Abstract: OBJECTIVE: To determine factors predicting the outcome after salvage surgery with microvascular flap reconstruction for recurrent squamous cell cancer (SCC) of the head and neck. STUDY DESIGN: This is a retrospective analysis of patients treated at an academic medical center. METHODS: One hundred six patients underwent salvage surgery and microvascular flap reconstruction after prior unsuccessful cancer treatment using surgery, radiation, or chemotherapy. All patients had a follow-up interval after salvage surgery of at least 24 months unless cancer rerecurrence occurred within 24 months after salvage surgery. Factors including age, sex, comorbidity level, tobacco use, alcohol use, disease-free interval since prior therapy, prior radiation, prior chemotherapy, prior surgery, recurrent tumor T class, recurrent tumor N class, recurrent cancer stage, and tumor location were examined to determine their association with cancer rerecurrence after salvage surgery. Successful treatment was defined as patients who remained free from cancer rerecurrence for a minimum 2 year period after salvage surgery. RESULTS: Advanced recurrent T class (P = .02) was significantly associated with cancer recurrence. Recurrent cancer stage and patient smoking status approached statistical significance (P = .06). CONCLUSION: Patients with recurrent T1 and T2 class are the best candidates for salvage surgery and microvascular flap reconstruction for treatment of recurrent SCC of the head and neck. Patients with T3 and T4 class recurrent cancers and patients who continue to smoke after initial diagnosis and treatment of head and neck SCC are poor candidates to undergo salvage surgery.
Abstract: The aim of this study is to identify the phenotype of resistant oral tumors, and to delineate the contribution of immune effectors to resistance of oral tumors. UCLA-1 oral tumors which were resistant to NK cell mediated cytotoxicity secreted increased amounts of IL-6, IL-1beta, GM-CSF, and IL-8 when cultured with or without immune effectors. In addition, the levels of vascular endothelial growth factor (VEGF) secretion in the co-cultures of naïve immune effectors with UCLA-1 rose significantly when compared to tumor cells alone. IL-2 activated NK cells decreased VEGF secretion in all tumor cells. However, NK cells which were induced to undergo cell death with anti-CD16 antibody were not only unable to decrease VEGF secretion, but they also contributed further to the increase in VEGF secretion by oral tumors. Overall, we show in this paper that naïve as well as non-viable immune effectors may contribute to the growth and resistance of oral tumors by triggering the secretion of key tumor cell growth factors.
Abstract: BACKGROUND: The role of fibula free flaps for reconstruction of through-and-through oromandibular defects is examined. METHODS: Thirty-four patients underwent reconstruction of through-and-through oromandibular defects using fibula free flaps that contain large, bilobed skin paddles for simultaneous reconstruction of intraoral mucosa and external skin. We examined the incidence of wound healing complications, the need for revision reconstructive surgery, and factors affecting the incidence of complications. RESULTS: Wound healing complications occurred in 50% of patients. There was a relatively high incidence of partial flap necrosis (26%) and revision surgery (41%). The area of the flap skin paddle was significantly associated with the risk of partial flap necrosis and the need for revision surgery. CONCLUSIONS: Many through-and-through oromandibular defects can be successfully reconstructed using a fibula free flap that contains a large, bilobed skin paddle. However, wound healing complications are increased when the flap skin paddle area exceeds 300 cm2.
Abstract: BACKGROUND: Adverse childhood experiences (ACE) are associated with mental illness and smoking in adulthood, but ACE has not been studied as a determinant of this comorbidity. This study was designed to examine effects of ACE on the expression of smoking behavior and mental illness in adulthood. METHODS: We examined the relationship between ACE, smoking status, and the expression of serious mental illness in adults (n = 101). Subjects were evaluated with a semi-structured interview that included psychiatric status, smoking status, substance abuse and presence and severity of ACE. Subjects were grouped into four categories based on psychiatric and smoking status: psychiatric smokers (PS), psychiatric nonsmokers (PNS), control smokers (CS) and control nonsmokers (CNS). RESULTS: ACE was associated with serious mental illness or smoking behaviors in adulthood, and to a lesser extent with co-morbid mental illness and smoking. Cumulative number of ACE was highest in the order of PS > PNS > CS > CNS. CONCLUSIONS: These preliminary results suggest an association between the presence of ACE and the expression of severe mental illness in adulthood, and possibly to comorbid smoking and mental illness. Longitudinal research using larger samples is needed to determine the causal relationship between ACE and co-morbid smoking and mental illness.
