ABSTRACT
BACKGROUND: To report our institution's experience treating soft palate squamous cell carcinoma with radiotherapy alone or combined with adjuvant chemotherapy and/or neck dissection for residual disease. METHODS: We analyzed 159 patients treated curatively between 1963 and 2016. Median follow-up was 4 years. RESULTS: The 5-year local control rates were T1, 90%; T2, 90%; T3, 70%; and T4, 59%. The 5-year cause-specific survival (CSS) rate was nearly identical for patients with stage I-III disease (88%, 86%, and 88%, respectively) compared to stage IVA/B (58%). Five-year overall survival was similar between patients with stage I-III disease (50%, 57%, and 54%, respectively) and approximately double that of patients with stage IVA/B disease (26%). Thirteen patients (8%) had severe complications related to radiotherapy. CONCLUSIONS: The likelihood of cure after definitive radiotherapy is relatively high in patients with stage I-III disease with soft palate carcinoma. Patients with stage IVA/B disease have a lower cure rate but with a 5-year CSS exceeding 50%.
Subject(s)
Carcinoma, Squamous Cell , Head and Neck Neoplasms , Palatal Neoplasms , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/radiotherapy , Follow-Up Studies , Humans , Neoplasm Staging , Palatal Neoplasms/radiotherapy , Palate, Soft/pathologyABSTRACT
Stevens-Johnson syndrome is a rare adverse cutaneous drug reaction characterized by epidermal detachment of <10% body surface area with an average mortality rate of 1-5%. The mechanism of SJS is not fully understood. Nivolumab is a monoclonal antibody directed against programmed cell death-1 protein (PD-1), a receptor with immune checkpoint inhibitory and antineoplastic activities. We present a case of SJS in a patient being treated with anti-PD-1 therapy nivolumab for metastatic squamous cell carcinoma of the oropharynx. This case is unusual because of the severe accentuation with striking enhancement at his prior radiation site and in the cutaneous region with heavier tumor burden from his metastatic disease. This reaction may give insight to the underlying pathophysiology of SJS, suggesting that immune checkpoint inhibitors can activate T-cells to target keratinocytes and that external factors may be involved in creating distinct epitopes for T-cell recognition. We hope this case adds to the body of knowledge in the pathogenesis of Stevens-Johnson syndrome and cutaneous adverse events seen with checkpoint inhibitors.
Subject(s)
Antineoplastic Agents/adverse effects , Nivolumab/adverse effects , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Skin/radiation effects , Stevens-Johnson Syndrome/etiology , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/radiotherapy , Humans , Male , Middle Aged , Palatal Neoplasms/drug therapy , Palatal Neoplasms/radiotherapy , Skin/drug effects , Skin/pathologySubject(s)
Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/surgery , Palatal Neoplasms/radiotherapy , Palatal Neoplasms/surgery , Palate, Soft , Plastic Surgery Procedures , Adult , Aged , Female , Forearm , Free Tissue Flaps , Humans , Male , Middle Aged , Radiotherapy, Adjuvant , Treatment OutcomeABSTRACT
Carbon ion radiotherapy, a form of charged particle radiotherapy that has been used to treat various inoperable and radio-resistant tumors, has been associated with less severe late effects than conventional radiotherapy. A 63-year-old woman with a soft palate defect received carbon ion radiotherapy (total dose: 64 Gray equivalents). Several late effects were observed, and osteoradionecrosis was observed not only on the tumor side but also on the other side and gradually expanded during maxillofacial prosthetic rehabilitation. While the definitive prosthesis improved her speech and eating ability, careful adjustments and close follow-up should continue with respect to postradiation effects.
