Inoperable oropharyngeal carcinoma treated with concomitant irradiation, mitomycin C and bleomycin - long term results.

Patients with inoperable head and neck tumors were treated concomitantly with radiochemotherapy with mitomycin C and bleomycin in our prospective randomized clinical trial (1991- 1993). For the subgroup of patients with oropharyngeal carcinoma the results with radiochemotherapy were significantly superior to irradiation alone. Such scheme of treatment was then adopted as standard method. Here we present the long-term results and dose- response relationships in patients with inoperable oropharyngeal carcinoma treated by the same radiochemotherapy scheme till 1997. Ninety-five patients with stage III and IV inoperable oropharyngeal squamous cell carcinoma were treated with curative intent, concomitantly with supra-voltage irradiation 2 Gy/day 5 times weekly to 60-73 Gy, bleomycin 5 mg 2 times weekly and. one application of mitomycin C 15 mg/m(2) after 10 Gy. Logistic dose- response curve was calculated. Median follow-up was 85 months. The loco-regional control, disease- free survival and overall survival at 5 years were 55%, 51% and 32% (95% CI: 44-67%, 41-62%, 22-42%), respectively. The probability of new primary malignancy at 5 years was 23%. In multivariate analysis performance status, biological equivalent dose, dose of bleomycin, and stage were identified as independent prognostic factors for loco-regional control, disease-free, and overall survival. Th gamma-value of dose response curve was 2.86. The outcome of the disease was directly proportional to intensity of irradiation and chemotherapy. It appears that in our concomitant radiochemotherapy MiC increased radioresponsiveness of the tumor by its effect on hypoxic fraction.

Autofluorescence imaging in the diagnosis of laryngeal cancer.

Differences in autofluorescence (fluorescence without photodynamic drugs) between normal and malignant tissues offer new possibilities in detecting and localizing early laryngeal carcinoma. Autofluorescence imaging was performed using a modified fluorescence endoscopy system from Xillix Technologies (Richmond, Canada). Fluorescence was induced by blue light at 442 nm and captured by an image-intensified camera through a laryngeal telescope. The images were then processed by the system and displayed on a video monitor. Normal tissue appeared green while malignant sites appeared reddish-brown. The autofluorescence imaging technique was compared to standard microlaryngoscopy in 108 patients with laryngeal pathologies (in 74 of whom malignancy was suspected). The acquired reflectance and fluorescence images of each lesion were assessed independently as malignant or not malignant by three ENT specialists who were familiar with the procedure but were not provided with clinical data or histopathological information concerning the lesion. The assessments of pathology were determined from the two imaging modalities and were compared to histopathological findings of the biopsy specimens taken from the lesion. The present study showed that autofluorescence imaging can be a useful complementary method to microlaryngoscopy for detecting and delineating laryngeal malignancies. If in the future, the device can be developed for use in an outpatient office, a significant improvement can be made for the early detection of laryngeal malignancies.

Estimation of arterial CO2 partial pressure by measurement of tracheal CO2 during high-frequency jet ventilation in patients with a laryngectomy.

Tracheal and arterial CO2 partial pressures were measured simultaneously in 27 laryngectomized patients both while they were awake and during high-frequency jet ventilation. Tracheal gas was sampled during brief interruptions of high-frequency jet ventilation. Agreement between tracheal and arterial CO2 partial pressures was assessed using the Bland-Altman method. The tracheal-arterial CO2 partial pressures gradient during spontaneous breathing was significantly lower (P < 0.0002) than during high-frequency jet ventilation. During spontaneous ventilation, the bias was -0.77 kPa (95% CI = -0.99 to -0.55 kPa), and the upper and lower limits of agreement were 0.29 kPa (95% CI = -0.11 to -0.7 kPa) and -1.83 kPa (95% CI = -2.24 to -1.43 kPa). During high-frequency jet ventilation, the bias was -1.61 kPa (95% CI = -1.76 to -1.46 kPa), and the limits of agreement were -0.48 kPa (95% CI = -0.75 to -0.21 kPa) and -2.74 kPa (95% CI = -3.01 to -2.47 kPa). Despite the poor agreement between tracheal CO2 partial pressure and arterial CO2 partial pressure, it is sufficient to allow for adjustment of ventilator settings during jet ventilation.

Laser induced fluorescence in diagnostics of laryngeal cancer.

Differences in autofluorescence between normal and malignant tissues offer new possibilities for detecting and localizing early laryngeal carcinomas. In the present study imaging was performed using a specially designed device that exploits differences in fluorescent properties of normal and cancerous tissues without photodynamic drugs. Fluorescence was induced by helium-cadmium laser, captured by an image-intensified camera and displayed on a video monitor after previous computerization. 40 patients were evaluated, of whom 20 had suspect malignancies. Laryngoscopic appearances during standard microlaryngoscopy, fluorescence images and computerized fluorescence intensities were compared to histopathological findings. The experience from this study shows that autofluorescence laryngoscopy may be a useful complementary method for detecting laryngeal malignancies.

Detection and localization of early laryngeal cancer with laser-induced fluorescence: preliminary report.

Differences in autofluorescence between normal and malignant tissues offer new possibilities for detecting and localizing early laryngeal carcinomas. In the present study imaging was performed using a specially designed device that exploits differences in fluorescent properties of normal and cancerous tissues without photodynamic drugs. Fluorescence was induced by a helium-cadmium laser, captured by an image-intensified camera and displayed on a video monitor after previous computerization. Thirty patients were evaluated, of whom 18 had suspect malignancies. Laryngoscopic appearances during standard microlaryngoscopy were compared to fluorescence images, computerized fluorescence intensities and histopathological findings. The experience from this study shows that autofluorescence laryngoscopy may be a useful complementary method for detecting laryngeal malignancies.

A simple and inexpensive method for laryngeal photography with the operating microscope.

After a brief review of the history of laryngeal photography, a simple and inexpensive method as used at the ENT Clinic of Ljubljana is described. The equipment consists of a standard 35 mm Olympus OM-1 camera attached to the Olympus of OME-J operating microscope and an Olympus T-32 flash unit connected via a large bore flexible light cable to a specially designed laryngoscope. With the equipment described excellent photographs can be obtained even in inexperienced hands without interference with endoscopic procedures.