ABSTRACT
Therapeutic options for recurrent carcinoma of the upper aérodigestive tract (UADT) are limited. The prognosis of these tumours remains poor with significant rate of recurrence and a lower median survival time. Photodynamic therapy (PDT) is a relatively new therapeutic alternative which combines the use of a photosensitising agent and light to induce a cytotoxic effect on the tissues. This is a retrospective single-centre study carried out in patients with a recurrence of an oral cavity or oropharyngeal carcinoma or a second appearance of tumour in a previously irradiated area. There were no metastases in lymph nodes or other organs. Laser treatment was carried out 96 h after temoporfin (Foscan(®)) injection. In our series we had 14 cases with a complete response, 1 partial response. Overall survival at 1 year was 72 % and 36 % at 5 years. Disease-specific survival at 1 year was 82 % and 45 % at 5 years. Recurrence-free survival at 1 year was 52 % and 34 % at 5 years. Side effects mainly described are pain in the area of illumination, well controlled. PDT with Foscan(®) gives useful results in terms of survival and improvement in quality of life with few adverse events or severe complications. The fact that it has low toxicity and that treatment sessions can be repeated mean it should be considered in the therapeutic armamentarium for recurrent carcinoma of the UADT.
Subject(s)
Antineoplastic Agents/therapeutic use , Hematoporphyrin Photoradiation/methods , Mesoporphyrins/therapeutic use , Mouth Neoplasms/drug therapy , Neoplasm Recurrence, Local/drug therapy , Oropharyngeal Neoplasms/drug therapy , Aged , Aged, 80 and over , Antineoplastic Agents/adverse effects , Disease-Free Survival , Female , Hematoporphyrin Photoradiation/adverse effects , Humans , Male , Mesoporphyrins/adverse effects , Middle Aged , Mouth Neoplasms/mortality , Neoplasm Recurrence, Local/mortality , Oropharyngeal Neoplasms/mortality , Treatment OutcomeABSTRACT
OBJECTIVE: To review treatment options in a rare type of parotid tumor, in a clinical case study. CASE STUDY: A 62-year-old woman presenting with recurrence of acinic cell carcinoma of the parotid gland with invasion of the skull base was treated by external 3D conformational radiation, having refused large-scale exeresis. Sixty-six Gy (70Gy equivalent) were delivered in 2007. Clinical and paraclinical follow-up found regular tumor volume regression over a 2.5-year period without side-effects of radiation. DISCUSSION: There are no specific data on the efficacy of external radiation therapy in acinic cell carcinoma; reports on exclusive radiation treatment of salivary gland cancer include different histological types. Exclusive radiation treatment should be at least 66-70Gy, preferably by neutron- or hadrontherapy. CONCLUSION: Management of acinic cell carcinoma of the parotid is surgical with possible secondary radiation therapy; exclusive external radiation therapy is, however, an option in case of contra-indication for surgery or patient refusal.
Subject(s)
Carcinoma, Acinar Cell/radiotherapy , Parotid Neoplasms/radiotherapy , Radiotherapy, Conformal , Skull Base Neoplasms/radiotherapy , Carcinoma, Acinar Cell/pathology , Female , Humans , Middle Aged , Neoplasm Invasiveness , Parotid Neoplasms/pathology , Skull Base Neoplasms/pathologyABSTRACT
The authors report two new cases of inflammatory pseudotumours, sited in the pharynx and neck--sites in which no previous cases have so far been reported in the literature. The aetiology and clinical course of these rare benign tumours remain little understood even today. Their treatment is also not clearly described. This is most often surgical, although medical treatment is often very effective, and is sometimes appropriate. The authors begin by describing these two clinical cases, and then use the literature to give an account of the clinical course and treatment of inflammatory pseudotumours.
Subject(s)
Granuloma, Plasma Cell/pathology , Granuloma, Plasma Cell/surgery , Neck , Pharyngeal Diseases/pathology , Pharyngeal Diseases/surgery , Adult , Anti-Inflammatory Agents/therapeutic use , Biopsy , Combined Modality Therapy , Disease Progression , Granuloma, Plasma Cell/etiology , Humans , Male , Middle Aged , Pharyngeal Diseases/etiology , Steroids , Treatment OutcomeABSTRACT
PURPOSE: Brachytherapy performed in patients with posterior pharyngeal wall carcinoma in a previously irradiated area is evaluated in terms of local control, survival, and complications. METHODS AND MATERIALS: Between January 1982 and July 1993, 14 patients were treated with interstitial low dose rate brachytherapy alone for posterior pharyngeal wall squamous cell carcinoma in a previously irradiated area (local recurrences in five cases and second tumors in nine cases). Tumor size ranged from 1 to 4 cm. No patient had a macroscopic nodal involvement or metastase at the time of diagnosis. Median dose delivered was 55 Gy (39 to 60 Gy). RESULTS: Thirteen patients were assessed for local control. Twelve of them achieved complete macroscopic response within 2 months after brachytherapy. Local relapse occurred in five patients, from 5 to 29 months after brachytherapy. One patient developed distant metastatis without loco-regional relapse. Disease free survival was 69, 59, and 37% at 1, 2, and 5 years, respectively; overall survival was 78, 50, and 21% at 1, 2, and 5 years, respectively. Three patients were still alive without recurrence (8, 8, and 10 years after treatment). We did not observe any severe acute or delayed toxicity. CONCLUSION: Based on these results, interstitial brachytherapy should be considered as a potentially curative treatment for selected patients with posterior pharyngeal wall squamous cell carcinoma in a previously irradiated area. There are no reports in the literature on this subject.