Subject(s)
Heavy Ion Radiotherapy/adverse effects , Maxillary Diseases/etiology , Osteoradionecrosis/etiology , Palatal Obturators , Palate, Soft/surgery , Carcinoma/radiotherapy , Carcinoma/surgery , Deglutition Disorders/rehabilitation , Dental Prosthesis Design , Female , Follow-Up Studies , Humans , Middle Aged , Neoplasm Recurrence, Local/radiotherapy , Palatal Neoplasms/radiotherapy , Palatal Neoplasms/surgery , Palate, Soft/radiation effects , Root Canal Therapy/methods , Velopharyngeal Insufficiency/rehabilitationABSTRACT
Osteoradionecrosis (ORN) of the jaw is a complication of radiation therapy for head and neck cancers. We report a case of ORN of the posterior maxilla treated with Er: YAG laser and a pedicled buccal fat pad (bichat bulla adipose) flap. A 69-year-old man presented complaining of pain on left maxilla. He had received high-dose radiotherapy (90 Gy) for squamous cell carcinoma of the left soft palate 2 years earlier. Clinical and radiographic examinations revealed ORN of the left maxillary molar region and maxillary sinusitis. Daily home care consisted of 0.9% saline irrigation and 0.8% H2O2 gel application. Sequestrectomy and tooth extraction were followed by debridement with Er: YAG laser and repair with a pedicled buccal fat pad flap. Complete resolution of ORN and maxillary sinusitis was established one year postsurgically. The excellent clinical outcome suggests that Er: YAG laser debridement and pedicled buccal fat pad flap are a viable option to treat ORN of the posterior maxilla.
Subject(s)
Adipose Tissue/transplantation , Lasers, Solid-State/therapeutic use , Maxillary Diseases/surgery , Osteoradionecrosis/surgery , Surgical Flaps/transplantation , Aged , Autografts/transplantation , Carcinoma, Squamous Cell/radiotherapy , Debridement/methods , Follow-Up Studies , Humans , Hydrogen Peroxide/therapeutic use , Male , Maxillary Diseases/drug therapy , Maxillary Sinusitis/drug therapy , Maxillary Sinusitis/surgery , Osteoradionecrosis/drug therapy , Palatal Neoplasms/radiotherapy , Therapeutic Irrigation/methods , Tooth Extraction/methods , Treatment OutcomeSubject(s)
Hemorrhage/etiology , Lung Neoplasms/secondary , Sarcoma, Kaposi/secondary , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/drug therapy , Bronchoscopy , Facial Neoplasms/secondary , Hemorrhage/diagnosis , Humans , Lung Neoplasms/complications , Lung Neoplasms/diagnostic imaging , Male , Palatal Neoplasms/radiotherapy , Pleural Effusion, Malignant/etiology , Radiography , Sarcoma, Kaposi/complications , Sarcoma, Kaposi/diagnostic imaging , Young AdultABSTRACT
Angiosarcomas are rare, malignant neoplasms of vascular origin that account for less than 1% of all soft tissue tumors. Angiosarcomas of the oral cavity are especially rare, and brachytherapy may be prescribed as a localized treatment to manage these malignancies. Intraoral brachytherapy requires collaboration between the radiation oncologist and a dental professional for the fabrication of the brachytherapy delivery prosthesis. This clinical report describes an intraoral angiosarcoma and the fabrication of an intraoral brachytherapy prosthesis to manage this malignancy.
Subject(s)
Brachytherapy/instrumentation , Hemangiosarcoma/radiotherapy , Palatal Neoplasms/radiotherapy , Prostheses and Implants , Prosthesis Design , Aged , Biocompatible Materials/chemistry , Catheterization/instrumentation , Follow-Up Studies , Hemangiosarcoma/secondary , Humans , Male , Neoplasm Recurrence, Local/radiotherapy , Patient Care Planning , Polymethyl Methacrylate/chemistry , Radiation Protection/instrumentation , Radiotherapy DosageABSTRACT
PURPOSE: Although the most common neoplastic lesion of the oral cavity is squamous cell carcinoma (SCC), primary neoplastic lesions of the hard palate have not been systematically reviewed to date. The aim of this study was to determine the histopathologic composition and characteristics of neoplasms of the hard palate. MATERIALS AND METHODS: A retrospective analysis of 66 patients with a primary neoplasm of the hard palate managed at the authors' institution from 1985 through 2012 was performed. Demographic features, malignancy rate, histopathologic characteristics and distribution, TNM staging results, metastasis patterns, and management strategies were investigated. RESULTS: The sample was composed of 66 patients (mean age, 45.0 yr; 57.6% men). Neoplasms were benign in 57.6% of cases and malignant in 42.4%. Epithelial neoplasms and mesenchymal neoplasms were encountered in 52 patients (78.8%) and 14 patients (21.2%), respectively. Minor salivary gland tumors (MSGTs) were the most common histopathologic group (60.6%), followed by benign mesenchymal tumors (15.2%), SCCs (12.1%), malignant melanomas (6.1%), lymphomas (3.0%), and sarcomas (3.0%). Although 75.0% of malignant epithelial neoplasms were at an advanced stage, there were no pN+ SCC or malignant MSGT cases at presentation. CONCLUSION: The most common neoplasms of the hard palate were MSGTs. SCCs were relatively rare in this series. Although three-fourths of neoplasms were at an advanced stage, neck metastasis was not a characteristic of malignant epithelial neoplasms located in the hard palate.
