125 years of head and neck radiotherapy: could organ-sparing radiotherapy of larynx cancer have prevented World War I?

PURPOSE: We aim to recapitulate the rapid development of head and neck radiotherapy in the context of otorhinolaryngology (ORL) medicine starting 125 years ago. This is put into context with the unsuccessful treatment of the laryngeal cancer (LC) of the German emperor Frederick III and its historical consequences. METHODS: The three-step process consisted in the analysis of (1) historical sources of the development of ORL radiotherapy from the discovery of x­rays and radioactivity until World War I, (2) course and treatment of Frederick's III LC, (3) political context with a special focus on the escalation towards World War I. Pertinent historical illustrations of technical developments of radiotherapy were summarized in a video. RESULTS: ORL radiotherapy initiated on 03 February 1896, only 65 days after the discovery of X­rays. By 1914, organ-sparing LC radiotherapy was established with a predominance of curietherapy over roentgentherapy. Correct diagnosis of Frederick III's primarily radiocurable cT1a glottic LC was delayed by one year, which resulted in advancement to a fatal pT4 pN1 Mx tumour stage. Historically, his successor, William II, was assumed to have contributed to the causes of World War I. CONCLUSION: ORL radiotherapy came only eight years late to treat Frederick III who might have impeded World War I. This illustrates the potential impact of modern curative radiotherapy on the future course of public life beyond the personal fate of the patient himself.

Information for decision making by patients with early-stage prostate cancer: a comparison across 9 countries.

PURPOSE: To describe decisional roles of patients with early-stage prostate cancer in 9 countries and to compare the information they rated important for decision making (DM). METHOD: A survey of recently treated patients was conducted in Canada, Italy, England, Germany, Poland, Portugal, Netherlands, Spain, and Turkey. Participants indicated their decisional role in their actual decision and the role they would prefer now. Each participant also rated (essential/desired/no opinion/avoid) the importance of obtaining answers, between diagnosis and treatment decision, to each of 92 questions. For each essential/desired question, participants specified all purposes for that information (to help them: understand/decide/plan/not sure/other). RESULTS: A total of 659 patients participated with country-specific response rates between 58%-77%. Between 83%-96% of each country's participants recalled actually taking an active decisional role and, in most countries, that increased slightly if they were to make the decision today; there were no significant differences among countries. There was a small reliable difference in the mean number of questions rated essential for DM across countries. More striking, however, was the wide variability within each country: no question was rated essential for DM by even 50% of its participants but almost every question was rated essential by some. CONCLUSIONS: Almost all participants from each country want to participate in their treatment decisions. Although there are country-specific differences in the amount of information required, wide variation within each country suggests that information that patients feel is essential or desired for DM should be addressed on an individual basis in all countries.

Information needs of early-stage prostate cancer patients: a comparison of nine countries.

BACKGROUND AND PURPOSE: Providing information to patients can improve their medical and psychological outcomes. We sought to identify core information needs common to most early-stage prostate cancer patients in participating countries. MATERIAL AND METHODS: Convenience samples of patients treated 3-24 months earlier were surveyed in Canada, England, Italy, Germany, Poland, Portugal, Netherlands, Spain, and Turkey. Each participant rated the importance of addressing each of 92 questions in the diagnosis-to-treatment decision interval (essential/desired/no opinion/avoid). Multivariate modelling determined the extent of variance accounted by covariates, and produced an unbiased prediction of the proportion of essential responses for each question. RESULTS: Six hundred and fifty-nine patients responded (response rates 45-77%). On average, 35-53 questions were essential within each country; similar questions were essential to most patients in most countries. Beyond cross-country similarities, each country showed wide variability in the number and which questions were essential. Multivariate modelling showed an adjusted R-squared with predictors country, age, education, and treatment group of only 6% of the variance. A core of 20 questions were predicted to be essential to >2/3 of patients. CONCLUSIONS: Core information can be identified across countries. However, providing the core should only be a first step; each country should then provide information tailored to the needs of the individual patient.

Effects of imatinib mesylate on adenoid cystic carcinomas.

BACKGROUND: Adenoid cystic carcinomas (ACCs) are rare tumors which most often arise in the salivary glands. They have a propensity for local relapse and tend to metastasize, frequently with a protracted clinical course. A substantial fraction of the tumors expresses c-Kit or the platelet-derived growth factor receptor beta (PDGFRbeta), both targets for imatinib mesylate. No standard systemic therapy is known for these neoplasms. PATIENTS AND METHODS: c-kit and PDGFRbeta-expression were determined by immunohistochemistry. Four patients with distant metastases and with at least one positive result were treated with 400 mg imatinib mesylate once daily and their response assessed. RESULTS: c-Kit and PDGFRbeta expressions were variable among the tumor samples. Toxicity was mild. No remissions were observed. CONCLUSION: These data support that c-Kit or PDGFRbeta expression per se are not prognostic for the therapeutic response of metastasized ACCs to imatinib mesylate.

Post-traumatic atrophy of the olfactory tract: clinicopathological features.

We present the clinicopathological features of a 51-year-old male patient with post-traumatic atrophy of the olfactory bulb and tract, and additional contusion on the base of the temporal lobe. Prior to death, there was no clinical evidence of an impaired olfactory function; the lesions were identified during post-mortem evaluation. Macroscopically, the left olfactory tract appeared to be substantially diminished in volume, whereas the right olfactory tract could not be identified within the markedly fibrotic leptomeninges in the fronto-orbital region. Postmortem MRI examination of the brain demonstrated superficial defects in the fronto-orbital cortex on the right side, corresponding to the region of the atrophic olfactory tract. Microscopic examination revealed degenerative changes with reactive gliosis and a large amount of corpora amylacea most pronounced in the right olfactory tract. The pathophysiologic mechanisms of olfactory degeneration after head trauma are discussed.