ABSTRACT
With the development of systemic diagnostic technique in cancer, the diagnostic methods of head and neck region are developing, also. Now, it is usually used computed tomography(CT), magnetic resornance image(MRI) in head and neck cancer and positron emission tomography(PET) is being increased in diagnostic use because of tumor specificity and accuracy. However, CT and MRI show the advantage of showing precise anatomical landmarks, but the disadvantage of these methods is much affecting by anatomical variations and changes. Otherwise, PET presents the imaging of physiologic and biochemical phenomenon and the disadvantage is the difficult differentiation of normal physiologic uptake, the lack of normal anatomical landmarks. PET/CT, the combination of clinical PET and CT imaging in a single unit is introduced recently, and it helps to get more accurate diagnostic interpretation and to improve in evaluating response to therapy, in management of patients with malignant tumors. So, we report the advantages of PET/CT in the diagnosis of oral cancer with review of literatures.
Subject(s)
Humans , Biochemical Phenomena , Diagnosis , Electrons , Head , Head and Neck Neoplasms , Magnetic Resonance Imaging , Mouth Neoplasms , Neck , Positron Emission Tomography Computed Tomography , Sensitivity and SpecificityABSTRACT
Malignant fibrous histiocytoma(MFH) is the malignant part of mesenchymal cell-originated tumor, which is supposed that the tumor is presented various histologic features consisted of fibrosarcomatic and histiocytic portions. When the tumor is arisen in the head and neck region, the most affected sites are the nasal cavity and paranasal sinuses, and secondly the maxillary alveolar bone is occasionally influenced. Therefore, MFH can readily involve the adjacent alveolar bone. The treatment of MFH in the head and neck is various, that is, the involved sites and the differentiation of tumor must be considered when the tumor is treated. The treatment protocols are subjected to general ones of soft tissue sarcoma, and simple or combination therapy is used in the surgery, chemotherapy and radiation therapy. So, we report a clinical case of chemotherapy involving intraarterial chemotherapy, and surgery of malignant fibrous histiocytoma(MFH) in the maxilla, with review of the literature.
Subject(s)
Clinical Protocols , Drug Therapy , Head , Maxilla , Nasal Cavity , Neck , Paranasal Sinuses , SarcomaABSTRACT
CyberKnife is a stereotactic radiosurgery system which could be used to treat many tumors and lesions. It provides the surgeon unparalleled flexibility in targeting using a compact light linear accelerator mounted on a robotic arm. Advanced image guidance technology tracks patient and target position during treatment, ensuring accuracy without the use of an invasive head frame. CyberKnife with Dynamic Tracking Software is cleared to provide radiosurgery for lesions anywhere in the body when radiation treatment is indicated. It has often been used to radiosurgically treat otherwise untreatable tumors and malformations. Moreover, this instrument treats tumors at body sites, most of which are unreachable by other stereotactic systems. Compared with conventional radiotherapy, it is fundamentally different that using non-invasive, frameless, no excessive radiation exposure to normal tissue. In oral malignant neoplasm, surgical excision and radiation therapy should be tried first, additionally hemotherapy could be considered. However, after failure of conventional therapies, patients had poor systemic condition and surgical limitation. So, CyberKnife could be a suitable therapy. A 49 years man was referred in recurred mandibular cancer treated by radiotherapy. The tumor was considered inoperable, because of extensive invasion and was not expected to good response to conventional therapies. We experienced a case of CyberKnife after 4 cycle chemotherapies, so we report it with review of literature.
Subject(s)
Humans , Arm , Drug Therapy , Head , Mouth Neoplasms , Particle Accelerators , Pliability , Radiosurgery , RadiotherapyABSTRACT
Subject(s)
Adolescent , Female , Humans , Abdomen , Cheek , Diagnosis , Ganglia , Ganglioneuroma , Mediastinum , Neuroblastoma , Parasympathetic Nervous System , ThoraxABSTRACT
Kaposi sarcoma (KS) has attracted much attention recently because of its high incidence among patients with acquired immune deficiency syndrome. Other groups with a high risk of developing KS are renal transplant recipients treated with immunosuppressive drugs and, to a lesser extent, patients with autoimmune diseases. We report the case of a patient who developed KS during corticosteroid therapy for idiopathic thrombocytopenic purpura, which subsequently regressed with combination chemotherapy.