Subject(s)
Carcinoma, Squamous Cell/pathology , Palatal Neoplasms/pathology , Palate, Hard/pathology , Salivary Gland Neoplasms/pathology , Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/surgery , Female , Humans , Lymphoma/pathology , Male , Melanoma/pathology , Melanoma/surgery , Middle Aged , Neoplasm Grading , Neoplasm Metastasis , Neoplasm Staging , Palatal Neoplasms/radiotherapy , Palatal Neoplasms/surgery , Palate, Hard/surgery , Radiotherapy, Adjuvant , Retrospective Studies , Salivary Gland Neoplasms/radiotherapy , Salivary Gland Neoplasms/surgery , Sarcoma/pathology , Sarcoma/surgeryABSTRACT
PURPOSE: Setup, range, and anatomical uncertainties influence the dose delivered with intensity modulated proton therapy (IMPT), but clinical quantification of these errors for oropharyngeal cancer is lacking. We quantified these factors and investigated treatment fidelity, that is, robustness, as influenced by adaptive planning and by applying more beam directions. METHODS AND MATERIALS: We used an in-house treatment planning system with multicriteria optimization of pencil beam energies, directions, and weights to create treatment plans for 3-, 5-, and 7-beam directions for 10 oropharyngeal cancer patients. The dose prescription was a simultaneously integrated boost scheme, prescribing 66 Gy to primary tumor and positive neck levels (clinical target volume-66 Gy; CTV-66 Gy) and 54 Gy to elective neck levels (CTV-54 Gy). Doses were recalculated in 3700 simulations of setup, range, and anatomical uncertainties. Repeat computed tomography (CT) scans were used to evaluate an adaptive planning strategy using nonrigid registration for dose accumulation. RESULTS: For the recalculated 3-beam plans including all treatment uncertainty sources, only 69% (CTV-66 Gy) and 88% (CTV-54 Gy) of the simulations had a dose received by 98% of the target volume (D98%) >95% of the prescription dose. Doses to organs at risk (OARs) showed considerable spread around planned values. Causes for major deviations were mixed. Adaptive planning based on repeat imaging positively affected dose delivery accuracy: in the presence of the other errors, percentages of treatments with D98% >95% increased to 96% (CTV-66 Gy) and 100% (CTV-54 Gy). Plans with more beam directions were not more robust. CONCLUSIONS: For oropharyngeal cancer patients, treatment uncertainties can result in significant differences between planned and delivered IMPT doses. Given the mixed causes for major deviations, we advise repeat diagnostic CT scans during treatment, recalculation of the dose, and if required, adaptive planning to improve adequate IMPT dose delivery.
