Trismus indicates severely restricted mouth opening of any etiology. A mouth opening of 35 mm or ... more Trismus indicates severely restricted mouth opening of any etiology. A mouth opening of 35 mm or less should be regarded as trismus. Aim of the present study was to review the etiopathogenesis, incidence, treatment and prevention of trismus in head and neck cancer patients.
Oral and Symposium abstracts, Friday 18 May 63 and subsequent malignancy were 41% gingiva or vest... more Oral and Symposium abstracts, Friday 18 May 63 and subsequent malignancy were 41% gingiva or vestibule, 32% ventral tongue, 14% dorsum tongue, 14% buccal mucosa. 50% of these arose in a background of Erosive oral lichen planus, 27% in relation to the reticular form of LP and 14% associated with the atypical form. We present a follow up of this case series.
AIMS: Simultaneous assessment of DNA ploidy and biomarker expression in paraffin-embedded tissue ... more AIMS: Simultaneous assessment of DNA ploidy and biomarker expression in paraffin-embedded tissue sections Aims: Aneuploidy is a potential biomarker for predicting progression of premalignancies. Ploidy assessment is mostly performed on nuclei isolated from tissue sections. Ploidy assessment in situ in tissue sections may be a large improvement, enabling selective sampling of nuclei, thus allowing the correlation between ploidy and histology.
Relapses have a great impact on both the morbidity and mortality rates of oral squamous cell carc... more Relapses have a great impact on both the morbidity and mortality rates of oral squamous cell carcinoma (OSCC) patients. Current classification criteria are imprecise and need improvements. Recent advances in understanding of OSCC relapses on a molecular level provide new possibilities to better classify true recurrences and second primary tumors. This review discusses the limitations of the current OSCC relapse classification method and presents possible alternatives to improve this classification based on molecular techniques. Moreover, these molecular techniques add to the further understanding of these lesions and may provide tools for clinical management.
This article provides an update on the current understanding of adenoid cystic carcinoma of the h... more This article provides an update on the current understanding of adenoid cystic carcinoma of the head and neck, including a review of its epidemiology, clinical behavior, pathology, molecular biology, diagnostic workup, treatment and prognosis. Adenoid cystic carcinoma is an uncommon salivary gland tumor that may arise in a wide variety of anatomical sites in the head and neck, often with an advanced stage at diagnosis. The clinical course is characterized by very late recurrences; consequently, clinical follow-up should extend at least >15years. The optimal treatment is generally considered to be surgery with postoperative radiotherapy to optimize local disease control. Much effort has been invested into understanding the tumor's molecular biological processes, aiming to identify patients at high risk of recurrence, in hopes that they could benefit from other, still unproven treatment modalities such as chemotherapy or biological therapy.
Current assessment of lymph node metastasis in patients with head and neck squamous cell carcinom... more Current assessment of lymph node metastasis in patients with head and neck squamous cell carcinoma is not accurate enough to prevent overtreatment. The aim of this study was validation of a gene expression signature for distinguishing metastasizing (Nϩ) from nonmetastasizing (N0) squamous cell carcinoma of the oral cavity (OSCC) and oropharynx (OPSCC) in a large multicenter cohort, using a diagnostic DNA microarray in a Clinical Laboratory Improvement Amendments/ International Organization for Standardization-approved laboratory.
The Annals of otology, rhinology, and laryngology, 2002
In patients with laryngeal carcinoma, nodal metastasis, recurrence after radiotherapy, and progno... more In patients with laryngeal carcinoma, nodal metastasis, recurrence after radiotherapy, and prognosis are important factors in clinical decision-making. Parameters such as tumor stage are considered insufficient for predicting these important items. The DNA ploidy status of the tumor may be a useful additional marker. The DNA ploidy status of 38 laryngeal cancers was determined by flow cytometry. Correlations were studied with TNM stage, differentiation, survival rate, relapse risk, recurrence after radiotherapy, and nodal metastasis. A positive correlation of DNA ploidy status with the development of lymph node metastases was found for diploid and peridiploid versus aneuploid tumors (DNA index, <1.4 versus > or = 1.4; p = .007). No correlation was found between ploidy status and recurrence after radiotherapy. The overall survival rate (p = .01), but not the disease-specific survival rate or the relapse risk, showed a correlation with the ploidy status. The DNA ploidy status ma...
