Radiation-induced squamous cell carcinoma of the nasopharynx after radiotherapy for nasopharyngeal carcinoma.

BACKGROUND: The purpose of this study was to investigate the treatment outcome of radiation-induced squamous cell carcinoma (SCC) of the nasopharynx after radiotherapy (RT) for nasopharyngeal carcinoma (NPC). METHODS: We conducted a retrospective review of patients who underwent radiation therapy for NPC, which resulted in radiation-induced SCC of the nasopharynx. RESULTS: Between 1998 and 2011, 24 patients had radiation-induced SCC of the nasopharynx. The median age of diagnosis was 68.2 years. The majority of patients (66.7%) presented with early-stage NPC initially, and they were treated with RT alone (n = 18) or concurrent chemoradiation (n = 6). The mean latency period for the second malignancy was 10.5 years. All the patients were treated with maxillary-swing nasopharyngectomy. Clear resection margin was achieved in 66.7%, and 75% of those with involved margin received adjuvant RT. The mean follow-up duration was 48.2 months. The overall 5-year actuarial local tumor control was 56% and the overall 5-year disease-free survival was 38%. CONCLUSION: Radiation-induced SCC of the nasopharynx is rare after RT for NPC. The prognosis remained poor despite aggressive surgery and adjuvant RT.

Multivariate analysis of prognostic factors for salvage nasopharyngectomy via the maxillary swing approach.

BACKGROUND: The purpose of this study was to investigate the prognostic factors for salvage nasopharyngectomy. METHODS: A retrospective review was conducted on maxillary swing nasopharyngectomy performed between 1998 and 2010. Univariate and multivariate analyses identified prognostic factors affecting actuarial local tumor control and overall survival. RESULTS: The median follow-up duration was 52 months. Among the 268 patients, 79.1% had clear resection margins. The 5-year actuarial local tumor control and overall survival was 74% and 62.1%, respectively. On multivariate analysis, tumor size, resection margin status, and gross tumor in the sphenoid sinus were independent prognostic factors for local tumor control. For overall survival, resection margin status, synchronous cervical nodal recurrence, and cavernous sinus invasion had a negative influence on overall survival after surgery. CONCLUSION: Extent of nasopharyngectomy should be tailored to the individual tumor to achieve clear resection margins. Cavernous sinus invasion is associated with poor survival outcome, and detailed counseling and meticulous surgical planning is crucial in such circumstances.

Quality of dying in head and neck cancer patients: the role of surgical palliation.

To study the role of surgery for symptom palliation in patients with advanced head and neck malignancy. Between 2000 and 2011, patients with locoregionally advanced cancer in the head and neck region, who chose surgical palliation for symptom control, were studied retrospectively. During the study period, 52 patients were included. The index tumour included carcinoma of the maxilla (23.1 %), tongue (19.2 %), larynx/hypopharynx (15.4 %), post-radiation sarcoma (11.5 %), primary sarcoma (11.5 %), carcinoma of the lower alveolus (11.5 %), nasal mucosal melanoma (3.9 %) and metastatic tumour in the head and neck region (3.9 %). The major symptoms included bleeding (53.9 %), tumour pain (19.2 %), dysphagia (11.5 %), non-healing ulcerations (7.7 %), airway obstruction (5.8 %) and pathological fracture of the mandible (1.9 %). Ligation of the carotid artery was performed in 10 patients, complete resection of tumour in 35, and surgical debulking of the tumour in 7 patients. Mean survival of the patients was 5.6 months. The majority of the patients achieved satisfactory and persistent control of symptoms. One patient died from pneumonia during the hospital stay, and the rest were discharged after a mean duration of 16.4 days. In selected patients, surgery is effective in palliating symptoms which are otherwise difficult to manage. Detailed planning and good communication is the key to success in improving the quality of dying.

Efficacy of fine-needle aspiration in diagnosing cervical nodal metastasis from nasopharyngeal carcinoma after radiotherapy.