Abstract: BACKGROUND.: The outcome of patients undergoing rigid plate fixation of symphyseal mandibular osteotomies for exposure, resection, and reconstruction of tumors in the oral cavity or oropharynx was analyzed to determine the impact of hardware selection on complications. METHODS.: Forty-five patients underwent titanium plate rigid internal fixation of mandibular osteotomies during cancer resection and free flap reconstruction at an academic medical center. The incidence of hardware-related complications and mandibular nonunion was compared in patients receiving either locking hardware or nonlocking hardware. RESULTS.: The incidence of osteotomy-related complications in patients with an inferior border nonlocking mandibular fracture plate was 21%. In the patients with locking hardware or an inferior border nonlocking mandibular fracture plate combined with a tension band, there were no hardware-related complications and no mandibular nonunions. This difference was statistically significant (chi(2) = 6.01, p < .05). CONCLUSIONS.: Locking mandibular reconstruction plates are associated with fewer complications than inferior border nonlocking mandibular fracture plates for rigid fixation of mandibular osteotomies in patients undergoing resection of head and neck cancer.
Abstract: The inhibitory role of TNF-alpha on survival of naïve and IL-2 treated NK cells has been demonstrated in the past. However, its effect on the function of these cells against tumor cells, in particular against oral tumors has not been established. We investigated the significance of secreted TNF-alpha in death and functional loss of splenocytes and NK cells in ex-vivo cultures with oral tumors. Oral tumors trigger potent secretion of TNF-alpha by human and murine immune effectors. Absence of TNF-alpha increases the cytotoxic activity and secretion of IFN-gamma by IL-2 treated splenocytes and NK cells in co-cultures with MOK L2D1+/p53-/- oral tumor cells. IL-2 treated splenocytes and NK cells from TNF-alpha -/- mice survive and proliferate more when compared to cells from TNF-alpha +/+ mice. Cell death induced by F. nucleatum, an oral bacteria, in TNF-alpha -/- splenocytes are considerably lower than that induced in TNF-alpha +/+ splenocytes where potent release of TNF-alpha is reproducibly observed. Addition of exogenous rTNF-alpha to IL-2 treated splenocytes and NK cells decreased survival and function of splenocytes and NK cells obtained from TNF-alpha -/- mice against oral tumors. These findings suggest that potent induction of TNF-alpha during interaction of immune effectors with oral tumors and/or oral bacteria is an important factor in decreasing the function and survival of cytotoxic immune effectors. Strategies to neutralize TNF-alpha may be beneficial in the treatment of oral cancers.
Abstract: BACKGROUND: Salivary duct carcinoma (SDC) is an aggressive tumor of the head and neck with a poor prognosis. The objective was to study SDC and recommend the use of trastuzumab as adjuvant therapy. METHODS: A retrospective chart review of patients seen between 1993 and 2006 was performed. Tumor specimens were examined for HER-2 protein overexpression via immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) methods. RESULTS: Of the 7 patients with SDC, 57% had tumors arising in the parotid gland, the majority having facial nerve paralysis, 71% with nodal disease, and 43% having recurrence. All samples were HER-2 positive on IHC. Three patients had FISH-positive tumors, recurrent disease, and recieved trastuzumab therapy; 1 of the 3 died after 20 months and a second has shown disappearance of metastatic disease. CONCLUSIONS: Trastuzumab is effective in treating HER-2-positive breast cancer. Given immunohistochemical similarities between SDC and ductal carcinoma of the breast, patients with FISH-positive HER-2/neu SDC should be considered for trastuzumab therapy. (c) 2007 Wiley Periodicals, Inc. Head Neck 2007.