Chemoprevention Head and neck cancer Premalignant lesions Oral dysplasia Carcinoma in situ Second... more Chemoprevention Head and neck cancer Premalignant lesions Oral dysplasia Carcinoma in situ Second primary tumor s u m m a r y
Objective: To identify markers that are relevant as predictors of lymph node metastasis in head a... more Objective: To identify markers that are relevant as predictors of lymph node metastasis in head and neck squamous cell cancer. Design: Expression of p53, Rb, cyclin D1, E-cadherin, and epithelial cell adhesion molecule was examined using immunohistochemical analysis and traditional histological parameters, and the correlation of these markers with the histologically verified presence of regional metastases was determined. Subjects: The
Primary mucosal melanomas (PMMs) of the head and neck are uncommon malignancies that arise mainly... more Primary mucosal melanomas (PMMs) of the head and neck are uncommon malignancies that arise mainly in the nasal cavity and paranasal sinuses, followed by the oral cavity. The mainstay of treatment is radical surgical resection followed by adjuvant radiotherapy in selected patients with high-risk melanoma. Multimodality therapy has not been well studied and is not standardized. Adjuvant radiotherapy seems to improve locoregional control but does not improve overall survival. Elective neck dissection is advocated in patients with oral PMMs. Systemic therapy should be considered only for patients with metastatic or unresectable locoregional disease. Despite improvements in the field of surgery, radiotherapy and systemic therapy, patients with PMMs still face a very unfavorable prognosis (5-year disease free survival less than 20%) with high rates of recurrence and metastasis. The present review aims to summarize the current state knowledge on the molecular biology, pathological diagnosis and management of this disease. Head Neck, 2014.
Background: Dysphagia resulting in altered food intake is common among head and neck cancer patie... more Background: Dysphagia resulting in altered food intake is common among head and neck cancer patients. This randomized trial investigated the effect of combined individual dietary counseling (IDC) with individualized swallowing therapy (intervention) compared to IDC (control) on normalcy of food intake (NFI). Methods: Patients with stage II-IV head and neck cancer treated with postoperative (chemo)radiation were randomly assigned. NFI, dysphagia severity, social eating, and nutritional status were measured at the start of treatment and in weeks 6, 10, 18 and 30. Results: One hundred-twenty patients, 60 in each group, were recruited. No overall estimated difference was detected for NFI, dysphagia severity, social eating, or nutritional status. At week 10, the intervention group slightly improved dysphagia recovery 0.6 (95% CI: 0.1 to 1.1). This difference diminished by week 30. Conclusions: Adding individualized swallowing therapy to individual dietary counseling did not improve norma...
Regional metastasis is a prominent feature of head and neck squamous cell carcinoma (HNSCC) and i... more Regional metastasis is a prominent feature of head and neck squamous cell carcinoma (HNSCC) and is an important prognostic factor. The currently available imaging techniques for assessment of the neck have limitations in accuracy; thus, elective neck dissection has remained the usual choice of management of the clinically N0 neck (cN0) for tumors with significant (≥20%) incidence of occult regional metastasis. As a consequence, the majority of patients without regional metastasis will undergo unnecessary treatment. The purpose of this review was to discuss new developments in techniques that potentially improve the accuracy of the assessment of the neck in patients with HNSCC. Although imaging has improved in the last decades, a limitation common to all imaging techniques is a lack of sensitivity for small tumor deposits. Therefore, complementary to improvements in imaging techniques, developments in more invasive diagnostic procedures, such as sentinel node biopsy (SNB) will add to...
