Response rate and toxicity of Docetaxel / Cisplatin /5FU in comparison with cisplatin / 5FU induction chemotherapy in locally advanced head and neck squamous cell carcinoma

Introduction: Response to chemotherapy is a reliable marker for radiation sensitivity in patients with locally advanced head and neck squamous cell carcinoma. We compared the response rate and toxicity after two cycles of chemotherapy using Docetaxel / Cisplatin /5FU or Cisplatin / 5FU among these patients

Materials and Methods: We randomly assigned 16 to 75 years old patients with stage III or IV non-metastatic locally advanced head and neck squamous cell carcinoma to receive either DCF or CF every 3 weeks for two cycles. All patients who received at least one and two cycles of chemotherapy were considered for toxicity and response evaluation respectively

Results: Seventy patients underwent randomization, 36 and 34 patients were assigned to Docetaxel / Cisplatin /5FU and Cisplatin / 5FU groups respectively. Three and 8 patients were excluded after randomization and before receiving any chemotherapy in Docetaxel / Cisplatin /5FU and Cisplatin / 5FU groups respectively. Finally 30 and 25 in Docetaxel / Cisplatin /5FU group and 25 and 23 patients in Cisplatin / 5FU group were evaluated for toxicity and response respectively. Response rate [complete and partial response] was%83 [35% complete and 48% partial response] and%84[16% complete and 68% partial response] in Cisplatin / 5FU and Docetaxel / Cisplatin /5FU groups respectively [P= 0.28]. There was no differences in complete response rate between two groups [P=0.18]. Neutropenia, phlebitis and mucositis were more common in Cisplatin / 5FU group without statistically significant difference. Constipation was significantly more common in Cisplatin / 5FU group [P= 0.008]. Diarrhea, alopecia and febrile neutropenia were significantly more common in Docetaxel / Cisplatin /5FU group [P= 0.006, 0.01 and 0.03 respectivly]

Conclusion: We could not find any significant differences between response to Docetaxel / Cisplatin /5FU and Cisplatin /5FU combination chemotherapy among Iranian patients with locally advanced head and neck squamous cell carcinoma. However, for better evaluation, larger studies with better designs are being conducted in our center

[Evaluation of vestibular function following cochlear implant surgery]

There are contradictory reports regarding vestibular function after cochlear implant surgery. In this study, we evaluated the influence of cochlear implant surgery on vestibular function by comparing the results of caloric test in both ears of patients who received implants. 24 adult patients who had undergone cochlear implant surgery at least 6 months earlier, were participated in this study. Caloric test with the stimulus of cold and warm water was performed on both ears of each patient and results were compared with each other regarding unilateral weakness, directional preponderance and areflexia. The differences between two ears regarding directional preponderance, unilateral weakness and areflexia were not statistically significant. It seems the pathological cause of deafness is a more influential factor on vestibular dysfunction than the damage following cochlear implant surgery

[ prevalence of occult neck metastasis in patients with N0 neck disease in squamous cell carcinoma of upper aerodigestive tract]

Cancers of head and neck can cause functional, cosmetic, social and economic problems. Neck metastasis from upper aerodigestive tract cancers is a concern in management. The aim of this study is to determine the occult neck metastasis from squamouse cell carcinoma [SCC] of upper aerodigestive tract and its proper management. This is a cross ' sectional study on patients with squamouse cell carcinoma of upper aerodigestive tract that hospitalized in departments of Otolaryngology Head and Neck Surgery and general surgery in Amir-alam referral hospital of Tehran University of Medical Scienses. 33% of patients were involved in occult metastasis in cervical lymph nodes. In 60% of patients more than one lymph node were involved. In the majority of patients tumor was in T2 stage. The occult neck metastasis was 24.6% in SCC of oral cavity, 44.7% in SCC of larynx and 42% in SCC of hypopharynx. There was significant relation between occult neck metastasis and T stage of tumor. When the risk of occult neck metastasis is higher than 20% and the primary site treatment modality is surgery elective neck dissection is indicated. In extracapsular spread or involvment of multiple lymph nodes with microscopic metastsis the postoperative radiation to neck is necessary

[Clinical and laboratory evaluation of thyroid function following total laryngectomy in laryngeal cancer]

Hypothyroidism is a well-documented complication after treatment of laryngeal cancer and is particularly significant among patients undergoing laryngectomy. We investigated the frequency of hypothyroidism in patients treated with total laryngectomy for laryngeal cancer. We also evaluated the effect of neck radiotherapy on thyroid function after total laryngectomy for laryngeal cancer. In a cross-sectional study, we evaluated 31 patients with laryngeal squamous cell carcinoma [mean age 53.6 years]. Among these patients, 14 were treated with surgery only and 17 were treated with surgery plus radiotherapy. Laboratory evaluation included levels of thyroid stimulating hormone [TSH], free T4, free T3, and antithyroid antibodies both preoperatively and postoperatively at the first day, as well as one and six months after surgery. All patients had normal thyroid function before treatment; however, after 6 months, five patients [16.1%] were hypothyroid. Of these, three patients [9.6%] had subclinical symptoms, including elevated thyroid-stimulating hormone with normal free T4, and two patients [6.5%] showed clinical symptoms of hypothyroidism. Radiotherapy and neck dissection were significantly associated with higher incidences of hypothyroidism. Our data suggest that hypothyroidism occurs in a substantial proportion of patients undergoing surgery for laryngeal cancer. The results indicate that thyroid function studies should be routinely performed in the follow-up care of laryngeal cancer patients, especially if radiotherapy and neck dissection were part of the treatment. We suggest that this approach will improve the patient's quality of life and diminish the co-morbidity associated with this kind of surgery

Suppression of tinnitus in patients undergoing cochlear implantation

Tinnitus is a frequent complaint in patients with sensorineural deafness. Different reports suggest that electrical stimulation caused by cochlear implant devices supresses tinnitus to a considerable degree. In a longitudinal study we have evaluated the severity and duration of tinnitus in both ears of 17 cochlear implant patients before and after operation. Severity of tinnitus was reduced in both implanted and not implanted ears after the implantation [P = 0.003 and P = 0.004 respectively]. Duration of tinnitus, however, was not affected significantly. No significant difference in tinnitus suppression was observed between the implanted and not implanted ears. This might be attributed to both the electrical stimulation caused by the device and the psychogenic stability provided by return to the world of sound