ERCC1, XPF and XPA-locoregional differences and prognostic value of DNA repair protein expression in patients with head and neck squamous cell carcinoma.

OBJECTIVES: Nucleotide excision repair protein expression has been claimed to be responsible for platinum-based chemotherapy resistance. ERCC1, XPF and XPA, core proteins in DNA repair, were evaluated regarding their prognostic value in patients with head and neck squamous cell carcinoma by looking at overall survival and time to recurrence. MATERIALS AND METHODS: Tissue microarrays were constructed from 453 cases of HNSCC, including 222 oral (49%), 126 oropharyngeal (27.8%) and 105 laryngeal (23.2%) tumours. There were 284 XPF, 293 XPA and 294 ERCC1 specimens evaluable for protein expression analysis after immunohistochemical workup. Expression levels were dichotomised into high- and low-expressing groups. Outcomes for overall survival (OS) and time to recurrence (TTR) were analysed using the Kaplan-Meier method. RESULTS: No correlation between ERCC1, XPA and XPF expression and OS was found by looking at the overall patient cohort. However, subsite analysis revealed that high ERCC1 expression was associated with a significantly inferior OS in patients with SCC of the oral cavity (p = 0.028) and showed an independent predictive value in multivariate analysis (p = 0.0123). High XPA expression showed a significantly increased OS in patients with oropharyngeal SCC (p = 0.0386). Regarding XPF, no impact on OS in any subsite could be shown. CONCLUSIONS: While high ERCC1 expression functions as a predictive marker with decreased OS in patients with squamous cell carcinoma of the oral cavity, high XPA expression shows an inverse effect in the subsite of the oropharynx, which has not been described previously. CLINICAL RELEVANCE: ERCC1 and XPA might be candidates to overcome chemotherapy resistance in subtypes of HNSCC.

Xerostomia after radiotherapy. What matters--mean total dose or dose to each parotid gland?

PURPOSE: Xerostomia is a debilitating side effect of radiotherapy in patients with head and neck cancer. We undertook a prospective study of the effect on xerostomia and outcomes of sparing one or both parotid glands during radiotherapy for patients with squamous cell carcinoma of the head and neck. METHODS AND MATERIALS: Patients with locally advanced squamous cell carcinoma of the head and neck received definitive (70 Gy in 2 Gy fractions) or adjuvant (60-66 Gy in 2 Gy fractions) curative-intent radiotherapy using helical tomotherapy with concurrent chemotherapy if appropriate. Group A received < 26 Gy to the left and right parotids and group B received < 26 Gy to either parotid. RESULTS: The study included 126 patients; 114 (55 in group A and 59 in group B) had follow-up data. There were no statistically significant differences between groups in disease stage. Xerostomia was significantly reduced in group A vs. group B (p = 0.0381). Patients in group A also had significantly less dysphagia. Relapse-free and overall survival were not compromised in group A: 2-year relapse-free survival was 86% vs. 72% in group B (p = 0.361); 2-year overall survival was 88% and 76%, respectively (p = 0.251). CONCLUSION: This analysis suggests that reducing radiotherapy doses to both parotid glands to < 26 Gy can reduce xerostomia and dysphagia significantly without compromising survival. Sparing both parotids while maintaining target volume coverage and clinical outcome should be the treatment goal and reporting radiotherapy doses delivered to the individual parotids should be standard practice.

Radiographic examination of patients with dehiscence of semicircular canals with digital volume tomography.

Digital volume tomography (DVT) is an extension of panoramic tomography. With this diagnostic technique, characterized by high resolution, a narrow section width (0.125 mm), and three-dimensional display, small pathological processes can be well visualized. We examined 434 patients with DVT (Accu-I-tomo, Morita, Japan). Eleven patients with a history of peripheral vertigo presented a fistula of the labyrinth. The results were compared with intraoperative findings to evaluate the diagnostic value of DVT in cases of erosion of the semicircular canals. With high resolution and artifact-free demonstration of the labyrinth and inner ear structures, it was possible to determine the presence of a fistula of the semicircular canals in all 11 patients. An erosion of the lateral semicircular canal was found in nine patients with additional fistulae of the superior and posterior semicircular canals in one patient, a dehiscence of bone of the superior semicircular canal in one patient, and a dehiscence of the posterior semicircular canal in another patient. The predicted erosion of semicircular canals was verified in all patients during surgery where a closure of the fistulae was performed. DVT is an excellent technique to examine the semicircular canal structures in patients with peripheral vertigo, and expand the application of diagnostic possibilities in the lateral skull base. With this method, the preoperative diagnosis is improved allowing more accurate planning of the surgical procedure. DVT delivers a small radiation dose with a high resolution and a low purchase price for the equipment.