Pharyngocutaneous fistulae (PCF) are known to occur in nearly one-third of patients after salvage... more Pharyngocutaneous fistulae (PCF) are known to occur in nearly one-third of patients after salvage total laryngectomy (STL). PCF has severe impact on duration of admission and costs and quality of life and can even cause severe complications such as bleeding, infection and death. Many patients need further surgical procedures. The implications for functional outcome and survival are less clear. Several studies have shown that using vascularized tissue from outside the radiation field reduces the risk of PCFs following STL. This review and meta-analysis aims to identify the evidence base to support this hypothesis. English language literature from 2004 to 2013 REVIEW METHODS: We searched the English language literature for articles published on the subject from 2004 to 2013. Adequate data was available to identify pooled incidence rates from seven articles. The pooled relative risk derived from 591 patients was 0.63 (95% CI: 0.47 to 0.85), indicating that patients who have flap reconstruction/reinforcement reduced their risk of PCF by one-third. This pooled analysis suggests that there is a clear advantage in using vascularized tissue from outside the radiation field in the laryngectomy defect. While some studies show a clear reduction in PCF rates, others suggest that the fistulae that occur are smaller and rarely need repair.
This review discusses the role of adjuvant treatment after curative surgery for patients with hea... more This review discusses the role of adjuvant treatment after curative surgery for patients with head and neck squamous cell carcinoma (HNSCC). In general, patients with unfavourable prognostic factors have a high-risk of loco-regional recurrence and subsequent worse survival after surgery alone and are therefore considered proper candidates for adjuvant treatment by either postoperative radiotherapy alone or postoperative chemoradiation. Selection of the most optimal adjuvant treatment strategy should be based on the most important prognostic factors.
Oral cancer Squamous cell carcinoma Molecular biology Cancer research Advances and applications s... more Oral cancer Squamous cell carcinoma Molecular biology Cancer research Advances and applications s u m m a r y Cancer of the oral cavity accounts for almost 3% of cancer cases in the world. The incidence varies widely reflecting geographic differences in exposure to risk factors. The recent rise in younger age groups and females seen in many countries is of particular concern. Treatment and management of complications, locoregional recurrence and further primary tumors result in high morbidity and mortality especially when the disease is advanced stage at initial diagnosis. Progress in cancer research has provided abundant new knowledge about cellular processes and molecular biology underlying oral carcinogenesis and tumor progression. The present review attempts to summarize the current most widely-used research approaches and their application in the prevention, diagnosis, effective treatment, and improved outcome of oral cancer.
Distant metastases Head and neck squamous cell carcinoma Metastasis Cancer invasion Sites of dist... more Distant metastases Head and neck squamous cell carcinoma Metastasis Cancer invasion Sites of distant metastases s u m m a r y
International Journal of Radiation Oncology*Biology*Physics, 2011
the number of chemotherapy and radiotherapy cycles, number of radiation fractions, the chemothera... more the number of chemotherapy and radiotherapy cycles, number of radiation fractions, the chemotherapy drug dose and the midplane radiation dose at the central axis. However, the patients in IM group had a smaller radiation dose gradient across the entire treatment volume (p Ͻ 0.001) and required unscheduled treatment break in 2/18 (11%) of patients as compared to 9/21 (43%) of patients in NIM group (pϭ.04). Acute Toxicities (RTOG): IM group had lower grade 3 or 4 toxicities in most of the organs studied: *(pϽ.05), Skin (50% vs 62%), Mucositis (61% vs 90%), Dysphagia (50% vs 67%), Pain (28% vs 67%)*, Weight Loss (0% vs 14%), and Voice Changes (22% vs 10%). Chronic Toxicities (RTOG): The IM group had lower grade 3 or 4 toxicities: Skin (0% vs 24%)*, Dysphagia (22% vs 43%), Salivary glands (22% vs 38%), Mandible (0% vs 5%), and Larynx (6% vs 10%). SOMA Scale: The IM group had lower SOMA scores; Skin and Subcutaneous tissue (0.30 vs 0.51), Mucosa (0.48 vs 0.62), Salivary gland (2.50 vs 2.72), Mandible (0 vs 0.18) and Larynx (0.32 vs 0.43). Descriptive Analysis: There were four postcricoid stictures, 1 laryngeal stenosis, 1 laryngeal necrosis and 1 mandibular fracture in NIM group. None of this occurred in IM group. Swallowing Measures: Patients in IM group were able to maintain better oral intake more than or equal to 50% of their nutrition, had lower pharyngeal residue and better Orophyaryngeal swallow efficiency. Patients in IM group were able to swallow multiple bolus types in higher percentage and significantly more at the 3 and 5 ml volumes (pϽ.01). Speech Measures: The individual consonant speech sounds were consistently more understandable in the IM group. The difference in correct articulation of all consonants approaches significance in favor of the IM group. Quality of Life: The change in difficulty in swallowing was statistically significantly different between groups with more patients in the NIM group getting worse. On many of the other performance outcomes and functions/symptoms evaluated. There was a trend for more patients in the NIM group to be more symptomatic.
