Clinical analysis of nimotuzumab plus cisplatin and fluorouracil regimen as induction treatment in resectable head and neck squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>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).</p><p><b>METHODS</b>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%).</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSION</b>For resectable HNSCC, nimotuzumab plus PF regimen as induction treatment is highly effective for preserving the organ function and the toxicities are well tolerable.</p>

Predictive factors for level VI lymph node metastasis in papillary thyroid microcarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the predictive factors for level VI lymph node (LN) metastasis in thyroid papillary microcarcinoma (PTMC).</p><p><b>METHODS</b>From November 2005 to January 2007, 86 patients with PTMC with a lateral cN0 were treated by thyroidectomy and elective level VI LN dissection without comprehensive lateral neck dissection. The data from the cases were analyzed retrospectively to determine the predictive factors for level VI LN metastasis.</p><p><b>RESULTS</b>Forty cases (46.5%) of the patients were found with level VI LN metastasis. Tumor size (> or = 5 mm), thyroid capsular invasion or extracapsular invasion, enlarged level VI LN size (> or = 4 mm) were found significantly related to level VI LN metastasis on univariate analysis (P < 0.05). Tumor size (> or = 5 mm) and thyroid capsular invasion or extracapsular invasion were found to be independent predictive factors for level VI LN metastasis on multivariate analysis (P < 0.05).</p><p><b>CONCLUSIONS</b>Thyroid capsular invasion or extracapsular invasion, tumor size (> or = 5 mm) were significantly associated with level VI LN metastasis in patients with PTMC. Elective neck dissection in level VI should be considered particularly in patients with thyroid capsular invasion or extracapsular invasion and a tumor greater than 5 mm.</p>

Treatment of desmoid tumour in head and neck / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To find out the suitable therapy for the patient of desmoid tumour in head and neck.</p><p><b>METHODS</b>Forty-four patients with desmoid tumours of the head and neck treated at Cancer Hospital of Fudan University between 1987 and 2002 were identified from inpatient tumour database. Patients were classified into three groups: operation group (15 cases); operation + radiation group (12 cases); radiation group (17 cases). All patients were prospectively followed. Clinicopathologic features and treatment modalities were evaluated.</p><p><b>RESULTS</b>In the group of operation, four of operation group had recurrences 26.7% (4/15). In the group of radiation, three of radiation group had recurrences 17.6% (3/17). And the recurrence of operation + radiation group was 23.5% (4/17). No patient died of their disease.</p><p><b>CONCLUSION</b>For desmoid tumors of the head neck, operation + radiation was recommended, and the benefits of radiation therapy were demonstrated.</p>

Long-term impact of initial surgical and medical therapy on young patients with papillary thyroid cancer and bilateral cervical metastases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are few reviews on the clinical features and prognosis of young patients with papillary thyroid cancer and bilateral cervical metastases. We have investigated the long-term impact of initial surgical and medical therapy on such patients.</p><p><b>METHODS</b>A retrospective study was performed on 24 young patients (11 females and 13 males) with papillary thyroid cancer and bilateral cervical lymph node metastases, ranging in age from 11 to 20 years (mean age, 16.6 years), who were treated in our institution from 1 January 1970 to 31 December 1985.</p><p><b>RESULTS</b>All the patients in this group were followed up for 20 years. The survival of the patients at 20 years was 91.7%. The recurrence of local tumor and distant metastases was 20.8% and 12.5%, respectively. Based on analysis of the clinical data, we determined that the completeness of the surgical excision had a significant correlation with tumor recurrence.</p><p><b>CONCLUSION</b>These young patients with papillary thyroid cancer and cervical metastases have a good prognosis after suitable treatment.</p>

Surgical management of papillary thyroid carcinoma with endotracheal infiltration / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the diagnosis and treatment of papillary thyroid carcinoma with endotracheal infiltration.</p><p><b>METHODS</b>Clinical data of 12 patients treated from January 1999 to December 2006 were retrospectively analyzed. Six patients received tracheal partial resection-sternocleidomastoid musculoperiosteal flap reconstruction (group A). Six patients received tracheal sleeve resection-end to end anastomosis (group B).</p><p><b>RESULTS</b>Ten patients had the symptoms which indicated the tracheal invasion. Endotracheal focuses were detected in the region from 2 cm to 4 cm under glottis by endoscopy and positive rate of smear biopsy was 33%. Positive rate of CT scan was 92%. Mean diameter of carcinoma focus was 3.8 cm (from 3 cm to 7 cm), and mean number of tracheal ring resected was 4. For group A, even 7 rings were resected, and the longest longitude and latitude was 7 cm and 3 cm, respectively. For group B, the greatest number of rings resected was 4. Incidence rate of perioperative complication and mortality was 58% and 0%, respectively. Mean duration of follow-up was 49 months. One patient died of local recurrence, 1 patient died of lung metastasis. Two patients with tumor recurrence were also alive. For group A, extubation was successful in all patients.</p><p><b>CONCLUSIONS</b>Comprehensive use of diagnostic methods, especially MRI, will give detailed information for operation. Tracheal partial resection-sternocleidomastoid musculoperiosteal flap reconstruction and tracheal sleeve resection-end to end anastomosis are safe and useful methods to reconstruct the defects caused by tracheal operation.</p>

