Neoadjuvant Chemotherapy Followed by Concurrent Chemoradiation in Locally Advanced Head and Neck Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgery with postoperative radiotherapy has been the standard treatment for locally advanced head and neck squamous cell carcinoma (HNSCC). However, the prognosis still remains dismal. To increase survival rate and organ preservation rate, alternative approach is needed. Incorporating the taxane regimen into the treatment of HNSCC, the new treatment strategy of sequential therapy has been introduced. The purpose of this study is to determine the efficacy of neoadjuvant chemotherapy, followed by concurrent chemoradiotherapy for the HNSCC. SUBJECTS AND METHOD: Between January 2001 and June 2005, 19 patients with HNSCC were treated with neoadjuvant chemotherapy, followed by concurrent chemoradiotherapy. The sites of primary tumors were hypopharynx in eight patients, oropharynx in six patients, and larynx in five patients. Neoadjuvant chemotherapy included 70 mg/m2 of docetaxel on day 1, 70 mg/m2 of cisplantin on day 2 and 800 mg/m2 of 5-fluorouracil on day 2-4. The cycles were repeated every three weeks. Concurrent chemoradiotherapy starts after two cycles of neoadjuvant chemotherapy. Radiation dose was 200 cGy/dayx5/week with a total of 6,000-7,000 cGy, and the concurrent chemotherapy of 20 mg/m2 of docetaxel or 20 mg/m2 of cisplantin was given weekly. RESULTS: The median follow-up was 21 months. The overall 2-year survival rate was 70.1% and the 2-year organ preservation rate was 59.4%. The survival rate and organ preservation rate of larynx cancer patients were higher than those of hypopharynx and oropharynx cancer patients, but it was not statistically significant (p=0.09, 0.16). The patients of the lower stage showed higher survival rate and organ preservation rate, but it was not statistically significant (p=0.19, 0.48). The most common Grade 3 or 4 toxicities of neoadjuvant chemotherapy were leukopenia, anorexia, nausea and vomiting, whereas the most common Grade 3 or 4 toxicities during concurrent chemoradiotherapy were mucositis, stomatitis, and leukopenia. One patient died due to sepsis during treatment. CONCLUSION: Neoadjuvant chemotherapy with three combined regimens followed by concurrent chemoradiotherapy might be effective treatment modality for HNSCC. Further studies with large number of patients and longer follow-up will be needed.

Clinical Characteristics of Pilomatricoma in the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pilomatricoma, also known as calcifying epitheliomas of Malherbe is uncommon, benign skin neoplasm that arise from outer root sheath cell of hair follicle or hair follicle of sebaceous glands. In more than half of the cases, pilomatricoma typically involves the head and neck followed by upper extremities and trunk, with the majority occurring in children. The purpose of this study is to analyze the data from the author's experience with head and neck pilomatricoma and to discuss diagnostic and therapeutic management. SUBJECTS AND METHOD: A retrospective analysis of the patients of pilomatricoma treated between 1994 and 2004 revealed 21 cases of head and neck pilomatricoma. RESULTS: The typical clinical manifestation of pilomatricoma was non-tender, firm, subcutaneous, and nodular mass. The age range was from 9 months to 62 years (mean 17.4 years). The male-to-female ratio was 4 : 3. The common sites of occurrence were the neck (33%), cheek (24%), suboccipital (14%), preauricular (14%). The size of the mass ranged from 0.5 cm to 3 cm, and the mean was 1.1 cm. CT with contrast enhancement scans revealed densely calcified, mild enhancing and well circumscribed soft tissue densities in subcutaneous tissues. Additionally, MRI with gadolinum enhancement scans revealed partially enhanced, well demarcated and intermediate signal intensity mass lesions. Surgical excision was curative in all cases. CONCLUSION: Pilomatricoma is cutaneous neoplasms that occur commonly in the head and neck region. Even if the preoperative diagnosis may be difficult in some cases, pilomaticoma must be considered in the differential diagnosis of a superficial head and neck mass.

A Case of Chondroid Syringoma of the Nasal Columella / 대한이비인후과학회지

Chondroid syringoma, or mixed tumor of skin is a benign cutaneous neoplasm of sweat gland origin. It is rare in incidence, and most frequently found at the head and neck area. It is usually present as a slowly growing, painless intradermal or subcutaneous nodule in patients between the ages of 20 and 60 years. Histologically, there are two types, which are tubular, branching lumina type and small, tubular lumina type, and it contains both epithelial and stromal component. The treatment of choice is complete local excision. We report a case of chondroid syringoma presenting as a nasal columellar mass in a 50 year old woman with a brief review of literature.

Solitary Neurofibroma of the Nasal Cavity: Transnasal Endoscopic Excision / 대한이비인후과학회지

Neurofibroma is a neurogenic tumor arising from schwann cells or peripheral tissues of nerve sheaths. It is extremely rare in the sinonasal tract. We report on a case of neurofibroma of the nasal cavity treated by endoscopic surgery. Preoprative computed tomography (CT), magnetic resonance imaging (MRI), and punch biopsy suggested that the tumor was benign neurogenic tumor confined to right nasal cavity. The tumor was removed with endoscopic surgery completely, and confirmed as neurofibroma by histological and immunohistochemical examination. We discuss the clinical and pathological characters of neurofibroma arising in the nasal cavity

Elective Neck Dissection in Oral Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The status of cervical lymph node is important factor influencing the prognosis of patients with oral cavity squamous cell carcinoma. There has been some controversy regarding the treatment of clinical N0 neck in oral cavity squamous cell carcinoma, and the purpose of this study is to analyze the outcomes and efficacy of the elective neck dissection. SUBJECTS AND METHOD: Authors analyzed outcomes of elective neck dissection by a retrospective study with a review of medical records of 41 oral cavity squamous cell carcinoma patients who had clinical N0 neck. RESULTS: The overall rate of occult neck metastasis was 27%, and the rate of occult metastasis beyond T2 stage was 45%. The occult metastasis rates of the primary sites in the oral tongue, floor of mouth and retromolar trigon were 26.7%, 40% and 33.3%, respectively. Three cases had bilateral occult metastasis and other three had nodal recurrence after elective neck dissection. CONCLUSION: Because there were high occult neck metastasis rate but no significant postoperative complications in using the elective neck dissection, it could be used in T2, T3 or T4 oral cavity squamous cell carcinoma with clinical N0 neck.