    Li, Xiang; Wang, Haopeng; Bowen, Kit H

    2010-10-14

    The hydrated nucleoside anions, uridine(-)(H(2)O)(n=0-2), cytidine(-)(H(2)O)(n=0-2), and thymidine(-)(H(2)O)(n=0,1), have been prepared in beams and studied by anion photoelectron spectroscopy in order to investigate the effects of a microhydrated environment on parent nucleoside anions. Vertical detachment energies (VDEs) were measured for all eight anions, and from these, estimates were made for five sequential anion hydration energies. Excellent agreement was found between our measured VDE value for thymidine(-)(H(2)O)(1) and its calculated value in the companion article by S. Kim and H. F. Schaefer III.

  11. Photoelectron spectroscopic study of the hydrated nucleoside anions: Uridine-(H2O)n=0-2, cytidine-(H2O)n=0-2, and thymidine-(H2O)n=0,1

    NASA Astrophysics Data System (ADS)

    Li, Xiang; Wang, Haopeng; Bowen, Kit H.

    2010-10-01

    The hydrated nucleoside anions, uridine-(H2O)n=0-2, cytidine-(H2O)n=0-2, and thymidine-(H2O)n=0,1, have been prepared in beams and studied by anion photoelectron spectroscopy in order to investigate the effects of a microhydrated environment on parent nucleoside anions. Vertical detachment energies (VDEs) were measured for all eight anions, and from these, estimates were made for five sequential anion hydration energies. Excellent agreement was found between our measured VDE value for thymidine-(H2O)1 and its calculated value in the companion article by S. Kim and H. F. Schaefer III.

  12. Neck Injuries and Disorders

    MedlinePlus

    ... cause of neck pain. Whiplash, a soft tissue injury to the neck, is also called neck sprain or strain. Treatment depends on the cause, but may include applying ice, taking pain relievers, getting physical therapy or wearing a cervical collar. You rarely need surgery.

  13. Deformable image registration based automatic CT-to-CT contour propagation for head and neck adaptive radiotherapy in the routine clinical setting.

    PubMed

    Kumarasiri, Akila; Siddiqui, Farzan; Liu, Chang; Yechieli, Raphael; Shah, Mira; Pradhan, Deepak; Zhong, Hualiang; Chetty, Indrin J; Kim, Jinkoo

    2014-12-01

    To evaluate the clinical potential of deformable image registration (DIR)-based automatic propagation of physician-drawn contours from a planning CT to midtreatment CT images for head and neck (H&N) adaptive radiotherapy. Ten H&N patients, each with a planning CT (CT1) and a subsequent CT (CT2) taken approximately 3-4 week into treatment, were considered retrospectively. Clinically relevant organs and targets were manually delineated by a radiation oncologist on both sets of images. Four commercial DIR algorithms, two B-spline-based and two Demons-based, were used to deform CT1 and the relevant contour sets onto corresponding CT2 images. Agreement of the propagated contours with manually drawn contours on CT2 was visually rated by four radiation oncologists in a scale from 1 to 5, the volume overlap was quantified using Dice coefficients, and a distance analysis was done using center of mass (CoM) displacements and Hausdorff distances (HDs). Performance of these four commercial algorithms was validated using a parameter-optimized Elastix DIR algorithm. All algorithms attained Dice coefficients of >0.85 for organs with clear boundaries and those with volumes >9 cm(3). Organs with volumes <3 cm(3) and/or those with poorly defined boundaries showed Dice coefficients of ∼ 0.5-0.6. For the propagation of small organs (<3 cm(3)), the B-spline-based algorithms showed higher mean Dice values (Dice = 0.60) than the Demons-based algorithms (Dice = 0.54). For the gross and planning target volumes, the respective mean Dice coefficients were 0.8 and 0.9. There was no statistically significant difference in the Dice coefficients, CoM, or HD among investigated DIR algorithms. The mean radiation oncologist visual scores of the four algorithms ranged from 3.2 to 3.8, which indicated that the quality of transferred contours was "clinically acceptable with minor modification or major modification in a small number of contours." Use of DIR-based contour propagation in the routine

  14. Deformable image registration based automatic CT-to-CT contour propagation for head and neck adaptive radiotherapy in the routine clinical setting

    SciTech Connect

    Kumarasiri, Akila Siddiqui, Farzan; Liu, Chang; Yechieli, Raphael; Shah, Mira; Pradhan, Deepak; Zhong, Hualiang; Chetty, Indrin J.; Kim, Jinkoo

