Effects of Radiation on Olfactory Function in Head and Neck Malignancy.

OBJECTIVES: Olfactory dysfunction is an overlooked adverse effect of radiation therapy. This study is designed to find the effect of radiation therapy on olfactory function in head and neck malignancy excluding tumors of nose and nasopharynx and correlate the olfactory changes with the radiotherapy dose. METHOD: This prospective observational study was done over a 2-year period in 34 participants with head and neck malignancies who underwent radiation therapy (RT). The participants olfaction was evaluated subjectively with Italian Nose Obstruction Symptom Evaluation (I-NOSE) scale and objectively by a modified I-Smell test which included an olfactory identification score and an olfactory threshold score at 5 time points. The beginning of RT (T0), at 2 weeks of RT(T1), end of RT (T2), 1 month follow-up (T3), and 3-month follow-up (T4). The near maximum dose to the nasal cavity (D2%) and mean dose to the nasal cavity (Dmean) were calculated for all participants and correlated with olfactory function. RESULTS: A total of 34 patients with head neck malignancy were recruited. The median I-NOSE score reached maximum at the end of radiation and decreased to baseline at 3 months follow-up (P < .001). The olfactory identification score, olfactory threshold score, and median combined olfactory score showed a significant decrease at the end of radiation therapy compared to Pre-radiation therapy values. There was a significant but incomplete recovery in the 3-month follow-up period (P < .001). CONCLUSION: There was a significant deterioration in quality of life for olfaction, olfactory identification, and olfactory threshold at the completion of radiotherapy. At 3 months follow-up, though there was no complete recovery of olfaction, it did not have an adverse effect on the quality of life.

Solitary fibrous tumour of cervical spinal cord.

Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms of fibroblastic origin. They commonly arise from visceral pleura, but also arise from nonserosal sites such as meninges, central nervous system parenchyma, and spinal cord. In the spinal cord, SFTs commonly arise from the thoracic spinal cord, followed by cervical spinal cord, lumbar spinal cord, and sacrum. Histologically, SFTs can be similar to hemangiopericytoma, schwannoma, fibrous meningioma, fibroma, gliofibroma, and ependymoma. Immunohistochemistry (IHC) plays an important role in differentiating SFTs from other identical tumors. Here, we report a rare case of SFT of the cervical spinal cord, which was initially reported as hemangiopericytoma, and the diagnosis of SFT was confirmed by IHC.

Résumé Les tumeurs fibreuses solitaires (SFT) sont des néoplasmes mésenchymateux rares d'origine fibroblastique. Ils proviennent généralement de la plèvre viscérale, mais aussi proviennent de sites non séreux tels que les méninges, le parenchyme du système nerveux central et la moelle épinière. Dans la moelle épinière, les SFT proviennent de la moelle épinière thoracique, suivie de la moelle épinière cervicale, de la moelle épinière lombaire et du sacrum. Histologiquement, les SFT peuvent être similaires à hémangiopéricytome, schwannome, méningiome fibreux, fibrome, gliofibrome et épendymome. L'immunohistochimie (IHC) joue un rôle important dans la différenciation des SFT des autres tumeurs identiques. Ici, nous rapportons un rare cas de SFT de la moelle épinière cervicale, qui a été initialement signalé comme hémangiopéricytome, et le diagnostic de SFT a été confirmé par IHC.

Unresectable squamous cell carcinoma of upper trachea with long-term survival after concurrent chemoradiotherapy.

Upper tracheal malignancies are rare, and long-term survival is even rarer, especially among the unresectable malignancies. A 66-year-old chronic smoker was diagnosed as a locally advanced, non-metastatic squamous cell carcinoma of the upper trachea. Being unresectable, he was treated with six cycles of concurrent weekly cisplatin and three-dimensional conformal radiotherapy to a dose of 60 Gy in 30 fractions over 6 weeks. Follow-up imaging at 6 and 12 months revealed no disease. Our patient is presently 36 months post-treatment and is disease free without tracheal necrosis, fistula or radiation pneumonitis but developed hypothyroidism and is presently euthyroid. Concurrent chemoradiotherapy appears safe up to 3 years at least without any necrosis and is effective in controlling local disease. Meticulous planning obviates the need for higher technology like motion management techniques or intensity-modulated radiotherapy.