International Journal of Radiation OncologyBiologyPhysics, 1998
Head and neck oncologists have not reached consensus regarding the role of contemporary imaging t... more Head and neck oncologists have not reached consensus regarding the role of contemporary imaging techniques in the evaluation of the clinically negative neck in patients with head and neck squamous cell carcinoma (HNSCC). The purpose of the present study was to compare the accuracy of ultrasound with guided fine-needle aspiration biopsy (UGFNAB) and computed tomography (CT) in detecting lymph node metastasis in the clinically negative neck. Sixty-four neck sides of patients with HNSCC were examined preoperatively by ultrasound/UGFNAB and CT at one of five participating tertiary care medical centers. The findings were correlated with the results of histopathologic examination of the neck specimen. Ultrasound with guided fine-needle aspiration biopsy was characterized by a sensitivity of 48%, specificity of 100%, and overall accuracy of 79%. Three cases had nondiagnostic aspirations using UGFNAB and were excluded. CT demonstrated a sensitivity of 54%, specificity of 92%, and overall accuracy of 77%. UGFNAB detected two additional metastases not visualized on CT, whereas CT detected no metastases not seen on UGFNAB. The results of UGFNAB were similar between the participating centers. Approximately one half of the clinically occult nodal metastases in our patient group were identified by both CT and UGFNAB. Overall, UGFNAB and CT demonstrated comparable accuracy. The sensitivity of CT was slightly better than UGFNAB, but the latter remained characterized by a superior specificity. The results of CT and UGFNAB did not appear to be supplementary. The choice of imaging modality for staging of the clinically negative neck depends on tumor site, T-stage, and experience and preference of the head and neck oncologist. If CT is required for staging of the primary tumor, additional staging of the neck by UGFNAB does not provide significant additional value.
Trismus indicates severely restricted mouth opening of any etiology. A mouth opening of 35 mm or ... more Trismus indicates severely restricted mouth opening of any etiology. A mouth opening of 35 mm or less should be regarded as trismus. Aim of the present study was to review the etiopathogenesis, incidence, treatment and prevention of trismus in head and neck cancer patients.
Oral and Symposium abstracts, Friday 18 May 63 and subsequent malignancy were 41% gingiva or vest... more Oral and Symposium abstracts, Friday 18 May 63 and subsequent malignancy were 41% gingiva or vestibule, 32% ventral tongue, 14% dorsum tongue, 14% buccal mucosa. 50% of these arose in a background of Erosive oral lichen planus, 27% in relation to the reticular form of LP and 14% associated with the atypical form. We present a follow up of this case series.
AIMS: Simultaneous assessment of DNA ploidy and biomarker expression in paraffin-embedded tissue ... more AIMS: Simultaneous assessment of DNA ploidy and biomarker expression in paraffin-embedded tissue sections Aims: Aneuploidy is a potential biomarker for predicting progression of premalignancies. Ploidy assessment is mostly performed on nuclei isolated from tissue sections. Ploidy assessment in situ in tissue sections may be a large improvement, enabling selective sampling of nuclei, thus allowing the correlation between ploidy and histology.
Relapses have a great impact on both the morbidity and mortality rates of oral squamous cell carc... more Relapses have a great impact on both the morbidity and mortality rates of oral squamous cell carcinoma (OSCC) patients. Current classification criteria are imprecise and need improvements. Recent advances in understanding of OSCC relapses on a molecular level provide new possibilities to better classify true recurrences and second primary tumors. This review discusses the limitations of the current OSCC relapse classification method and presents possible alternatives to improve this classification based on molecular techniques. Moreover, these molecular techniques add to the further understanding of these lesions and may provide tools for clinical management.