Measurement and comparison of labyrinthine structures with the digital volume tomography: ancient Egyptian mummies' versus today's temporal bones.

The objective of this study was to investigate whether the labyrinthine structures of ancient Egyptian mummies differ significantly from modern labyrinths. The new technique of digital volume tomography (DVT) was used to visualize the temporal bones. To obtain standardized images and measurements, precise instructions regarding volume rotation, slicing and measurements' positioning were determined. Twenty-five dimensions were obtained. The groups were compared statistically. No significant differences could be found except one cochlear diameter which proved to be significantly larger in the control group. DVT is applicable for imaging of temporal bones. Measurements might help to increase understanding of the temporal bone's structure, to aid the diagnostics of pathologies as well as to supplement the planning of surgical procedures.

Investigation of noise levels generated by otologic drills.

Drilling during temporal bone surgery may result in temporary or permanent noise-induced hearing loss or tinnitus. This has practical implications for both the patient and the surgeon. Different surgical drill devices, routinely used in temporal bone surgery, are examined referring to their emitted sound levels and sound transport. Two surgical drills were used on a brass tubing and a steel wire to simulate sound generation during temporal bone surgery. Overview measurements were performed on human cadaver in a medical laboratory. A set-up in a silent chamber was chosen to exclude external sound sources. The noise emissions and the vibration generated by a silver diamond bur and a cutting drill (Rose bur) were registered when used on a brass tubing and a solid steel wire with sound level meter and a non-contact laser vibrometer. The highest sound rate generated by the diamond burr did not exceed 63 dB(A) when used on a solid steel wire, whereas the cutting burr emitted 76 dB(A). Both drills produced lower sound levels on the brass tubing. Again the cutting burr topped the diamond burr with 68 dB(A) against 56 dB(A). The sound emission did not exceed 76 dB(A) outside a radius 4 cm around the drill location. In conclusion, sound emission generated by different surgical burs routinely used in temporal bone surgery is lower than expected. Still, within a small radius around those burs high sound pressure levels may be induced into surrounding structures such as ossicles, labyrinth, and cochlear. Still damage is feasible when using surgical drills for a longer time period close to sensitive structures.

[New aspects of HPV-positive head and neck cancer. Highlights from the 2011 ASCO Congress]. / Neue Aspekte HPV-positiver Kopf-Hals-Karzinome. Highlights vom ASCO-Kongress 2011.

HPV-positive head and neck carcinoma is significantly different than tobacco- and alcohol-induced cancer. Between 30% and 50% of oropharyngeal cancers are associated with human papillomavirus (HPV). Studies still show an increasing incidence. HPV-positive head and neck cancer patients have a better prognosis due to a better response to therapy. Especially patients with gene overexpression of immunological proteins in the antigen presentation are suggested to benefit from radiotherapy. A current retrospective study shows better outcomes for patients treated with radiotherapy in combination with biological targets compared to radiochemotherapy.

Imaging of ancient Egyptian mummies' temporal bones with digital volume tomography.

The radiographic imaging of ancient Egyptian mummies has always been of great interest. Computed tomography is the method of choice to demonstrate bony pathologies with high quality. As digital volume tomography (DVT) is an extension of panoramic tomography with a very high resolution, its qualities were evaluated by examination of temporal bones of Egyptian mummy skulls. Ten Egyptian mummy skulls from the Zoological Collection Marburg, estimated 1,700-5,000 years of age, from Abydos, Philae, Theben-West and Sakkarah, were examined by DVT (3D Accuitomo, Morita, Japan). Through a rotation 360° of the X-ray source around the region of interest, a cylinder of 3 × 4 cm was captured as a three-dimensional volume. The gained data were analyzed with the help of special software on a PC. The angles of the axial, coronal and sagittal sections were arbitrarily changed to represent single structures with high resolution of 0.125 mm to analyze specific anatomical structures. In all skulls, conditions of the temporal bone and its anatomical structures were evaluated and normal as well as pathological findings evaluated in detail. The analysis of special landmarks such as the ossicular chain, cochlea, external, and internal auditory canal, facial nerve canal, and semicircular canals showed an intact ossicular chain in six temporal bones, while only isolated and dislocated ossicles were found in eight temporal bones. Besides one dehiscence of the superior semicircular canal in one temporal bone which might have led to vertigo and deafness at lifetime, all other findings were normal. Fragments of foreign bodies additionally found in the labyrinth, external ear canal and intracranially were attributed to postmortem damage. Digital volume tomography extends the imaging possibilities of CT for paleoradiological evaluation of temporal bones. With its high resolution, geometric accuracy, reconstruction capabilities, rapidness, and comparably low costs, even small bony pathologies are precisely demonstrated in a limited area. Investigations of larger numbers of specimen might reveal further details of ancient history for further interdisciplinary investigation of anthropologists, Egyptiologists, otolaryngologists, and radiologists.

