Background: In the majority of patients irradiated for early glottic cancer an abnormal voice was reported. The purpose of the study was todetermine the factors influencing voice quality after radiotherapy for T1 glottic cancer. Methods: The voices of 75 male patients irradiated for T1 glottic carcinoma were assessed subjectively and objectively by acoustic analyses and aerodynamic measurements. The laryngeal function and morphology were evaluated by videolaryngostroboscopy. The data on smoking habits, the associated diseases influencing voice quality, the extent of the tumor, the type of biopsy, and the irradiation technique were collected from the medical records. The data on the factors influencing voice quality were compared for patients with a normal/near-normal voice and those with a hoarse voice. Results: Voice quality was at least slightly abnormal in 94.7% and 81.3% of patients, when assessed perceptively and objectively, respectively. Smoking after the completed treatment, more severe morphologic alterations of the vocal folds, dryness of the throat, incomplete closure of the vocal folds and functional voice disorders expressed as supraglottic activity adversely influenced the voice quality. A good correlation between the perceptive voice assessment and the acoustic analyses was established. Conclusions: After the successful irradiation for T1 glottic carcinoma, the great majority of the patients have at least a slightly hoarse voice. A better voice outcome could be achieved if radiotherapy was followed by the patient's cessation of smokingand the appropriate voice therapy.
COBISS.SI-ID: 26211545
Purpose: To assess radiosensitivity of neck metastases of squamous cell carcinoma of the head and neck (SCCHN) by immunocytochemical profiling of fineneedle aspiration biopsy (FNAB) cell specimens. Patients and methods: Immunocytochemical reactions to p53, cyclin D1, stefin A and Ki67 were determined in FNAB cell samples of neck metastases from 21 patients treated with concomitant chemoradiotherapy and correlated to clinical characteristics and response to therapy. Results: Six (28.6%), eight (38.1%), 15 (71.4%) and nine (42.9%) FNAB cell samples were classified as p53, cyclin D1, stefin A and Ki67 positive, respectively. Statistically significant predictors of favorable nodal response to chemoradiations were p53 (P=0.025) and cyclin D1 (cytoplasmic fraction, P=0.048) negativity and Ki67 positivity (P=0.045). Regional recurrence correlated with low Ki67 immunoreactivity. A favorable profile of cyclin D1 and Ki67 (one or both of the two) further improved the predictive strength of these markers. Conclusions: FNAB is a noninvasive, simple and cheap procedure, which could serve simultaneously for diagnostic purposes and for radiosensitivity testing. Immunocytochemical determination of cyclin D1 and Ki67 in FNAB cell samples from neck metastases of SCCHN seems to be a valuable marker for predicting regional response to radiotherapy and might assist when deciding on appropriate primary therapy.
COBISS.SI-ID: 832635
Purpose: To review experiences in the treatment of regionally advanced melanoma to the neck and/or parotid with emphasis on the role of adjuvant radiotherapy. Patients and methods: Clinical and histopathologic data, treatment details, and outcomes in patients treated during the period 2000-2006 at the Institute of Oncology, Ljubljana, Slovenia, were reviewed. Results: A total of 40 patients with 42 dissections underwent surgery, and 43 patients with 45 dissections received irradiation postoperatively to a median equivalent dose (eqTD (2): 2 Gy/fraction, 1 fraction/day, 5 fractions/week) of 60 Gy (range, 47.8-78.8). Regional control 2 years after surgery was 56% (95% confidence interval [CI] 40-72%) and after postoperative radiotherapy 78% (CI 63-92%) (p=0.015). On multivariate analysis, postoperative radiotherapy (yes vs. no: hazard ratio [HR] 6.3, CI 2.0-20.6) and sum of the risk factors present (i.e., risk factor score; HR 1.7 per score point, CI 1.2-2.6) were predictive for regional control. On logistic regression testing, the number of involved nodes was associated with the probability of distant metastases (p=0.021). The incidence of late toxicity did not correlate with the mode of therapy, eqTD(2), or fractionation pattern. Conclusions: Adjuvant radiotherapy has the potential to compensate effectively for the negative impact of adverse histopatologic features to disease control in a dissected nodal basin. More conventionally fractionated radiotherapy regimens using fraction doses of 22.5 Gy, with cumulative eqTD(2)) or =60 Gy, are recommended. The number of involved lymph nodes is proposed as an additional criterion for limiting the implementation of adjuvant irradiation.
COBISS.SI-ID: 947323
Purpose: We used computed tomography (CT) perfusion to evaluate the acute and late effect of radiation therapy (RT) on spinal cord (SC) hemodynamics in patients without symptoms of myelopathy. We hypothesized that SC perfusion could be acutely altered during RT. Methods and materials: We analyzed neck CT perfusion studies of 36 head and neck cancer patients (N1), 16 of whom had previously undergone RT. In a separate group of 6 patients (N2), CT perfusion studies were obtained before RT, after 40 Gy, and after treatment completion. Results: In the N1 group, SC blood flow (BF), blood volume (BV), mean transit time (MTT), and capillary permeability (CP) maps were not significantly different between RTtreated and RTnaive patients. In the N2 group, BF and CP were significantly increased during treatment compared with the baseline and postRT studies. Conclusions: Radiation therapy of the head and neck may cause transient perturbations of SC perfusion that seem to reverse after treatment. There are no definite chronic effects of RT on SC perfusion observeable at the typical doses administered during treatment of head and neck malignancies.
COBISS.SI-ID: 947579
The RARECARE project has proposed a different and more detailed grouping of cancers, based on localisation and histological type, in order to identify rare entities with clinical meaning. RARECARE gathered data on cancer patients diagnosed from 1978 to 2002 and archived in 76 populationbased cancer registries, all of which had vital status information available up to at least 31st December 2003. This study provides incidence, prevalence and survival rates for rare head and neck epithelial (H&N) cancers. Among the rare H&N cancers, those of oral cavity had the highest annual crude incidence rate of 48 per million, followed by oropharynx and 'major salivary glands and salivary gland type tumours' (28 and 13 per million, respectively). Incidence rates of epithelial tumours of nasal cavities, nasopharynx, eye and adnexa and middle ears were all lower than 5 per million. The prevalence for all investigated entities was lower than 35 per 100,000. The 5year relative survival rates ranged from 40% for epithelial cancer of oropharynx to 85% for epithelial cancer of eye and adnexa. Survival rates were lower for men and for patients aged ≥65 years. With few exceptions, the lowest and highest survival figures were observed for Eastern Europe and Northern Europe, respectively. According to the definition for rare tumours by RARECARE (incidence(6 per 100,000), as well as according to the definition for rare diseases by the European Commission (prevalence(50 per 100,000) the H&N cancers described in this paper should be considered rare and diagnosis and treatment of these cancers should therefore be centralised.
COBISS.SI-ID: 1165947