This article provides an update on the current understanding of adenoid cystic carcinoma of the h... more This article provides an update on the current understanding of adenoid cystic carcinoma of the head and neck, including a review of its epidemiology, clinical behavior, pathology, molecular biology, diagnostic workup, treatment and prognosis. Adenoid cystic carcinoma is an uncommon salivary gland tumor that may arise in a wide variety of anatomical sites in the head and neck, often with an advanced stage at diagnosis. The clinical course is characterized by very late recurrences; consequently, clinical follow-up should extend at least >15years. The optimal treatment is generally considered to be surgery with postoperative radiotherapy to optimize local disease control. Much effort has been invested into understanding the tumor's molecular biological processes, aiming to identify patients at high risk of recurrence, in hopes that they could benefit from other, still unproven treatment modalities such as chemotherapy or biological therapy.
Current assessment of lymph node metastasis in patients with head and neck squamous cell carcinom... more Current assessment of lymph node metastasis in patients with head and neck squamous cell carcinoma is not accurate enough to prevent overtreatment. The aim of this study was validation of a gene expression signature for distinguishing metastasizing (Nϩ) from nonmetastasizing (N0) squamous cell carcinoma of the oral cavity (OSCC) and oropharynx (OPSCC) in a large multicenter cohort, using a diagnostic DNA microarray in a Clinical Laboratory Improvement Amendments/ International Organization for Standardization-approved laboratory.
The Annals of otology, rhinology, and laryngology, 2002
In patients with laryngeal carcinoma, nodal metastasis, recurrence after radiotherapy, and progno... more In patients with laryngeal carcinoma, nodal metastasis, recurrence after radiotherapy, and prognosis are important factors in clinical decision-making. Parameters such as tumor stage are considered insufficient for predicting these important items. The DNA ploidy status of the tumor may be a useful additional marker. The DNA ploidy status of 38 laryngeal cancers was determined by flow cytometry. Correlations were studied with TNM stage, differentiation, survival rate, relapse risk, recurrence after radiotherapy, and nodal metastasis. A positive correlation of DNA ploidy status with the development of lymph node metastases was found for diploid and peridiploid versus aneuploid tumors (DNA index, <1.4 versus > or = 1.4; p = .007). No correlation was found between ploidy status and recurrence after radiotherapy. The overall survival rate (p = .01), but not the disease-specific survival rate or the relapse risk, showed a correlation with the ploidy status. The DNA ploidy status ma...
Chemoprevention Head and neck cancer Premalignant lesions Oral dysplasia Carcinoma in situ Second... more Chemoprevention Head and neck cancer Premalignant lesions Oral dysplasia Carcinoma in situ Second primary tumor s u m m a r y
Objective: To identify markers that are relevant as predictors of lymph node metastasis in head a... more Objective: To identify markers that are relevant as predictors of lymph node metastasis in head and neck squamous cell cancer. Design: Expression of p53, Rb, cyclin D1, E-cadherin, and epithelial cell adhesion molecule was examined using immunohistochemical analysis and traditional histological parameters, and the correlation of these markers with the histologically verified presence of regional metastases was determined. Subjects: The
Primary mucosal melanomas (PMMs) of the head and neck are uncommon malignancies that arise mainly... more Primary mucosal melanomas (PMMs) of the head and neck are uncommon malignancies that arise mainly in the nasal cavity and paranasal sinuses, followed by the oral cavity. The mainstay of treatment is radical surgical resection followed by adjuvant radiotherapy in selected patients with high-risk melanoma. Multimodality therapy has not been well studied and is not standardized. Adjuvant radiotherapy seems to improve locoregional control but does not improve overall survival. Elective neck dissection is advocated in patients with oral PMMs. Systemic therapy should be considered only for patients with metastatic or unresectable locoregional disease. Despite improvements in the field of surgery, radiotherapy and systemic therapy, patients with PMMs still face a very unfavorable prognosis (5-year disease free survival less than 20%) with high rates of recurrence and metastasis. The present review aims to summarize the current state knowledge on the molecular biology, pathological diagnosis and management of this disease. Head Neck, 2014.