    2014-12-15

    Purpose: To evaluate the clinical potential of deformable image registration (DIR)-based automatic propagation of physician-drawn contours from a planning CT to midtreatment CT images for head and neck (H and N) adaptive radiotherapy. Methods: Ten H and N patients, each with a planning CT (CT1) and a subsequent CT (CT2) taken approximately 3–4 week into treatment, were considered retrospectively. Clinically relevant organs and targets were manually delineated by a radiation oncologist on both sets of images. Four commercial DIR algorithms, two B-spline-based and two Demons-based, were used to deform CT1 and the relevant contour sets onto corresponding CT2 images. Agreement of the propagated contours with manually drawn contours on CT2 was visually rated by four radiation oncologists in a scale from 1 to 5, the volume overlap was quantified using Dice coefficients, and a distance analysis was done using center of mass (CoM) displacements and Hausdorff distances (HDs). Performance of these four commercial algorithms was validated using a parameter-optimized Elastix DIR algorithm. Results: All algorithms attained Dice coefficients of >0.85 for organs with clear boundaries and those with volumes >9 cm{sup 3}. Organs with volumes <3 cm{sup 3} and/or those with poorly defined boundaries showed Dice coefficients of ∼0.5–0.6. For the propagation of small organs (<3 cm{sup 3}), the B-spline-based algorithms showed higher mean Dice values (Dice = 0.60) than the Demons-based algorithms (Dice = 0.54). For the gross and planning target volumes, the respective mean Dice coefficients were 0.8 and 0.9. There was no statistically significant difference in the Dice coefficients, CoM, or HD among investigated DIR algorithms. The mean radiation oncologist visual scores of the four algorithms ranged from 3.2 to 3.8, which indicated that the quality of transferred contours was “clinically acceptable with minor modification or major modification in a small number of contours

  15. Elective Neck Dissection for Head and Neck Cutaneous Squamous Cell Carcinoma with Skull Base Invasion.

    PubMed

    Cannon, Richard B; Dundar, Yusuf; Thomas, Andrew; Monroe, Marcus M; Buchmann, Luke O; Witt, Benjamin L; Sowder, Aleksandra M; Hunt, Jason P

    2017-04-01

    Objectives Skull base invasion from cutaneous squamous cell carcinoma (cSCC) via perineural spread affects survival and the rate of regional metastasis. Our objective is to investigate the factors associated with elective neck dissection (END) in this population and the survival difference with END compared with observation for patients with a cN0 neck. Study Design Case series with chart review. Setting Academic. Subjects and Methods Patients were treated surgically for head and neck cSCC with skull base invasion via perineural spread with a cN0 neck from 2004 to 2014. Clinicopathologic data were collected and analyzed. Primary outcomes were disease-free survival (DFS) and overall survival (OS). Results Fifty-nine patients met inclusion criteria: 28 underwent an END and 31 underwent neck observation. Free tissue transfer reconstruction was significantly associated with END ( P < .001). Patients treated with an END had significantly improved 5-year DFS (57% and 32%, P = .042) and OS (60% and 37%, P = .036) compared with those who were observed and a significantly reduced rate of regional recurrence (9% and 37%, P = .024). The rate of occult nodal metastasis identified with END was 36% and is approximately equal to the regional failure rate of the neck observation group (37%). Conclusion END was more commonly used in cases requiring free tissue transfer. The use of END for head and neck cSCCs that have invaded the skull base is not routinely performed but was found to be associated with a survival advantage and reduced regional recurrence rate.

  16. Effects of tailored neck-shoulder pain treatment based on a decision model guided by clinical assessments and standardized functional tests. A study protocol of a randomized controlled trial

    PubMed Central

    2012-01-01

    Background A major problem with rehabilitation interventions for neck pain is that the condition may have multiple causes, thus a single treatment approach is seldom efficient. The present study protocol outlines a single blinded randomised controlled trial evaluating the effect of tailored treatment for neck-shoulder pain. The treatment is based on a decision model guided by standardized clinical assessment and functional tests with cut-off values. Our main hypothesis is that the tailored treatment has better short, intermediate and long-term effects than either non-tailored treatment or treatment-as-usual (TAU) on pain and function. We sub-sequentially hypothesize that tailored and non-tailored treatment both have better effect than TAU. Methods/Design 120 working women with minimum six weeks of nonspecific neck-shoulder pain aged 20–65, are allocated by minimisation with the factors age, duration of pain, pain intensity and disability in to the groups tailored treatment (T), non-tailored treatment (NT) or treatment-as-usual (TAU). Treatment is given to the groups T and NT for 11 weeks (27 sessions evenly distributed). An extensive presentation of the tests and treatment decision model is provided. The main treatment components are manual therapy, cranio-cervical flexion exercise and strength training, EMG-biofeedback training, treatment for cervicogenic headache, neck motor control training. A decision algorithm based on the baseline assessment determines the treatment components given to each participant of T- and NT-groups. Primary outcome measures are physical functioning (Neck Disability Index) and average pain intensity last week (Numeric Rating Scale). Secondary outcomes are general improvement (Patient Global Impression of Change scale), symptoms (Profile Fitness Mapping neck questionnaire), capacity to work in the last 6 weeks (quality and quantity) and pressure pain threshold of m. trapezius. Primary and secondary outcomes will be reported for

  17. pN0(i+) Breast Cancer: Treatment Patterns, Locoregional Recurrence, and Survival Outcomes

    SciTech Connect

    Karam, Irene; Lesperance, Maria F.; Berrang, Tanya; Speers, Caroline; Tyldesley, Scott; Truong, Pauline T.