Subject(s)
Humans , Acquired Immunodeficiency Syndrome , Autoimmune Diseases , Drug Therapy, Combination , Incidence , Purpura, Thrombocytopenic, Idiopathic , Sarcoma, Kaposi , TransplantationABSTRACT
Subject(s)
Aged, 80 and over , Female , Humans , Acyclovir , Early Diagnosis , Edema , Epithelium , Exanthema , Ganglia, Spinal , Herpes Zoster , Herpesvirus 3, Human , Latency Period, Psychological , Mouth Mucosa , Neuralgia, Postherpetic , Neurons , Trigeminal NerveABSTRACT
Positron Emission Tomography(PET) is a new diagnostic method that can create functional images of the distribution of positron emitting radionuclides, which when administered intravenously in the body, makes possible anatomical and functional analysis by quantity of biochemical and physiological process. After genetic and biochemical changes in initial stage, malignant tumor undergoes functional changes before undergoing anatomical changes. So, early diagnosis of malignant tumors by functional analysis with PET can be achieved, replacing traditional anatomical analysis, such as computed tomography(CT) and magnetic resonance image(MRI), etc. Similarly, PET can identify malignant tumor without confusion with scar and fibrosis in follow up check. In the Korea Cancer Center Hospital(KCCH) from October 1997 to September 1999, clinical study was performed in 79 cases that underwent 89 times PET evaluation with [18F]-Fluorodeoxyglucose for diagnosis of oral and maxillofacial tumors, and the data was analysed by Bayesian 2x2 Classification Table. The results were as follows : Evaluation for initial diagnosis with FDG-PET (P<0.005) 1. Agreement rate or accuracy rate is 88.9%. 2. Sensitivity is 95.2%, and specificity 66.7%. 3. Positive predictive rate is 90.9%, and negative predictive rate 80.0%. 4. In consideration of tumor stage, diagnostic rate in less than stage II was 90% and in greater than stage III 100%. 5. In consideration of tumor size, diagnostic rate in less than T2 was 92.3% and in greater than T3 100%. After primary treatment, evaluation for follow up check with FDG-PET (P < 0.001) 1. Agreement rate or accuracy rate is 85.4%. 2. Sensitivity is 87.5%, and specificity 82.4%. 3. Positive predictive rate is 87.5%, and negative predictive rate 82.4%. 4. In 24 recurred cases, 6 had distant metastasis, and 5 of them were diagnosed with FDG-PET, resulting in diagnostic rate of FDG-PET of 83.3%. From the above results, Positron Emission Tomography with [18F]- Fluorodeoxyglucose appears to be more sensitive and accurate for detecting the presence of oral and maxillofacial tumors, and has various clinical applications such as early diagnosis of tumor in initial and follow up check and detection of distant metastasis.
Subject(s)
Cicatrix , Classification , Diagnosis , Early Diagnosis , Electrons , Fibrosis , Follow-Up Studies , Korea , Neoplasm Metastasis , Physiological Phenomena , Positron-Emission Tomography , Radioisotopes , Sensitivity and SpecificityABSTRACT
BACKGROUND: Positron Emission Tomography(PET) with [18F]-fluorodeoxyglucose (FDG) is a new imaging technique that has the advantage of imaging metabolic changes linked to malignancy. PET-FDG can provide a functional image of the regional biochemistry which may be more sensitive and accurate for detecting the presence of tumor in early stage. Recently, the clinical use of PET scan has been studied in many cancers but, there is a few clinical reports in oral and maxillofacial cancers. We have evaluated the ability of PET-FDG for initial diagnosis and detection of early subclinical recurrent malignancies in follow up check. PATIENTS AND METHODS: PET-FDG studies were performed in 33 patients from october, 1997 to september, 1998. 14 patients underwent PET-FDG evaluation for initial diagnosis and 19 patients for follow up check. RESULTS: Evaluated for initial diagnosis, PET-FDG was found to have an overall accuracy of 79%, sensitivity of 90%, specificity of 60%, positive predictive rate of 80% and negative predictive rate of 75%. Evaluated for follow up check, PET-FDG demonstrated accuracy of 84%, sensitivity of 91%, specificity of 75%, positive predictive rate of 83% and negative predictive rate of 86%. CONCLUSION: These data indicate that PET-FDG scan appears to be effective in initial diagnosis and detection of early recurrent oral and maxillofacial malignancies. The informations gained with PET-FDG can be included for essential treatment planning because of possibility of detection for early subclinical malignancies and distant metastases.