Background: Dysphagia resulting in altered food intake is common among head and neck cancer patie... more Background: Dysphagia resulting in altered food intake is common among head and neck cancer patients. This randomized trial investigated the effect of combined individual dietary counseling (IDC) with individualized swallowing therapy (intervention) compared to IDC (control) on normalcy of food intake (NFI). Methods: Patients with stage II-IV head and neck cancer treated with postoperative (chemo)radiation were randomly assigned. NFI, dysphagia severity, social eating, and nutritional status were measured at the start of treatment and in weeks 6, 10, 18 and 30. Results: One hundred-twenty patients, 60 in each group, were recruited. No overall estimated difference was detected for NFI, dysphagia severity, social eating, or nutritional status. At week 10, the intervention group slightly improved dysphagia recovery 0.6 (95% CI: 0.1 to 1.1). This difference diminished by week 30. Conclusions: Adding individualized swallowing therapy to individual dietary counseling did not improve norma...
Regional metastasis is a prominent feature of head and neck squamous cell carcinoma (HNSCC) and i... more Regional metastasis is a prominent feature of head and neck squamous cell carcinoma (HNSCC) and is an important prognostic factor. The currently available imaging techniques for assessment of the neck have limitations in accuracy; thus, elective neck dissection has remained the usual choice of management of the clinically N0 neck (cN0) for tumors with significant (≥20%) incidence of occult regional metastasis. As a consequence, the majority of patients without regional metastasis will undergo unnecessary treatment. The purpose of this review was to discuss new developments in techniques that potentially improve the accuracy of the assessment of the neck in patients with HNSCC. Although imaging has improved in the last decades, a limitation common to all imaging techniques is a lack of sensitivity for small tumor deposits. Therefore, complementary to improvements in imaging techniques, developments in more invasive diagnostic procedures, such as sentinel node biopsy (SNB) will add to...
Pharyngocutaneous fistulae (PCF) are known to occur in nearly one-third of patients after salvage... more Pharyngocutaneous fistulae (PCF) are known to occur in nearly one-third of patients after salvage total laryngectomy (STL). PCF has severe impact on duration of admission and costs and quality of life and can even cause severe complications such as bleeding, infection and death. Many patients need further surgical procedures. The implications for functional outcome and survival are less clear. Several studies have shown that using vascularized tissue from outside the radiation field reduces the risk of PCFs following STL. This review and meta-analysis aims to identify the evidence base to support this hypothesis. English language literature from 2004 to 2013 REVIEW METHODS: We searched the English language literature for articles published on the subject from 2004 to 2013. Adequate data was available to identify pooled incidence rates from seven articles. The pooled relative risk derived from 591 patients was 0.63 (95% CI: 0.47 to 0.85), indicating that patients who have flap reconstruction/reinforcement reduced their risk of PCF by one-third. This pooled analysis suggests that there is a clear advantage in using vascularized tissue from outside the radiation field in the laryngectomy defect. While some studies show a clear reduction in PCF rates, others suggest that the fistulae that occur are smaller and rarely need repair.
This review discusses the role of adjuvant treatment after curative surgery for patients with hea... more This review discusses the role of adjuvant treatment after curative surgery for patients with head and neck squamous cell carcinoma (HNSCC). In general, patients with unfavourable prognostic factors have a high-risk of loco-regional recurrence and subsequent worse survival after surgery alone and are therefore considered proper candidates for adjuvant treatment by either postoperative radiotherapy alone or postoperative chemoradiation. Selection of the most optimal adjuvant treatment strategy should be based on the most important prognostic factors.
Oral cancer Squamous cell carcinoma Molecular biology Cancer research Advances and applications s... more Oral cancer Squamous cell carcinoma Molecular biology Cancer research Advances and applications s u m m a r y Cancer of the oral cavity accounts for almost 3% of cancer cases in the world. The incidence varies widely reflecting geographic differences in exposure to risk factors. The recent rise in younger age groups and females seen in many countries is of particular concern. Treatment and management of complications, locoregional recurrence and further primary tumors result in high morbidity and mortality especially when the disease is advanced stage at initial diagnosis. Progress in cancer research has provided abundant new knowledge about cellular processes and molecular biology underlying oral carcinogenesis and tumor progression. The present review attempts to summarize the current most widely-used research approaches and their application in the prevention, diagnosis, effective treatment, and improved outcome of oral cancer.