    2013-11-15

    Purpose: To examine treatment patterns, recurrence, and survival outcomes in patients with pN0(i+) breast cancer. Methods and Materials: Subjects were 5999 women with AJCC (6th edition) pT1-3, pN0-N1a, M0 breast cancer diagnosed between 2003 and 2006. Of these, 4342 (72%) had pN0, 96 (2%) had pN0(i+), 349 (6%) had pNmic (micrometastases >0.2 mm to ≤2 mm), and 1212 (20%) had pN1a (1-3 positive macroscopic nodes) disease. Treatment characteristics and 5-year Kaplan-Meier local recurrence, regional recurrence (RR), locoregional recurrence (LRR), and overall survival were compared between nodal subgroups. Multivariable analysis was performed using Cox regression modeling. A 1:3 case-match analysis examined outcomes in pN0(i+) cases compared with pN0 controls matched for similar tumor and treatment characteristics. Results: Median follow-up was 4.8 years. Adjuvant systemic therapy use increased with nodal stage: 81%, 92%, 95%, and 94% in pN0, pN0(i+), pNmic, and pN1a disease, respectively (P<.001). Nodal radiation therapy (RT) use also increased with nodal stage: 1.7% in pN0, 27% in pN0(i+), 33% in pNmic, and 63% in pN1a cohorts (P<.001). Five-year Kaplan-Meier outcomes in pN0 versus pN0(i+) cases were as follows: local recurrence 1.7% versus 3.7% (P=.20), RR 0.5% versus 2.2% (P=.02), and LRR 2.1% versus 5.8% (P=.02). There were no RR events in 26 patients with pN0(i+) disease who received nodal RT and 2 RR events in 70 patients who did not receive nodal RT. On multivariable analysis, pN0(i+) was not associated with worse locoregional control or survival. On case-match analysis, LRR and overall survival were similar between pN0(i+) and matched pN0 counterparts. Conclusions: Nodal involvement with isolated tumor cells is not a significant prognostic factor for LRR or survival in this study's multivariable and case-match analyses. These data do not support the routine use of nodal RT in the setting of pN0(i+) disease. Prospective studies are needed to define optimal

  18. Exploring patient satisfaction: a secondary analysis of a randomized clinical trial of spinal manipulation, home exercise, and medication for acute and subacute neck pain.

    PubMed

    Leininger, Brent D; Evans, Roni; Bronfort, Gert

    2014-10-01

    The purpose of this study was to assess satisfaction with specific aspects of care for acute neck pain and explore the relationship between satisfaction with care, neck pain, and global satisfaction. This study was a secondary analysis of patient satisfaction from a randomized trial of spinal manipulation therapy (SMT) delivered by doctors of chiropractic, home exercise and advice (HEA) delivered by exercise therapists, and medication (MED) prescribed by a medical doctors for acute/subacute neck pain. Differences in satisfaction with specific aspects of care were analyzed using a linear mixed model. The relationship between specific aspects of care and (1) change in neck pain (primary outcome of the randomized trial) and (2) global satisfaction were assessed using Pearson's correlation and multiple linear regression. Individuals receiving SMT or HEA were more satisfied with the information and general care received than MED group participants. Spinal manipulation therapy and HEA groups reported similar satisfaction with information provided during treatment; however, the SMT group was more satisfied with general care. Satisfaction with general care (r = -0.75 to -0.77; R(2) = 0.55-0.56) had a stronger relationship with global satisfaction compared with satisfaction with information provided (r = -0.65 to 0.67; R(2) = 0.39-0.46). The relationship between satisfaction with care and neck pain was weak (r = 0.17-0.38; R(2) = 0.08-0.21). Individuals with acute/subacute neck pain were more satisfied with specific aspects of care received during spinal manipulation therapy or home exercise interventions compared to receiving medication. The relationship between neck pain and satisfaction with care was weak. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  19. Selective neck dissection: a review of the evidence.

    PubMed

    Pagedar, Nitin A; Gilbert, Ralph W

    2009-01-01

    The management of regional metastatic disease in patients with oral cancer is a topic of controversy. Comprehensive neck dissection has been the mainstay of treatment historically, but clinicians have sought alternatives to limit the morbidity of the classic radical neck dissection. This article will review evidence on the applicability of selective neck dissection in two settings: as primary treatment of the clinically positive neck and as salvage treatment of recurrent neck disease after radiotherapy. In the text, for each article cited we supply the level of evidence thereof according to the Oxford Centre for Evidence-based medicine.

  20. Oral and head and neck cancer. Special listing

    SciTech Connect

    Not Available

    1980-07-03

    The Special Listing of Current Cancer Research Projects is a publication of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute. Each Listing contains descriptions of ongoing projects in one selected cancer research area. The research areas include: Diagnostic and prognostic studies of oral and head and neck cancers; Treatment of oral and head and neck cancers; Rehabilitation and other support following treatment of oral and head and neck cancers; Etiology, epidemiology, and follow-up studies of patients with oral and head and neck cancers; Training programs for dental professions; Broad clinical programs for treatment of head and neck cancers; Salivary gland pathology.