Sarcomas of the head and neck: a 10-year retrospective of 25 patients to evaluate treatment modalities, function and survival.

Sarcomas of the maxillofacial region are rare but aggressive. Traditional treatment for those in the long bones has comprised neoadjuvant chemotherapy followed by resection, with or without radiotherapy. This philosophy has often been extrapolated to the management of sarcomas of the head and neck. We have treated 25 cases during the last 10 years (August 1997-2007), present our results, and evaluate the treatments and survival. The group contains both hard and soft tissue sarcomas, including 17 cases of osteosarcoma of the jaw. The overall survival was 80%. Our results are broadly in line with most comparable published series. We report disease status, microscopic response to chemotherapy, and functional outcome, and compare and contrast osteosarcomas of the jaws and the long bones. We think that in patients with sarcomas of the head and neck, particularly of the jaws, early radical resection should be considered the primary treatment with the aim of local control. Radiotherapy and chemotherapy should be considered if there are inadequate resection margins or distant spread. The role of neoadjuvant chemotherapy is questionable; because of the rarity of the disease, multicentre randomised trials should be encouraged to evaluate it.

Induction of apoptotic cell death by photodynamic therapy in human keratinocytes.

The use of photodynamic therapy (PDT) for the treatment of skin and oral cancer has been the subject of several clinical studies but there has been little scientific evaluation of its mechanism of action. Evidence to date suggests that whilst epithelial cell death may be secondary to vascular damage, direct cell killing may occur and may involve an apoptosis-like mechanism. To investigate the mechanism of epithelial cell death following PDT, two cell lines, human epidermal keratinocytes (UP) and oral squamous cell carcinoma-derived cells (H376) were subjected to PDT with aluminium disulphonated phthalocyanine (AlS2Pc) as the photosensitizer and red laser light at 675 nm. Control groups received red laser light, photosensitizer or neither. The effects of PDT were assessed using an MTS cell-proliferation assay, which showed a significant reduction in viability (p < 0.01) for PDT-treated cells compared to controls. For morphological analysis, cells were stained with haemotoxylin and eosin and the numbers showing typical apoptotic features counted. The treated cultures showed significantly increased numbers of apoptotic cells. Moreover, the H376 control cultures showed a baseline level of apoptosis of approx. 15%. Apoptosis was confirmed by ultrastructural analysis and by in situ end-labeling of DNA fragments. The results show that PDT using AlS2Pc as a photosensitizer promotes apoptotic cell death in UP and H376 cells in vitro and suggest that direct killing of epithelial cells may contribute to tumour necrosis in vivo.