Distant metastases Head and neck squamous cell carcinoma Metastasis Cancer invasion Sites of dist... more Distant metastases Head and neck squamous cell carcinoma Metastasis Cancer invasion Sites of distant metastases s u m m a r y
International Journal of Radiation Oncology*Biology*Physics, 2011
the number of chemotherapy and radiotherapy cycles, number of radiation fractions, the chemothera... more the number of chemotherapy and radiotherapy cycles, number of radiation fractions, the chemotherapy drug dose and the midplane radiation dose at the central axis. However, the patients in IM group had a smaller radiation dose gradient across the entire treatment volume (p Ͻ 0.001) and required unscheduled treatment break in 2/18 (11%) of patients as compared to 9/21 (43%) of patients in NIM group (pϭ.04). Acute Toxicities (RTOG): IM group had lower grade 3 or 4 toxicities in most of the organs studied: *(pϽ.05), Skin (50% vs 62%), Mucositis (61% vs 90%), Dysphagia (50% vs 67%), Pain (28% vs 67%)*, Weight Loss (0% vs 14%), and Voice Changes (22% vs 10%). Chronic Toxicities (RTOG): The IM group had lower grade 3 or 4 toxicities: Skin (0% vs 24%)*, Dysphagia (22% vs 43%), Salivary glands (22% vs 38%), Mandible (0% vs 5%), and Larynx (6% vs 10%). SOMA Scale: The IM group had lower SOMA scores; Skin and Subcutaneous tissue (0.30 vs 0.51), Mucosa (0.48 vs 0.62), Salivary gland (2.50 vs 2.72), Mandible (0 vs 0.18) and Larynx (0.32 vs 0.43). Descriptive Analysis: There were four postcricoid stictures, 1 laryngeal stenosis, 1 laryngeal necrosis and 1 mandibular fracture in NIM group. None of this occurred in IM group. Swallowing Measures: Patients in IM group were able to maintain better oral intake more than or equal to 50% of their nutrition, had lower pharyngeal residue and better Orophyaryngeal swallow efficiency. Patients in IM group were able to swallow multiple bolus types in higher percentage and significantly more at the 3 and 5 ml volumes (pϽ.01). Speech Measures: The individual consonant speech sounds were consistently more understandable in the IM group. The difference in correct articulation of all consonants approaches significance in favor of the IM group. Quality of Life: The change in difficulty in swallowing was statistically significantly different between groups with more patients in the NIM group getting worse. On many of the other performance outcomes and functions/symptoms evaluated. There was a trend for more patients in the NIM group to be more symptomatic.
International Journal of Radiation OncologyBiologyPhysics, 1998
Head and neck oncologists have not reached consensus regarding the role of contemporary imaging t... more Head and neck oncologists have not reached consensus regarding the role of contemporary imaging techniques in the evaluation of the clinically negative neck in patients with head and neck squamous cell carcinoma (HNSCC). The purpose of the present study was to compare the accuracy of ultrasound with guided fine-needle aspiration biopsy (UGFNAB) and computed tomography (CT) in detecting lymph node metastasis in the clinically negative neck. Sixty-four neck sides of patients with HNSCC were examined preoperatively by ultrasound/UGFNAB and CT at one of five participating tertiary care medical centers. The findings were correlated with the results of histopathologic examination of the neck specimen. Ultrasound with guided fine-needle aspiration biopsy was characterized by a sensitivity of 48%, specificity of 100%, and overall accuracy of 79%. Three cases had nondiagnostic aspirations using UGFNAB and were excluded. CT demonstrated a sensitivity of 54%, specificity of 92%, and overall accuracy of 77%. UGFNAB detected two additional metastases not visualized on CT, whereas CT detected no metastases not seen on UGFNAB. The results of UGFNAB were similar between the participating centers. Approximately one half of the clinically occult nodal metastases in our patient group were identified by both CT and UGFNAB. Overall, UGFNAB and CT demonstrated comparable accuracy. The sensitivity of CT was slightly better than UGFNAB, but the latter remained characterized by a superior specificity. The results of CT and UGFNAB did not appear to be supplementary. The choice of imaging modality for staging of the clinically negative neck depends on tumor site, T-stage, and experience and preference of the head and neck oncologist. If CT is required for staging of the primary tumor, additional staging of the neck by UGFNAB does not provide significant additional value.
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