Subject(s)
Organs at Risk/radiation effects , Oropharyngeal Neoplasms/radiotherapy , Proton Therapy/methods , Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy Setup Errors/adverse effects , Radiotherapy, Intensity-Modulated/methods , Aged , Aged, 80 and over , Humans , Middle Aged , Organs at Risk/anatomy & histology , Organs at Risk/diagnostic imaging , Oropharyngeal Neoplasms/diagnostic imaging , Oropharyngeal Neoplasms/pathology , Palatal Neoplasms/diagnostic imaging , Palatal Neoplasms/pathology , Palatal Neoplasms/radiotherapy , Palate, Soft , Quality Improvement , Radiography , Tongue Neoplasms/diagnostic imaging , Tongue Neoplasms/pathology , Tongue Neoplasms/radiotherapy , Tonsillar Neoplasms/diagnostic imaging , Tonsillar Neoplasms/pathology , Tonsillar Neoplasms/radiotherapy , UncertaintyABSTRACT
OBJECTIVES: To review outcomes and analyze the patterns of locoregional recurrence of oral cavity squamous cell carcinoma (OCSCC) treated with surgery and postoperative intensity-modulated radiation therapy (IMRT). MATERIALS AND METHODS: All patients with Stage I-IVB OCSCC treated with surgery and postoperative IMRT± concurrent chemotherapy between 2005 and 2010 were evaluated. Patient survival and tumor outcomes were prospectively recorded. Outcome measures were 2 year overall survival (OS), local control (LC), regional control (RC) and distant control (DC). Locoregional recurrences were spatially localized in relation to dosimetric plans. RESULTS: A total of 180 consecutive patients with median follow-up of 34 months were identified. Disease subsites were oral tongue (46%), floor of mouth (23%), alveolus and hard palate (12%), buccal (9%), retromolar trigone (5%), and lip (4%). The 2 year rates of OS, LC, RC, locoregional control (LRC), and DC were 65%, 87%, 83%, 78% and 83%, respectively. The 2-year estimated rates of LRC for larger subsites were: oral tongue (72%), floor of mouth (84%). Of the 180 patients, 38 (21%) had locoregional failure (LRF). Most LRFs were in-field (26, 68%) with 7 marginal and 5 out-of-field. Marginal/out-of-field failures occurred in the contralateral neck in N2b patients, at high level II/skull base, and in intentionally spared regions (near parotid) of pathologically involved necks. CONCLUSIONS: Nearly a third (12/38) of LR recurrences were marginal or out-of-field following postoperative IMRT for OCSCC. Postoperative IMRT following gross total surgical resection requires careful and comprehensive target volume delineation, and larger volumes may be needed than the primary RT setting.
Subject(s)
Carcinoma, Squamous Cell/surgery , Mouth Neoplasms/surgery , Radiotherapy, Intensity-Modulated/methods , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/secondary , Chemoradiotherapy , Female , Follow-Up Studies , Humans , Lymphatic Metastasis/pathology , Male , Middle Aged , Mouth Floor/radiation effects , Mouth Floor/surgery , Mouth Neoplasms/radiotherapy , Neck Dissection/methods , Neoadjuvant Therapy , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Palatal Neoplasms/radiotherapy , Palatal Neoplasms/surgery , Prospective Studies , Radiotherapy Dosage , Radiotherapy, Adjuvant , Survival Rate , Tongue Neoplasms/radiotherapy , Tongue Neoplasms/surgery , Treatment Failure , Young AdultABSTRACT
BACKGROUND: The superiority of volumetric staging (VS) over TNM/TNM-grouping system was previously prospectively tested in our head neck cancer population treated with intensity-modulated radiotherapy (IMRT); gross tumor volume (GTV) was the strongest predictor for disease control. Aim of this work was to specifically assess the prognostic value of VS in oropharyngeal cancer (OC). PATIENTS: Between 04/2002 and 12/2011, 277 consecutive OC patients underwent definitive IMRT. Mean/median follow-up was 33/27 months (3-113). Three volumetric cut-offs were used (resulting in 4 GTV subgroups: 1-15 cc (14%), 16-70 cc (62%), 71-130 cc (20%), >130 cc (4%)). METHODS: Outcome in the OC subgroup was prospectively assessed with VS and compared with that resulting from TNM and AJCC staging. RESULTS: Primary GTV was most reliably predicting local control (p<0.0001), all other outcome parameters were predicted best by the total GTV (p<0.0001). CONCLUSION: This is -to our knowledge- the first volumetric staging system for OC, and was found to be most reliable in predicting outcome in OC patients treated with IMRT.
