ABSTRACT
BACKGROUND: Multimodality therapy constitutes the standard treatment of advanced and recurrent head and neck cancer. Since locoregional recurrence comprises a major obstacle in attaining cure, the role of intraoperative radiation therapy (IORT) as an add-on in improving survival and local control of the disease has been investigated. IORT allows delivery of a single tumoricidal dose of radiation to areas of potential residual microscopic disease while minimizing doses to normal tissues. Advantages of IORT include the conformal delivery of a large dose of radiation in an exposed and precisely defined tumor bed, minimizing the risk of a geographic miss creating the potential for subsequent dose reduction of external beam radiation therapy (EBRT). This strategy allows for shortening overall treatment time and dose escalation. The aim of this review is to summarize recent published work on the use of IORT as an adjuvant modality to treat common head and neck cancer in the primary or recurrent setting. METHODS: We searched the Medline, Scopus, Ovid, Cochrane, Embase, and ISI Web of Science databases for articles published from 1980 up to March 2016. RESULTS: Based on relevant publications it appears that including IORT in the multimodal treatment may contribute to improved local control. However, the benefit in overall survival is not so clear. CONCLUSION: IORT seems to be a safe, promising adjunct in the management of head and neck cancer and yet further well organized clinical trials are required to determine its role more precisely.
Subject(s)
Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/radiotherapy , Combined Modality Therapy , Disease-Free Survival , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/surgery , Humans , Intraoperative Care/methods , Male , Prognosis , Radiotherapy Dosage , Risk Assessment , Survival Analysis , Treatment OutcomeABSTRACT
Electrochemotherapy is currently undergoing intensive investigation in the field of local control of cancer. In Greece, five medical centers have co-operated to perform ECT for the efficient management of growing, recurrent or newly emerging cutaneous and subcutaneous tumor nodules. ECT was applied alone or in combination with external beam radiation therapy, brachytherapy and surgery in 52 cancer patients, using bleomycin according to standard protocols. The treatment response for various tumors was 63.83% complete, 31.91% partial, and 95.74% overall of the treated nodules. Patients exerted neither systemic nor local side-effects. The results of ECT performance in Greece provided evidence that this new treatment strategy is safe and permits the effective control of tumors of various origins and histological types.
Subject(s)
Bleomycin/therapeutic use , Electrochemotherapy/methods , Neoplasms/drug therapy , Aged , Antibiotics, Antineoplastic/administration & dosage , Antibiotics, Antineoplastic/therapeutic use , Bleomycin/administration & dosage , Female , Greece , Head and Neck Neoplasms/drug therapy , Humans , Male , Prospective Studies , Skin Neoplasms/drug therapy , Treatment OutcomeABSTRACT
The case of a 31-year-old woman with progressive cerebellar degeneration preceding by several months the diagnosis and treatment of breast cancer initially and pseudomyxoma peritonei (PMP) with evidence of causative association with the latter is presented. Despite various chemotherapeutic and surgical manipulations, the patient did not substantially improve and succumbed 20 months following initial diagnosis of the neurological disorder. Interestingly, neurological symptoms partially regressed transiently only after surgical debulking of the PMP and not after the remission of breast cancer after various chemotherapeutic regimens suggesting an etiological relationship of the former and the cerebellar degeneration. Early recognition and appropriate therapy of this rare complication of PMP is imperative as it may be crucial for the outcome.