Gene rearrangement analysis of papillary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of RET/PTC and H47PTEN rearrangement and the association between gene rearrangement and clinicopathological properties of thyroid carcinoma.</p><p><b>METHODS</b>Rearrangement of RET/PTC-1, RET/PTC-2, RET/PTC-3, ELKS-RET and H4-PTEN (H4/PTEN and PTEN/H4) was analyzed in 139 thyroid tumor tissues by using RT-PCR and sequencing.</p><p><b>RESULTS</b>Twelve RET/PTC-1, 6 RET/PTC-3, 6 H4/PTEN and 7 PTEN/H4 were detected in 126 papillary thyroid carcinomas. In 3 cases, both RET/PTC and H4-PTEN were identified simultaneously. However, repeated experiments did not give the same results of H4-PTEN rearrangement. The overall frequency of rearrangement was 21.4% (27/126). The patients with gene rearrangement were younger (P = 0.02) and had a higher frequency of lymph node involvement (P = 0.02). High frequency of lateral neck lymph node involvement was detected in RET/PTC positive PTC (P < 0.01). PTEN/H4 rearrangement could also be detected in medullary thyroid carcinoma (2/5).</p><p><b>CONCLUSIONS</b>H4-PTEN rearrangement can occur simultaneously with RET/PTC rearrangement in PTC. High predisposition to gene rearrangement is a characteristic of PTC. The patients of PTC with gene rearrangement are younger and have a higher frequency of lymph node involvement.</p>

Whether VI region lymph nodes belong to primary site of the thyroid carcinoma or lateral cervical lymph node metastases / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the evaluation of elective neck dissection (END) for the cN(0) patients with papillary thyroid carcinoma (PTC).</p><p><b>METHODS</b>By analyzing the recurrent and metastatic region (thyroid, group VI lymph nodes, lateral neck region, beyond neck) of 139 PTC patients treated secondly in our hospital, group VI lymph nodal metastasis is divided into recurrence of primary site and distinguished from lateral neck lymph nodes. The clinical value of END for cN(0) PTC patients is also retrospectively analyzed.</p><p><b>RESULTS</b>Thyroidal recurrence accounts for 83% (73/88). Level VI metastasis accounts for 76% (67/88), 17 patients have received END and account for 65% (17/26). Metastasis to lateral neck lymph nodes account for 17% (17/98), among these patients, 5 patients have received END and account for 19% (5/26).</p><p><b>CONCLUSIONS</b>For the patients with cN(0) PTC, ipsilateral thyroid lobectomy plus level VI dissection is recommended and lateral END (level II-V) is not supported. For the patients with cN(0) but UB N(+) and/or CT N(+), lateral END (level II-V) is recommended. The necessity of CT examination in the diagnosis and treatment of thyroid cancer should be emphasized.</p>

Type of surgery for 147 patients with medullary carcinoma of the thyroid / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the optimum type of surgical treatment for thyroid medullary carcinoma.</p><p><b>METHODS</b>From May 1960 to July 2000, 147 patients with thyroid medullary carcinoma were treated with surgical treatment. The results of tumorectomy, subtotal and total thyroidectomy were compared.</p><p><b>RESULTS</b>The overall 5-, 10- and 15-year survival rates were 85.4%, 77.4% and 73.1%. The recurrence rate was lowest in the total thyroidectomy group, medium in the subtotal group and highest in tumor extirpation group (P < 0.05). The overall cervical lymph node metastasis rate was 72.1%. The cervical occult nodal metastasis rate in clinically N0 patients was 42.1% (occult metastasis rates in central and lateral cervical regions were 24.6% and 36.8%). Thirteen patients with persistent postoperative hypercalcitoninemia were observed from 5 months to 6 years without tumor recurrence.</p><p><b>CONCLUSION</b>Total thyroidectomy is the optimal treatment for thyroid medullary carcinoma. Regardless of clinical N0 or N1, central and ipsilateral neck dissection should be considered. Patients with persistent postoperative hypercalcitoninemia should be observed closely.</p>

Expression of chemokine receptor CXCR4 in hypopharyngeal carcinoma and its significance / 中国癌症杂志

Background and purpose:It was reported that chemokine receptor CXCR4 and its ligand stromal cell-derived factor 1(SDF-1)were involved in the proliferation,differentiation,and metastasis of tumor.This study was designed to observe the expression of chemokine receptor CXCR4 in hypopharyngeal squamous cell carcinoma tissue and study the relationship between the expression of chemokine receptor CXCR4 and different clinicopathlogical characteristics,and further to explore the clinical significance.Methods:For the detection of the expression of chemokine receptor CXCR4,43 primary hypopharyngeal squamous cell carcinoma tissues,27 normal hypopharyngeal tissues,34 lymph node metastastatic lesions and 9 normal lymph node lesions were detected by immunohistochemical method using rabbit anti-human CXCR4 polyclonal antibody.Results:The positive expression rates of CXCR4 in 43 hypopharyngeal carcinoma tissues and normal tissues were 95.3% and 22.2%,respectively(P