OBJECTIVES/HYPOTHESIS: Our purpose was to study the effect of previous radiotherapy (RT) on the efficacy of fine-needle aspiration (FNA) in diagnosing cervical nodal metastasis in nasopharyngeal carcinoma (NPC). STUDY DESIGN: Case-control study. METHODS: The diagnostic efficacy of FNA in a group of patients with residual or recurrent cervical lymphadenopathy after previous RT for NPC was compared with a cohort of patients with primary NPC before RT during the same period. RESULTS: Between 2008 and 2010, 50 patients were included for each group in the study. The specificity (100% vs. 88%, P = .12) and positive predictive value (100% vs. 89%, P = .12) was comparable in the two groups. However, the sensitivity (82% vs. 40%, P = .04), negative predictive value (NPV; 74% vs. 36%, P = .03), and accuracy (88% vs. 54%, P = .05) were significantly worse after previous RT. Previous RT was the only factor that was significantly associated with worse diagnostic efficacy (P = .001). When used together with plasma Epstein-Barr virus (pEBV)-DNA level and magnetic resonance imaging (MRI) findings (triple assessment), the diagnostic efficacy was significantly improved, especially regarding sensitivity (40% vs. 98%, P = .01), NPV (36% vs. 96%, P = .02), and accuracy (54% vs. 97%, P = .03). CONCLUSIONS: Diagnostic efficacy of FNA for residual or recurrent cervical lymph node metastasis in NPC is significantly reduced after previous RT. To ensure that the proper diagnosis is made early, triple assessment using FNA, pEBV-DNA, and MRI should be adopted in this scenario.

Secondary head and neck cancer in patients with history of hematological malignancy.

BACKGROUND: Head and neck cancer is a common second cancer in patients with a history of hematological malignancies. The purpose of this study was present the clinical characteristics and treatment outcomes of this group of patients. METHODS: A retrospective analysis was conducted of all patients who had a history of hematological malignancy and developed head and neck cancer in a 10-year period. RESULTS: The cohort had 10 patients; median age was 45.8 years. Most patients were nonsmokers and nondrinkers. Seven patients had chronic graft-versus-host disease. The median interval between the completion of treatment of hematological malignancy and the development of head and neck cancers was 8.79 years (range, 2.33-26.83 years). Six patients were alive and disease-free, 3 developed local recurrence, and 3 had metachronous head and neck cancers. CONCLUSION: The risk factors and etiology of head and neck cancers in patients with hematological malignancy may be different from the ordinary population.

Efficacy of neck dissection for locoregional failures versus isolated nodal failures in nasopharyngeal carcinoma.

BACKGROUND: Neck dissection has been shown to be effective in controlling nodal failures in nasopharyngeal carcinoma. Its efficacy in controlling the disease in patients with synchronous locoregional failure is, however, not documented. METHOD: A retrospective review of all patients who underwent neck dissection for nodal failures with or without treated local failure within 6 months was conducted for this study. The survivals of these 2 groups of patients were analyzed. RESULTS: The 5-year overall survival of the whole cohort was 58%. There was no difference in 5-year disease specific survival (68% vs 40%; p = .121) and 5-year progression free survival (44% vs 36%; p = .334) when comparing patients with isolated nodal failures and synchronous locoregional failures. Multivariate analysis showed that only the initial N classification affects survival. CONCLUSION: Neck dissection is efficacious in patients with nasopharyngeal carcinoma with nodal failure, with or without synchronous local failures.

Review of salivary gland neoplasms.

Salivary gland tumours most often present as painless enlarging masses. Most are located in the parotid glands and most are benign. The principal hurdle in their management lies in the difficulty in distinguishing benign from malignant tumours. Investigations such as fine needle aspiration cytology and MRI scans provide some useful information, but most cases will require surgical excision as a means of coming to a definitive diagnosis. Benign tumours and early low-grade malignancies can be adequately treated with surgery alone, while more advanced and high-grade tumours with regional lymph node metastasis will require postoperative radiotherapy. The role of chemotherapy remains largely palliative. This paper highlights some of the more important aspects in the management of salivary gland tumours.

Extracapsular lymph node spread in recurrent nasopharyngeal carcinoma.

OBJECTIVES/HYPOTHESIS: To study the efficacy of combined neck dissection and brachytherapy for nodal metastasis with extracapsular spread (ECS) in recurrent nasopharyngeal carcinoma (NPC). STUDY DESIGN: Prospective. METHODS: Between 1990 and 2010, we recruited patients who had regional recurrent NPC after radiotherapy. The prevalence of ECS, the type of treatments, and the postoperative complications were noted. Nodal tumor control and disease-free survival were compared between patients with or without ECS. RESULTS: Macroscopic ECS was seen in 25.9% of our series of 158 patients. They were treated by extended radical neck dissection (RND) followed by brachytherapy. The rest of the patients without ECS were treated by RND alone. Median follow-up duration was 62 months. With such aggressive treatment, there was no significant difference in the 5-year actuarial nodal control (62% and 65%, P = .18) and 5-year disease-free survival (38% and 44%, P = .08) between those with or without ECS. Regional flaps were employed (deltopectoral flap: 24 patients; pectoralis major flap: 17 patients) to prevent wound necrosis and carotid blowout after brachytherapy. The rate of delayed vagal and hypoglossal nerve palsy after brachytherapy was 2.4% and 4.8%, respectively. None of our patients developed cerebral ischemia secondary to accelerated atherosclerosis from brachytherapy after previous external radiotherapy. CONCLUSIONS: With combined surgery and brachytherapy, satisfactory results can be achieved in patients with ECS in recurrent NPC. Reconstruction with regional flaps is mandatory to prevent serious complications like wound necrosis and carotid artery blowout.