Subject(s)
Carcinoma, Squamous Cell/pathology , Oropharyngeal Neoplasms/pathology , Radiotherapy, Intensity-Modulated/methods , Adult , Aged , Aged, 80 and over , Antibodies, Monoclonal, Humanized/therapeutic use , Antineoplastic Agents/therapeutic use , Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/secondary , Cetuximab , Chemoradiotherapy , Cisplatin/therapeutic use , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Multimodal Imaging , Neoplasm Recurrence, Local/pathology , Neoplasm Staging/methods , Oropharyngeal Neoplasms/radiotherapy , Palatal Neoplasms/pathology , Palatal Neoplasms/radiotherapy , Positron-Emission Tomography , Prospective Studies , Radiotherapy Dosage , Reproducibility of Results , Survival Rate , Tomography, X-Ray Computed , Tongue Neoplasms/pathology , Tongue Neoplasms/radiotherapy , Tonsillar Neoplasms/pathology , Tonsillar Neoplasms/radiotherapy , Treatment OutcomeABSTRACT
PURPOSE: To update the Memorial Sloan-Kettering Cancer Center's experience with intensity-modulated radiotherapy (IMRT) in the treatment of oropharyngeal cancer (OPC). METHODS AND MATERIALS: Between September 1998 and April 2009, 442 patients with histologically confirmed OPC underwent IMRT at our center. There were 379 men and 63 women with a median age of 57 years (range, 27-91). The disease was Stage I in 2%, Stage II in 4%, Stage III in 21%, and Stage IV in 73% of patients. The primary tumor subsite was tonsil in 50%, base of tongue in 46%, pharyngeal wall in 3%, and soft palate in 2%. The median prescription dose to the planning target volume of the gross tumor was 70 Gy for definitive (n = 412) cases and 66 Gy for postoperative cases (n = 30). A total 404 patients (91%) received chemotherapy, including 389 (88%) who received concurrent chemotherapy, the majority of which was platinum-based. RESULTS: Median follow-up among surviving patients was 36.8 months (range, 3-135). The 3-year cumulative incidence of local failure, regional failure, and distant metastasis was 5.4%, 5.6%, and 12.5%, respectively. The 3-year OS rate was 84.9%. The incidence of late dysphagia and late xerostomia ≥Grade 2 was 11% and 29%, respectively. CONCLUSIONS: Our results confirm the feasibility of IMRT in achieving excellent locoregional control and low rates of xerostomia. According to our knowledge, this study is the largest report of patients treated with IMRT for OPC.
Subject(s)
Oropharyngeal Neoplasms/radiotherapy , Radiotherapy, Intensity-Modulated , Adult , Aged , Aged, 80 and over , Analysis of Variance , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cancer Care Facilities , Deglutition Disorders/epidemiology , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Neoplasm Staging , New York City , Oropharyngeal Neoplasms/drug therapy , Oropharyngeal Neoplasms/mortality , Oropharyngeal Neoplasms/pathology , Palatal Neoplasms/drug therapy , Palatal Neoplasms/mortality , Palatal Neoplasms/pathology , Palatal Neoplasms/radiotherapy , Palate, Soft , Pharyngeal Neoplasms/drug therapy , Pharyngeal Neoplasms/mortality , Pharyngeal Neoplasms/pathology , Pharyngeal Neoplasms/radiotherapy , Radiotherapy Dosage , Tongue Neoplasms/drug therapy , Tongue Neoplasms/mortality , Tongue Neoplasms/pathology , Tongue Neoplasms/radiotherapy , Tonsillar Neoplasms/drug therapy , Tonsillar Neoplasms/mortality , Tonsillar Neoplasms/pathology , Tonsillar Neoplasms/radiotherapy , Treatment Failure , Xerostomia/epidemiologyABSTRACT
