Radiation Induced Sarcoma of Hypopharynx: A Case Report

Radiation-induced sarcoma in the head and neck is a long term rare complication of radiation therapy. The incidence of these sarcomas is, however, likely to increase due to progressive aging of the population combined with improved survival in head and neck cancer patients resulting from better treatment regimes. Diagnosis and management of this problem can be extremely challenging and the overall prognosis of radiation-induced sarcoma is worse than other types of sarcomas at a similar stage. Because of the proximity to vital structures and multifocality, management can be extremely difficult in many cases. This is the case of post radiation sarcoma of the hypopharynx radiated for supraglottic laryngeal carcinoma previously. Here, we wish to share the diagnosis and management strategy in these types of late complications after radiation

New insights into photodynamic therapy of the head and neck

Photodynamic therapy (PDT) is a young method, which uses a combination of a light sensitive substance (photosensitizer) and visible light, to treat tumors. This thesis analyses the clinical efficacy of PDT in the head and neck area and introduces methods to improve the clinical results and broaden the treatment spectrum. The second chapter demonstrates that PDT is comparable to surgery of the early stage tumors of the oral cavity. The third chapter analyses the treatment success of PDT with regards to tumor location, size and previous treatments. Chapters 3-6 describes a new non-invasive spectroscopic method, fluorescence differential pathlength spectroscopy (FDPS), which gives information about two major components of PDT: oxygen and photosensitizer concentration in treated tissues. By incorporating FDPS into clinical practice it is possible to detect correctable errors during PDT, which potentially will result in improvement of the treatment. Chapters 7 and 8 introduces a treatment method to treat larger tumors using PDT. One of the limitations of PDT is that light can penetrate a limited distance into tissues. By implanting light sources in the tumors (interstitial PDT (iPDT)) this limitation can be overcome. Early experiences with this method is promising. A new treatment protocol to standardize iPDT is described in this thesis

Hoarseness and laryngopharyngeal reflux: a cause and effect relationship or coincidence?

WOS: 000240396200010PubMed: 16816932The role of laryngopharyngeal reflux (LPR) on hoarseness is widely assumed and accepted. Few articles present objective information on the subject. One of the main problems in establishing a relationship is our lack of knowledge of what is normal. We compared patients with chronic hoarseness and healthy controls to establish three goals: (1) to demonstrate the presence of additional symptoms and signs of LPR in patients with hoarseness; (2) to find the prevalence of LPR by utilizing 24 h double-probe in patients with hoarseness and compare it with that of the control group; (3) to contribute data to establish prevalence of LPR in healthy population. Forty-three patients with hoarseness and 20 healthy volunteers were enrolled in the study. All the patients in the study group had hoarseness of more than 3 months duration. The subjects recieved videolaryngoscopic evaluation and 24 h double-probe pH monitoring, and the results were compared. In the study group, 27 patients (62.8%) out of 43 had LPR episodes, compared to 6 (30%) of 20 healthy volunteers. Mean number of LPR episodes recorded by the pharyngeal probe was 7.0 [standard deviation (SD): 8.8] in 24 h, and this was significantly higher than that of the healthy controls [0.9/24 h (SD: 1.9)] (P = 0.003). Mean number of LPR episodes of the study group in upright position was 5.8 (SD: 7,0) and in supine position was 1.2 (SD: 3.3). These numbers were also significantly higher from the controls (P = 0.005 and P = 0.014 respectively). The results of this study show that: (1) most common additional symptoms were heartburn and chronic throat clearing and most common finding is pachydermia; (2) LPR incidence in patients with chronic hoarseness is significantly higher than the LPR incidence in healthy controls; (3) LPR is present in healthy people. However, the severity of LPR seems to be the causative factor rather than its presence

Local control of primary oropharyngeal malignant melanomas with limited tissue excision: a report of three cases

WOS: 000227443000002PubMed: 15455245Mucosal malignant melanomas are rare lesions, and they have different characteristics from their cutaneous counterparts. Since extended excisions of mucosal malignant melanomas located in the oropharyngeal region cause significant morbidity, limited surgical excision comes into consideration. Three cases of extensive oropharyngeal malignant melanomas were resected with 0.5-1.5-cm healthy tissue margins. The cases were followed for local recurrences. Case 1 applied radiotherapy and chemotherapy in addition to immunotherapy, and the patient is still alive without any local recurrences 18 months after surgery. The patient in case 2 underwent radiotherapy and immunotherapy and died 6 months after surgery. The patient in case 3 received chemotherapy in addition to immunotherapy and died 12 months after surgery as a result of distant metastasis. All cases were without any local recurrences. Surgical excision with limited tumor-free tissue margins may be the surgery of choice to prevent morbidity associated with wide resection of oropharyngeal malignant melanomas if other authors also reconfirm these results with many more cases in the future

Feasibility of salvage selective neck dissection after primary irradiation of pharyngeal and laryngeal carcinoma

Introduction: The concept of neck dissection (ND) in the management armamentarium of head and neck squamous cell carcinoma has evolved throughout the years. Nowadays, ND becomes more functional. Methodology: A retrospective study of 865 patients was performed at Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital to investigate the feasibility of selective ND (SND). All patients with squamous cell carcinoma of the pharynx and larynx who received primary radiation and underwent salvage ND were included in the study. Result: A total of 29 NDs were analyzed. In 17 neck sides, viable metastases were found (58%), whereas in the other 12 specimens there were no viable metastases. In 16 of the 17 necks (94%), the metastases were located either in level II, III, or IV or in a combination of these 3 levels. Level V was involved in only 1 case (6%). Conclusion: It is well justified to perform a salvage SND (levels II, III, and IV) for pharyngeal and laryngeal carcinoma after primary radiation. In carefully selected cases of supraglottic and oropharyngeal carcinoma, a superselective ND also appears as an efficient option

Adjuvant photodynamic therapy in head and neck cancer after tumor-positive resection margins

ObjectiveIn case of close or positive resection margins after oncological resection in head and neck surgery, additional treatment is necessary. When conventional options are exhausted, photodynamic therapy (PDT) can play a role in achieving clear margins. The purpose of the current study was to evaluate the clinical benefit of PDT as adjuvant therapy next to surgery with positive resection margins. The role of the time interval between surgery and PDT on survival outcomes also was investigated. Study DesignRetrospective cohort analysis. MethodsAdjuvant PDT was performed in patients with a malignancy in the head and neck region with close or positive resection margins who were not eligible for conventional treatment options. The primary endpoint was progression-free survival. Secondary endpoints were disease-free survival, overall survival, and optimal time interval between surgery and PDT. ResultsFifty-four patients were treated with surgery followed by meta-tetrahydroxyphenylchlorin-mediated PDT. There was a large diversity in tumor location and histopathology, as well as in time interval between surgery and PDT. The 2-year progression-free survival rate was 30%; 2-year disease-free survival rate was 28%; and 2-year overall survival was 51%. Disease-free survival was significantly better when the time interval between surgery and PDT was 6 weeks (P = 0.02). ConclusionPDT can be applied as adjuvant therapy after surgery in cases of a malignancy with close or positive tumor resection margins. However, the clinical benefits are yet to be determined. There is a significantly better disease-free survival with a time interval between surgery and PDT of minimal 6 weeks. Level of Evidence4. Laryngoscope, 128:657-663, 201