Efficacy of salvage neck dissection for isolated nodal recurrences in early carcinoma of oral tongue with watchful waiting management of initial N0 neck.

BACKGROUND: Recent studies have shown that salvage treatment may be effective for early tongue carcinoma with nodal failures after watchful waiting policy. We wanted to assess the efficacy of salvage neck dissection. METHODS: We conducted a retrospective review of all patients with pT1 and pT2 oral tongue cancer who underwent partial glossectomy without any neck surgery and determined the survival after salvage neck dissection in this group of patients. RESULTS: Seventy patients with N0 disease underwent partial glossectomy, 20 patients had development of isolated nodal failures after watchful waiting policy. Apart from the initial T classification, which found to have significant difference in 5-year disease specific survival rate (100% vs 46%, p = .023); other parameters including age, sex, tumor thickness, adjuvant radiotherapy and rN classification had shown no significance in affecting survival. CONCLUSIONS: Salvage neck dissection may not be effective for controlling isolated nodal recurrence in patients with oral tongue carcinoma with T2 disease.

Natural course and tumor doubling time of nasopharyngeal carcinoma. A study of 15 patients.

Nasopharyngeal carcinoma (NPC) is a non-lymphomatous carcinoma that develops in the epithelial lining of the nasopharynx. The knowledge of natural course of tumor progression has been based on anatomical model without clinical correlation. This study is the first to describe and analyze the natural progression of NPC based on clinical information and calculate the tumor growth rate of NPC. Fifteen NPC patients who refused treatment after initial work-up and then subsequent re-presentation at a later time were recruited during the period from January 2003 to August 2009. Clinical data were analyzed and CT scans were used to calculate the tumor volumes. The time interval between the first planning CT image and the subsequent planning CT image was used to calculate the rate of tumor growth in this group of patients. The tumor volume doubling time can be calculated by using the formula DT=tln2/(lnV2-lnV1), where t is the time interval between measurements and V(2) and V(1) are the tumor volumes at the end and beginning of the time interval, respectively. Cranial nerves palsies such as diplopia and systemic upset were the most common reason for re-presentation and the consent for treatment. The median growth rate was 1.63mm(3) per day and the median tumor doubling time was 279days. This study is the first report in the literature looking at the natural progression of nasopharyngeal carcinoma (NPC) based on clinical information. The current study showed that NPC has a propensity to grow superiorly to involve the skull base rather than laterally or anteriorly. Although the tumor growth rate was very variable, the median natural NPC growth rate was 1.63mm(3)/day.

MicroRNA let-7 suppresses nasopharyngeal carcinoma cells proliferation through downregulating c-Myc expression.

AIMS: This study aimed at evaluating the potential anti-proliferative effects of the microRNA let-7 family in nasopharyngeal carcinoma (NPC) cells. In addition, the association between let-7 suppression and DNA hypermethylation is examined. MATERIALS AND METHODS: Levels of mature let-7 family members (-a, -b, -d, -e, -g, and -i) in normal nasopharyngeal cells (NP69 and NP460) and nasopharyngeal carcinoma cells (HK1 and HONE1) were measured by real-time quantitative PCR. Cell-proliferation assay and c-Myc immunohistochemical staining were performed on NPC cells transfected with let-7 precursor molecules. In addition, expression changes in let-7 family members in response to demethylating agents (5-azacytidine and zebularine) were also examined. RESULTS: In comparison with the normal nasopharyngeal cells, let-7 (-a, -b, -d, -e, -g, and -i) levels were reduced in nasopharyngeal carcinoma cells. Ectopic expression of the let-7 family in nasopharyngeal carcinoma cells resulted in inhibition of cell proliferation through downregulation of c-Myc expression. Demethylation treatment of nasopharyngeal carcinoma cells caused activation of let-7 expression in poorly differentiated nasopharyngeal carcinoma cells only. CONCLUSION: Our results suggested that miRNA let-7 might play a role in the proliferation of NPC. DNA methylation is a potential regulatory pathway, which is affected when let-7 is suppressed in NPC cells. However, the extent of DNA hypermethylation/hypomethylation in regulating let-7 expression requires further elucidation.