BACKGROUND: Oronasal fistulas after oromaxillary surgery may sometimes be encountered and remain a challenging problem. They can cause significant disabilities such as phonetic problems and food or liquid regurgitation while swallowing. A few methods are reported to solve this problem, including using a dental appliance, local tissue rotation, or even free-tissue transfer. MATERIALS AND METHODS: An angular artery cutaneous flap was designed to repair the defect. The flap that included the skin and superficial fascia fed by the flow of angular artery was rotated through the buccal mucosa into the oral cavity to cover the palate defect. CASE REPORTS: Two oronasal fistula cases were reported in this series. Case 1: A 71-year-old man had hard palate cancer and had received wide excision in our hospital 2 years previously. He had received adjuvant radiotherapy (28 times) and was transferred to the plastic surgery department for dealing with oronasal fistula. The palate defect was 2 × 2 cm. Case 2: A 72-year-old woman was a patient with left palate mucoepidermoid carcinoma. She had received an operation and adjuvant radiotherapy 10 years previously. For her oronasal fistula and hypernasality, she had received reconstructive operations 3 times with local rotation flap for left-side palate defect at a previous hospital. However, the local flap failed and the fistula persisted. She then approached our plastic surgery department for help. The palate defect was about 1 × 1 cm. We successfully reconstructed the oronasal fistula by using the angular artery cutaneous flap. The flap successfully sealed the oral cavity during the follow-up period. CONCLUSION: Angular artery cutaneous flap is a good alternative for reconstruction of the oronasal fistula. Especially in elderly patients, donor-site comorbidities are fewer due to the redundant aging skin and the missing tooth.
Subject(s)
Fistula/surgery , Nose Diseases/surgery , Oral Fistula/surgery , Plastic Surgery Procedures/methods , Surgical Flaps/blood supply , Aged , Female , Humans , Male , Palatal Neoplasms/radiotherapy , Palatal Neoplasms/surgeryABSTRACT
OBJECTIVE: To design and make denture-like applicators containing radioactive seeds for treatment of malignant tumors in the hard palate where only thin layers of soft tissues are available. METHODS: Forty-two patients were treated with denture-like applicators containing (125)I radioactive seeds after local resection of malignant salivary gland tumors the hard palate. Sixteen patients were male, and 26 patients were female. The average age was 37.6 years old (18-74 years old). The denture-like applicators were consisted of three parts: resin layer (about 1.0 mm in thickness) which contacted with surgical area and contained radioactive seeds; the cobalt-chromium alloy layer (about 1.0 mm in thickness) which protected surrounding normal tissues; the clasps which acted as retainers for applicators. The resin layer and the alloy layer were connected together mechanically. Artificial teeth were applied on the applicators to restore the masticatory function when partially edentulous upper jaws were available. All these patients were followed up for 12-72 months. The complications in target areas and adjacent normal tissues were observed. The stability of radioactive seeds, the recurrence of the tumor was also observed during the follow-up. RESULTS: No patients complained about hurt or burning of adjacent normal tissues. 8/42 patients felt some uncomfortable, such as gagging, more saliva on the first one or two days. No radioactive seeds were lost and dislocated during the treatment. The surgical wounds healed perfectly. No mucosal ulcer, no recurrence of tumor, and no other complications for the target areas were observed. The living standard of the patients was improved. CONCLUSION: The denture-like applicator containing (125)I radioactive seeds is a feasible, effective, and convenient way to treat malignant tumors around the hard palate, where there is no enough room to implant radioactive seeds. This method can effectively irradiate the target areas when treating the malignant tumors in the palate.
