Cell carcinoma of the paranasal sinuses and skull base.

PURPOSE: To evaluate patients with squamous cell carcinoma of the paranasal sinus and skull base for factors that might predict clinical outcome. METHODS: A multi-institutional 13-year retrospective review of anterior skull base malignancies. RESULTS: Of 73 patients with anterior skull base malignancies, squamous cell carcinoma was the most prevalent-30 patients or 41%. Twenty-three patients underwent craniofacial surgery with or without adjuvant chemotherapy. Seven patients, deemed unresectable or not willing to have surgery, were treated with standard radiation protocols often with chemotherapy. The 3- and 5-year survival rates after surgery were 32% and 16%, respectively, compared to a 28% survival rate at 3 and 5 years for the nonsurgical group. Most tumors were in advanced stages accounting for a relatively poor survival in both groups. A Cox regression analysis demonstrated that age (P = .0172) was an independent determinant of poor outcome. Although 3- and 5-year survival of tumors free of sphenoid sinus, dura, retromaxillary, and ptyerygoid space, and orbit treated with surgery showed no significant difference to those patients with involvement, their median time of survival was increased for all anatomical regions. CONCLUSIONS: Squamous cell carcinoma of the sinus invading the skull base carries a very poor prognosis regardless of treatment modality. Surgery with adjunctive radiotherapy and/or chemotherapy offers a survival advantage over nonsurgical methods, but treatment should be individualized weighing prognostic factors, such as age, stage, and anatomical extension with morbidity of treatment.

Characterization of submucosal lesions using optical coherence tomography in the rabbit subglottis.

OBJECTIVE: To evaluate the efficacy of optical coherence tomography in differentiating between several simulated subglottic lesions, using an ex vivo rabbit laryngotracheal model. DESIGN: Laryngotracheal complexes were harvested from euthanized rabbits and divided into the following 4 groups: (1) control, (2) submucosal collagen injection (simulating scar formation), (3) dehydration and rehydration (simulating edema), and (4) repeated intubation trauma. The subglottic region was imaged using optical coherence tomography. Images were later correlated with conventional histologic findings. RESULTS: The epithelium, basement membrane, lamina propria, perichondrium, and cartilage (cricoid and tracheal) were clearly imaged. In group 2, an increase in the thickness of the lamina propria was observed, in addition to a characteristic optical pattern of the injected collagen. Dehydration (in group 3) produced a visible reduction in the thickness of the lamina propria, while rehydration of the same specimen with distilled water revealed a significant increase in submucosal swelling. Repeated intubation (in group 4) resulted in tissue edema that was seen as wavy heterogeneous thickening of the lamina propria. Edema produced by repeated intubation or distilled water immersion was easily differentiated from native and collagen-injected tissues. CONCLUSION: Optical coherence tomography successfully identifies the microstructure layers of the subglottis and can differentiate between edema and increased collagen deposition in the rabbit model.

Bioactive suture: a novel immunotherapy for head and neck cancer.

PURPOSE: We have proposed to characterize the mechanism through which bioactive surgical sutures generate a T(H)1 immune response and to define the immune-stimulating half-life of the sutures. EXPERIMENTAL DESIGN: Bioactive sutures of interferon gamma (IFNgamma), interleukin 2 (IL-2), anti-CD3/CD28, anti-CD3/CD28 + IL-2, or anti-CD3/CD28 + IFNgamma sutures were used to stimulate lymphocytes from normal donors and from head and neck cancer patients in vitro over a 24-day period. Cell supernatants were analyzed by ELISA, and T cells were phenotyped to characterize the immune response generated. Intracellular cytokine staining was performed to measure the expansion of flu-specific T cells. Electromobility shift assay and supershift assay were used to measure the intranuclear DNA binding activity of nuclear factor kappaB and its p65 subunit in T cells activated by sutures in the presence and absence of a proteasome inhibitor, MG-132. RESULTS: Anti-CD3/CD28, anti-CD3/CD28 + IL-2, or anti-CD3/CD28 + IFNgamma generated a prolonged T(H)1 immune response for 18 days in vitro. Anti-CD3/CD28 expanded flu-specific T cells. Activated T cells demonstrated enhanced CD40 ligand (CD40L) expression within 72 hours of stimulation, which stimulated other cells to secrete IL-12. Stimulated T cells demonstrated increased intranuclear expression of nuclear factor-kappaB, which was blocked by MG-132, and also reduced CD40L and IL-12 expression. CONCLUSIONS: This is the first report to demonstrate that bioactive surgical sutures can generate a prolonged T(H)1 immune response and expand flu-specific T cells. Bioactive sutures, which are primarily a T-cell stimulant, also stimulated other cells to secrete IL-12 and prolonged the immune response. Sutures may provide a novel in situ stimulating strategy for enhancing the immune system of cancer patients.