Outcomes of patients with head-and-neck cancer of unknown primary origin treated with intensity-modulated radiotherapy.

PURPOSE: To analyze survival, failure patterns, and toxicity in patients with head-and-neck carcinoma of unknown primary origin (HNCUP) treated with intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS: Records from 27 patients with HNCUP treated during the period 2002-2008 with IMRT were reviewed retrospectively. Nodal staging ranged from N1 to N3. The mean preoperative dose to gross or suspected disease, Waldeyer's ring, and uninvolved bilateral cervical nodes was 59.4, 53.5, and 51.0 Gy, respectively. Sixteen patients underwent neck dissection after radiation and 4 patients before radiation. Eight patients with advanced nodal disease (N2b-c, N3) or extracapsular extension received chemotherapy. RESULTS: With a median follow-up of 41.9 months (range, 25.3-93.9 months) for non deceased patients, the 5-year actuarial overall survival, disease-free survival, and nodal control rates were 70.9%, 85.2%, and 88.5%, respectively. Actuarial disease-free survival rates for N1, N2, and N3 disease were 100%, 94.1%, and 50.0%, respectively, at 5 years. When stratified by non advanced (N1, N2a nodal disease without extracapsular spread) vs. advanced nodal disease (N2b, N2c, N3), the 5-year actuarial disease-free survival rate for the non advanced nodal disease group was 100%, whereas for the advanced nodal disease group it was significantly lower at 66.7% (p = 0.017). Three nodal recurrences were observed: in 1 patient with bulky N2b disease and 2 in patients with N3 disease. No nodal failures occurred in patients with N1 or N2a disease who received only radiation and surgery. CONCLUSION: Definitive IMRT to 50-56 Gy followed by neck dissection results in excellent nodal control and overall and disease-free survival, with acceptable toxicity for patients with T0N1 or non bulky T0N2a disease without extracapsular spread. Patients with extracapsular spread, advanced N2 disease, or N3 disease may benefit from concurrent chemotherapy, targeted therapeutic agents, or accelerated radiation regimens in addition to surgery.

Episodic odor memory: influences of handedness, sex, and side of nose.

It is not known whether, or to what degree, odor memory is influenced by lateralized brain processes. In this study, we administered a 12-item match-to-sample odor memory test separately to the left and right sides of the nose of 30 left- and 30 right-handed subjects of equivalent age, sex distribution, and overall general smell ability. For each test item, one of three delay intervals (10-, 30-, and 60-s) was interspersed between smelling the target stimulus and smelling the first of four response alternatives. Women, but not men, performed significantly better on the left than on the right side of the nose, conceivably reflecting greater reliance upon left-hemisphere semantic processes. Subjects who received the first test on the right side of the nose outperformed those who received the first test on the left side of the nose. As in previous work, an age-related decrement in odor memory test scores was present. These data contribute to the debate on the role of lateralized brain processes in episodic odor memory, and suggest that performance on a standardized match-to-sample odor memory task is influenced by a number of interacting factors.

Odors and the perception of hygiene.

Although certain odors, such as lemon, are commonly associated with cleanliness and positive hygiene, empirical assessment of such associations for other odors and attributes is generally lacking. Moreover, differences between men and women in such associations have not been established. In this study of lemon, onion, pine, and smoke odors, ratings were obtained from 142 men and 336 women (M age= 30.1 yr., SD = 12.3) for odor intensity, gender association (masculine/feminine), and the success, sociability, intelligence, cleanliness, and attractiveness of a hypothetical person whose clothes smell like the odor in question. Ratings of the pleasantness or unpleasantness one would attribute to each odor in various rooms of the home were obtained, as well as a specification of whether such ratings are influenced by laundry habits, e.g., whether laundry is smelled before or after washing. Numerous associations were found. For example, a hypothetical person whose clothes smell of pine was rated as relatively more successful, intelligent, sociable, sanitary, and attractive than one whose clothes smelled of lemon, onion, or smoke. Sex differences, as well as differences between people who reported smelling their own laundry, were also found.

No influence of scopolamine hydrobromide on odor detection performance of rats.

Despite speculation that the muscarinic cholinergic antagonist, scopolamine, may influence the olfactory sensitivity of rats, there have been no definitive studies on this point to date. In this study, we examined the influence of a range of doses of scopolamine hydrobromine (namely, 0.10, 0.125, 0.15 and 0.20 mg/kg i.p.) on the odor detection performance of 15 adult male Long-Evans rats to ethyl acetate. Air-dilution olfactometry and a go/no-go operant signal detection task were employed. The drug conditions and a saline control were administered to each animal in an order counterbalanced by Latin squares, with 2 day intervals interspersed between tests. Scopolamine had no significant influence on odor detection performance per se, as measured by percent correct S+ and S- responses and a non-parametric signal detection measure of sensitivity. This is in contrast to the relatively large effects previously observed in the same test paradigm for such drugs as the D-1 agonist SKF 38393 and the D-2 agonist quinpirole. These data suggest that scopolamine has no meaningful influence on a well-practiced odor detection task.

Influences of antihypertensive and antihyperlipidemic drugs on the senses of taste and smell: a review.

According to the Physicians' Desk Reference (PDR), 36% of modern antihypertensive and antihyperlipidemic drugs produce untoward alterations in chemosensory perception. Such disturbances can adversely affect the quality of life, produce non-compliance to medication schedules, and may result in decreased food intake, loss of appetite, weight decrement, and depression. This review lists the primary antihypertensive and antihyperlipidemic drugs that adversely alter chemosensory function, provides information on better defining the nature of the dysfunction, outlines testing strategies and available tests that could be used to better define the prevalence of the dysfunction, and summarizes means for mitigating such alterations.