Subject(s)
Brachytherapy/instrumentation , Brachytherapy/methods , Dentures , Iodine Radioisotopes/therapeutic use , Palatal Neoplasms/radiotherapy , Adolescent , Adult , Aged , Equipment Design , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
We compared the outcomes and rates of survival provided by surgery alone and surgery combined with postoperative radiotherapy for patients with adenoid cystic carcinoma of the palate (ACP), a rare, low-grade malignant tumor arising within the salivary glands. Fifty-eight patients with ACP were included in this retrospective study. ACP at stages T(1), T(2), T(3,) and T(4) was found in 11, 32, 5, and 10 patients, respectively. The patients were treated with surgery alone or underwent surgery combined with postoperative radiotherapy. The 5, 10, and 15year survival rates were 75%, 37.5%, and 25%, respectively, among the 24 patients who underwent surgery alone. These were not significantly different from the rates of 70.6%, 35.3%, and 20.8%, respectively, among the 34 patients who underwent surgery plus postoperative radiotherapy (P=0.21). The 5 and 10year survival rates were significantly greater among patients receiving ⩾60Gy of radiotherapy than those among patients receiving <60Gy of radiotherapy (83.3% and 45.8% vs. 40.0% and 10.0%, respectively) (P=0.04). ACP exhibited good long-term survival rates when treated with surgery alone. Addition of postoperative radiotherapy at doses of ⩾60Gy had no effect on survival, but postoperative radiotherapy at doses of <60Gy reduced survival. Recurrence within the palate was the main cause of treatment failure.
Subject(s)
Carcinoma, Adenoid Cystic/mortality , Palatal Neoplasms/mortality , Adult , Aged , Carcinoma, Adenoid Cystic/radiotherapy , Carcinoma, Adenoid Cystic/surgery , Combined Modality Therapy/mortality , Female , Humans , Male , Middle Aged , Palatal Neoplasms/radiotherapy , Palatal Neoplasms/surgery , Postoperative Period , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
PURPOSE: To determine under what conditions positron emission tomography (PET) imaging will be useful in decisions regarding the use of radiotherapy for the treatment of clinically occult lymph node metastases in head-and-neck cancer. METHODS AND MATERIALS: A decision model of PET imaging and its downstream effects on radiotherapy outcomes was constructed using an influence diagram. This model included the sensitivity and specificity of PET, as well as the type and stage of the primary tumor. These parameters were varied to determine the optimal strategy for imaging and therapy for different clinical situations. Maximum expected utility was the metric by which different actions were ranked. RESULTS: For primary tumors with a low probability of lymph node metastases, the sensitivity of PET should be maximized, and 50 Gy should be delivered if PET is positive and 0 Gy if negative. As the probability for lymph node metastases increases, PET imaging becomes unnecessary in some situations, and the optimal dose to the lymph nodes increases. The model needed to include the causes of certain health states to predict current clinical practice. CONCLUSION: The model demonstrated the ability to reproduce expected outcomes for a range of tumors and provided recommendations for different clinical situations. The differences between the optimal policies and current clinical practice are likely due to a disparity between stated clinical decision processes and actual decision making by clinicians.
Subject(s)
Decision Trees , Head and Neck Neoplasms/diagnostic imaging , Head and Neck Neoplasms/radiotherapy , Lymph Nodes/diagnostic imaging , Lymphatic Irradiation/methods , Positron-Emission Tomography/methods , Bayes Theorem , Decision Support Techniques , Head and Neck Neoplasms/pathology , Humans , Lymphatic Metastasis/diagnostic imaging , Nasopharyngeal Neoplasms/diagnostic imaging , Nasopharyngeal Neoplasms/radiotherapy , Palatal Neoplasms/diagnostic imaging , Palatal Neoplasms/radiotherapy , Palate, Soft/diagnostic imaging , Radiotherapy Dosage , Sensitivity and Specificity , Tongue Neoplasms/diagnostic imaging , Tongue Neoplasms/radiotherapyABSTRACT
Solitary plasmacytoma is an uncommon tumor of plasma cells that can appear in the head and neck. It must be differentiated from multiple myeloma because of its initial presentation. A case of solitary plasmacytoma on the palate is presented. Furthermore, role of ¹8F-fluorodeoxyglucose Positron Emission Tomography (¹8F-FDG-PET) in its initial staging is analyzed.