Abstract: PURPOSE: The aim of the study was to determine the sensitivity of preoperative positron emission tomography (PET) scans in the detection of primary tumors of the tonsils. MATERIALS AND METHODS: We conducted a retrospective review of 46 patients treated at a university medical center for occult tonsillar cancer during the years 2002 to 2004. We identified patients who underwent a preoperative PET scan to locate an unknown primary tumor. Fusion computed tomography with PET (PET/CT) was used to further delineate anatomic localization to the tonsil area. A positive PET/CT scan was defined as asymmetric increased tracer uptake in the tonsil and/or tonsillar fossa ipsilateral to the tonsillar cancer site when compared with the contralateral site. A negative PET/CT scan was defined as equivocal symmetric tracer uptake bilaterally. RESULTS: Of the 46 patients, 6 (13.0%) had pretreatment PET scans. Of these 6 patients, 16.7% (n = 1) had positive PET, 66.7% (n = 4) had negative PET, and 16.7% (n = 1) demonstrated increased tracer uptake in tonsils bilaterally greater on the side contralateral to the cancer. In this group, PET scans had a sensitivity of 0.167 and false-negative ratio of 0.667 for tonsillar cancer detection. CONCLUSIONS: Although the patient population in this study is small (n = 6), the findings suggest that PET/ CT scans may offer a low sensitivity in detection of primary tonsillar cancers. However, PET/CT scans still have a significant role in the detection of other unknown primary head and neck tumors. Technical reasons for this finding are discussed.
Abstract: CONCLUSION: Both CT and MRI defined the extent of histologically proven recurrent disease, although it was impossible to radiographically distinguish recurrent disease from postoperative scar tissue or mucoperiosteal thickening. OBJECTIVE: A retrospective analysis of radiographic findings of patients with known inverted papilloma (IP) was performed to identify those characteristics that should prompt preoperative biopsy in patients with polypoid nasal masses. MATERIALS AND METHODS: The radiologic studies from a group of 77 patients with biopsy-proven IP of the nasal cavity or paranasal sinuses were reviewed. Fifty-three computed tomography (CT) scans, 17 cases of plain sinus radiography and 7 cases of magnetic resonance imaging (MRI) were analyzed. RESULTS: Although no preoperative MRI examinations were available for comparison, CT was the most helpful study for evaluation of primary, nonrecurrent inverted papilloma. CT demonstrated disease-related abnormalities in 90% of studies. The finding of frequent unilateral bony remodeling was demonstrated in 43% of scans. Plain sinus X-rays were abnormal in 70% of cases of primary tumor, with all positive studies showing nonspecific unilateral opacification of the maxillary antrum.
Abstract: BACKGROUND: Conventional cancer therapy including surgery, radiation, and chemotherapy often are physically debilitating and largely ineffective in previously treated patients with recurrent head and neck squamous cell carcinoma (SCC). A natural photochemical, hypericin, could be a less invasive method for laser photodynamic therapy (PDT) of these recurrent head and neck malignancies. Hypericin has powerful photo-oxidizing ability, tumor localization properties, and fluorescent imaging capabilities as well as minimal dark toxicity. The current study defined hypericin PDT in vitro with human SCC cells before the cells were grown as tumor transplants in nude mice and tested as a model for hypericin induced tumor fluorescence and PDT via laser fiberoptics. METHODS: SNU squamous carcinoma cells were grown in tissue culture, detached from monolayers with trypsin, and incubated with 0.1 microg to 10 microg/ml of hypericin before exposure to laser light at 514, 550, or 593 nm to define optimal dose, time, and wavelength for PDT of tumor cells. The SCC cells also were injected subcutaneously in nude mice and grown for 6-8 weeks to form tumors before hypericin injection and insertion of fiberoptics from a KTP532 surgical laser to assess the feasibility of this operating room instrument in stimulating fluorescence and PDT of tumors. RESULTS: In vitro testing revealed a hypericin dose of 0.2-0.5 microg/ml was needed for PDT of the SCC cells with an optimal tumoricidal response seen at the 593 nm light absorption maximum. In vivo tumor retention of injected hypericin was seen for 7 to 10 days using KTP532 laser induced fluorescence and biweekly PDT via laser fiberoptics led to regression of SCC tumor transplants under 0.4 cm2 diameter, but resulted in progression of larger size tumors in the nude mice. CONCLUSION: In this preclinical study, hypericin was tested for 514-593 nm dye laser PDT of human SCC cells in vitro and for KTP532 surgical laser targeting of SCC tumors in mice. The results suggest hypericin is a potent tumor imaging agent using this surgical laser that may prove useful in defining tumor margins and possibly in sterilizing post-resection margins. Deeply penetrating pulsed infrared laser emissions will be needed for PDT of larger and more inaccessible tumors.
Abstract: An uncommon presentation of prostate carcinoma to the supraclavicular lymph nodes is herein reviewed. With prompt diagnosis and treatment, patient survival can be extended. A high index of suspicion is necessary to make the diagnosis. The clinical features of four cases involving metastatic prostate carcinoma will be discussed.