Subject(s)
Humans , Biochemistry , Diagnosis , Electrons , Follow-Up Studies , Neoplasm Metastasis , Positron-Emission Tomography , Sensitivity and SpecificityABSTRACT
Positron emission tomography(PET) is a diagnostic method that creates high resolution, 3-Dimentional tomographic images of the distribution of positron emitting radionuclides in human body. Computed tomography(CT) and magnetic resonance imaging(MRI) are routinely used to delineate the presence and extent of primary and metastatic oral and maxillofacial malignancy. Because the CT and MRI criteria for malignancy depend upon morphology, these imaging techniques have limitations in their ability to identify malignant tissue when fascial planes are distorted or destroyed. PET has the advantage of imaging metabolic changes that appear to be linked to malignancy. Recently, PET has shown promise in the early detection of primary and metastatic oral and maxillofacial canter and has been used to evaluate the tumor response to chemotherapy and radiotherapy. We report cases of diagnosis of oral and maxillofacial cancers and review the literatures to determine whether PET is effective in identifying oral and maxillofacial tumors.
Subject(s)
Diagnosis , Drug Therapy , Electrons , Human Body , Magnetic Resonance Imaging , Positron-Emission Tomography , Radioisotopes , RadiotherapyABSTRACT
The standard methods of treatment in oral and maxillofacial cencer are surgery, radiotherapy and chemotherapy. But all of them can induce significant morbidities, surgery in this area can cause remarkable junctional and esthetic problems. The applications of photodynamic therapy(PDT) has been studying and trying in these days to minimize post-treatment complications. It can almost directly affect tumor cells except surrounding normal tissues, so we are able to reduce post-operative complications. But there can be a couple of complications after PDT, as like skin photosensitivity, so therapists must attend to its use and completely understand their mechanism before doing it. In our clinic, PDT was tried in an early tongue cancer patient using topically applied delta-aminolaevulinic acid (delta-ALA). The 64-year-old man was gargled with 5% delta-ALA 4 hours before irradiation. The previous punched biopsy was reported as well differentiated squamous cell carcinoma(T1N0M0). Light of 635nm wave-length from argon-pumper dye laser was used. Total 150J/cm2 was applied. After 10 days, PDT was applied again in a small suspicious area, 10 days after then, small area was excised and examined histologically. It was revealed as cancer free. Now, the patient was periodically checked up. Conclusively, PDT can be thought to be a acceptable alternative and promising method in treating of early oral and maxillofacial cancer.
Subject(s)
Humans , Middle Aged , Biopsy , Drug Therapy , Lasers, Dye , Photochemotherapy , Radiotherapy , Skin , Tongue Neoplasms , TongueABSTRACT
During 10 years (from 1986 to 1995), 54 patients were diagnosed as maxillary cancer and undergone maxillectomy in department of Oral and Maxillofacial Surgery, Korea Cancer Center Hospital. We studied clinically about their age and sex distribution, TNM staging, histopathologic diagnoses, treatment modalities, overall survival rates, survival rates according to stages and treatment modalities. In them, 23 patients were delivered maxillary obturators, we also studied clinically about them and their obturators. The overall 3-year and 5-year survival rates of these maxillectomized patients were 59.0% and 55.0%. The 5-year survival rates of stage II and stage III patients was 63.0%, and that of stage IV patient was 50.0%. According to treatment modalities, The 5-year survival rates in cases of surgery only was 66.7%, in cases of preoperative chemotherapy and/or radiaiotherapy was 63.5%, in cases of postoperative radiotherapy and/or chemotherapy was 50.4%. The 5-year survival rate of obturator delivered patients was 56.8%, and that of no-obturator delivered patients was 51.8%. The using rates of obturator were 70.5% at 1 year, 59.7% at 2 years, and 53.0% at 3 years.
Subject(s)
Humans , Diagnosis , Drug Therapy , Korea , Neoplasm Staging , Radiotherapy , Sex Distribution , Surgery, Oral , Survival RateABSTRACT
Subject(s)
Carcinoma in Situ , Carcinoma, Squamous Cell , Epithelium , Odontogenic Cysts , PrognosisABSTRACT
Subject(s)
Humans , Carcinoma, Squamous Cell , Gingiva , Head , Hyperbaric Oxygenation , Neck , Osteoradionecrosis , Prostheses and Implants , RadiotherapyABSTRACT