Subject(s)
Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Palatal Neoplasms/diagnostic imaging , Palate, Soft/diagnostic imaging , Plasmacytoma/diagnostic imaging , Positron-Emission Tomography , Radiopharmaceuticals , Tomography, X-Ray Computed , Female , Humans , Immunoglobulin Light Chains/blood , Magnetic Resonance Imaging , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging/methods , Palatal Neoplasms/blood , Palatal Neoplasms/pathology , Palatal Neoplasms/radiotherapy , Palate, Soft/pathology , Paraproteins/analysis , Pharynx/diagnostic imaging , Pharynx/pathology , Plasmacytoma/blood , Plasmacytoma/pathology , Plasmacytoma/radiotherapy , Remission InductionABSTRACT
BACKGROUND: Carcinoma ex pleomorphic adenoma (CXPA) is an aggressive salivary gland malignancy and rare in minor salivary gland. A soft palate CXPA initially presenting as direct cavernous sinus (CS) invasion is very rare. CASE PRESENTATION: A 60-year-old male had a 3-month history of a small soft palatal mass with progressing left cheek numbness, proptosis, and disturbed vision. Biopsy of soft palatal tumor showed pleomorphic adenoma. Magnetic resonance imaging showed a tumor involving left maxilla, and extended from pterygopalatine fossa, inferior orbital fissure to CS. Excision of tumor revealed CXPA. Adjuvant concomitant chemo-radiation therapy (CCRT) was given. The tumor recurred 5 months later in left CS which was re-treated with CCRT. The disease status was stable at 2 years after the diagnosis of CXPA. CONCLUSION: We present this case to emphasize that patients with symptoms such as facial numbness, proptosis and disturbed vision should be carefully investigated for lesions invading CS by perineural spread.
Subject(s)
Adenoma, Pleomorphic/pathology , Brain Neoplasms/pathology , Cavernous Sinus/pathology , Maxillary Sinus Neoplasms/pathology , Neoplasm Recurrence, Local/pathology , Palatal Neoplasms/pathology , Palate, Soft/pathology , Adenoma, Pleomorphic/drug therapy , Adenoma, Pleomorphic/radiotherapy , Brain Neoplasms/drug therapy , Brain Neoplasms/radiotherapy , Combined Modality Therapy , Humans , Magnetic Resonance Imaging , Male , Maxillary Sinus Neoplasms/drug therapy , Maxillary Sinus Neoplasms/radiotherapy , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local/therapy , Palatal Neoplasms/drug therapy , Palatal Neoplasms/radiotherapy , Tomography, X-Ray ComputedABSTRACT
Various techniques have been used to repair maxillary defects. The aim of this study was to evaluate the suitability of pedicled temporal musculoperiosteal flap (PTMF) and free calvarial bone graft for the reconstruction of maxillary defects. In this retrospective series, 34 patients operated on from 1995 to 2006 at Turku University Central Hospital because of defects of maxilla reconstructed using PTMF with or without free calvarial bone graft were evaluated. The diagnosis, the indication for surgery, the location and staging of the tumours, and the type of radiotherapy used were reviewed. The classification of the maxillary defects was performed according to the classification of Brown (Br J Oral Maxillofac Surg 40:183-190, 2002) and the success rates of the reconstructions were evaluated. Of the patients, 32 had been operated on due to a malignant tumour, one due to a benign tumour and one due to posttraumatic palatal defect. Preoperative radiotherapy (n = 14), preoperative chemoradiotherapy (n = 2) or postoperative radiotherapy (n = 11) had been used in the tumour group. As a reconstructive method, PTMF had been used with (n = 21) or without (n = 13) free calvarial bone graft. The use of free calvarial bone graft did not have a significant effect on flap survival. At 1-month follow-up, the flap survival in the 32 patients was 71.9%, whereas 28.1% of the patients suffered from partial flap loss, but there was no total flap loss. At 6-month follow-up, the flap survival in 26 patients was 76.9%, whereas 7.7% of the patients suffered from partial flap loss, and there were four (15.4%) total flap losses. If unilateral alveolar maxillectomy had been performed (Brown classification a), at 1-month follow-up, the flap survival was 82.6%, 17.4% of the patients suffered from partial flap loss, and there was no total flap loss. At 6-month follow-up, the flap survival was 89.5%, while 10.5% of the patients suffered from partial flap loss, and there was no total flap loss. The application of PTMF with or without free calvarial bone graft for reconstruction of limited palatal and maxillary defects appears to be feasible.