[Laryngeal squamous cell carcinoma in a 12-year-old boy]. / Plattenepithelkarzinom des Larynx bei einem 12-jährigen Jungen.

This is a case report on a middle grade differentiated keratinized squamous cell carcinoma of the larynx in a 12-year-old boy. Squamous cell carcinoma of the larynx is very rare in children and adolescents and in older literature studies less than 70 cases have been reported in children. Histologically the same variants are present as in adults. The way to the final diagnosis of laryngeal carcinoma often takes longer in children because dysphonia or dyspnoe are often caused by other pediatric diseases, risk factors such as those found in adults cannot be elucidated and many symptoms can be due to incomplete development of the laryngeal skeleton. Generally speaking, prior radiation therapy of the neck region and papillomatosis have been described as risk factors. In rare cases translocations or mutations can play a causative role.

Integration of human papilloma virus type 26 in laryngeal cancer of a child.

Squamous cell carcinoma (SCC) in larynx is rare with children and adolescents. Usually larynx cancer is common with male smokers in the 7th decade. Among patients with no history of tobacco and/or alcohol consumption several factors have can play a role in the outbreak of laryngeal cancer: such as individual predisposition, radiation, gastroesophageal reflux, viral infection, dietary factors and environmental influences. In literature only few cases of laryngeal cancer with children are reported. Recent studies show that the most frequent laryngeal malignancy is the embryonal rhabdomyosarcoma. Besides the recurrent respiratory papillomatosis (RRP) based on an infection with human papilloma virus (HPV) types 6 and 11 (low risk) and types 16 and 18 (high risk) is known for a possible malignant transformation towards a SCC. HPV type 26 is only reported as low risk type HPV associated with cervical cancer. Final diagnosis often takes a long time. Initial symptoms such as hoarseness, cough or shortness of breath are often referred to more typical pediatric diseases or laryngeal development.

Benign and malignant salivary gland diseases in children A retrospective study of 549 cases from the Salivary Gland Registry, Hamburg.

OBJECTIVE: Tumors of salivary glands in children are rare. Basically all types of salivary gland diseases during the period of childhood are described. The incidences of salivary gland tumors in children (0-14 years) differ completely from those in adults. Especially the malignant neoplasms are very rarely described in literature. Only some collective reviews and case reports try to summarize frequency, distribution concerning sex and age, morphology and localization. METHODS: In our study we were able to draw data from the Hamburg Salivary Gland Registry, concerning the last 25 years regarding histopathological diagnosis, age, gender and localisation of the pathologies. Findings were compared to other studies. Most of the specimens were presented by the Clinic for Otorhinolaryngology and Head and Neck Surgery, University Hamburg, Eppendorf. As a reference centre for salivary gland diseases some material was sent by other institutions. RESULTS: This study will give a detailed survey of salivary gland diseases and tumors in children up to the age of 14 which have undergone surgical therapy/biopsy. We present the general distribution of the different tumors/diseases, the distribution in certain age groups and the various locations. 549 cases could be examined. Comparing the distribution of malignant tumors with other studies, the epithelial-myoepithelial carcinomas followed by salivary duct carcinomas represent the largest group in childhood. CONCLUSIONS: The study shows that comparing to adulthood different tumors play an important role in adolescence. The distribution of tumors in childhood may help in diagnostic. Further many salivary gland diseases in childhood underwent surgery/biopsy although this is not supposed to be the proper treatment. The study shows that the right diagnosis most often can only be reached by surgery and histology.