Monocytes, Dendritic Cells, Macrophages, T cells and Head and Neck Cancer : the effect of a thymic hormone preparation in restoring defective immune functions

It is generally accepted that cell mediated immunity (CMI) has more importance in the control of cancer than the antibody-mediated immune response. The cell mediated immune response is the basis of the so-called natural host resistance to cancer, which is also referred to as "immunosurveillance". Although the concept of immunosurveillance has been much debated over the past decades, there is now no doubt that suppression of the immune function increases the incidence of a few types of cancer. Also, spontaneous regression has been observed for some tumors, including melanoma, renal cell carcinoma, and lymphoma, and evidence for a role of immunosurveilance is well supported in these tumors. The role of a cell mediated immunosurveilance in patients with a head and neck squamous cell carcinoma (HNSCC) is less clear. Immunosuppressed patients do not develop head and neck cancer more frequently and spontanous regression is at most anecdotal. Despite this, defects of the CMI in HNSCC patients have extensively been documented. One of the first tests to reflect the status of the CMI which was found abnormal in HNSCC patients, was delayed type hypersensitivity (dth) as measured by skin reactions to ONCB- dinitrochlorobenzene). Ninetyfive percent of the normal adult popUlation react with a dth reaction towards skin-applied ONCB, however such a positive reaction is often absent in HNSCC patients. These observations have not led to a present clinical use of ONCB

Early and long-term morbidity after total laryngopharyngectomy

To determine the early and long-term morbidity of patients treated with a total laryngopharyngectomy and reconstruction using a jejunum interposition or gastric pull-up procedure. It is a retrospective study; and it is conducted in tertiairy referral center. Sixty-three patients were included in whom 70 reconstructions were performed (51 jejunum interpositions and 19 gastric pull-up procedures) between 1990 and 2007. The studied parameters were success rate of the reconstruction, early and long-term complication rate, and functional outcome including quality of life. Subjective quality of life analysis was determined by two questionnaires: the EORTC Quality of Life Questionnaire (QLQ)-C30 Dutch version 3.0, and the EORTC-Head and Neck (H & N 35). The success rates were 84 and 74%, respectively. The procedures were associated with a high complication rate (63% after jejunum interposition and 89% after gastric pull-up), and a lengthy rehabilitation. Surviving patients were found to have a good long-term quality of life. Complete oral intake was achieved in 97%, and speech rehabilitation in 95%. These procedures are associated with significant morbidity, high complication rates, lengthy rehabilitation, but a good long-term quality of life

Chemoradiation for advanced hypopharyngeal carcinoma: a retrospective study on efficacy, morbidity and quality of life

Chemoradiation (CRT) is a valuable treatment option for advanced hypopharyngeal squamous cell cancer (HSCC). However, long-term toxicity and quality of life (QOL) is scarcely reported. Therefore, efficacy, acute and long-term toxic effects, and long-term QOL of CRT for advanced HSCC were evaluated,using retrospective study and post-treatment quality of life questionnaires. in a tertiary hospital setting. Analysis was performed of 73 patients that had been treated with CRT. Toxicity was rated using the CTCAE score list. QOL questionnaires EORTC QLQ-C30, QLQ-H&N35, and VHI were analyzed. The most common acute toxic effects were dysphagia and mucositis. Dysphagia and xerostomia remained problematic during long-term follow-up. After 3 years, the disease-specific survival was 41%, local disease control was 71%, and regional disease control was 97%. The results indicated that CRT for advanced HSCC is associated with high locoregional control and disease-specific survival. However, significant acute and long-term toxic effects occur, and organ preservation appears not necessarily equivalent to preservation of function and better QOL

Adenocarcinoma of the ethmoidal sinus complex: Surgical debulking and topical fluorouracil may be the optimal treatment

Objectives: To report our experience with the management of adenocarcinoma of the ethmoidal sinuses using a regimen of surgical debulking and topical chemotherapy, to report long-term survival, and to compare our results with recently published series of patients undergoing craniofacial resection. Design: Review of prospectively collected data. Setting: Tertiary cancer center. Patients: Seventy consecutive patients with ethmoidal adenocarcinoma referred to the Department of Head and Neck Surgery, University Hospital of Rotterdam, Rotterdam, the Netherlands, between January 1976 and December 1997. Sixty-two patients were eligible for primary treatment. Interventions: Surgical debulking via an extended anterior maxillary antrostomy followed by a combination of repeated topical chemotherapy (fluorouracil) and necrotomy. Additionally 8 patients (13%) required radiotherapy for local recurrence; 1 patient required surgery for regional lymph node metastases. Main Outcome Measures: Survival measured by the Kaplan-Meier method. Clinical complications related to the therapy. Results: There were no perioperative deaths. Complications did occur, such as temporary periorbital swelling (25 patients [40%]) and temporary cerebrospinal fluid leakage (5 patients [8%]). One patient (1.6%) developed meningitis. Adjusted disease-free survival at 2, 5, and 10 years is 96%, 87%, and 74%, respectively. Conclusion: Our 23-year experience with a combination of surgical debulking and repeated topical chemotherapy for patients with adenocarcinoma of the ethmoidal sinuses leads us to believe that it represents the current treatment of choice for these patients for long-term disease-free survival

Intraoperative validation of CT-based lymph nodal levels, sublevels IIa and IIb: is it of clinical relevance in selective radiation therapy?

PURPOSE: The objectives of this study are to discuss the intraoperative validation of CT-based boundaries of lymph nodal levels in the neck, and in particular the clinical relevance of the delineation of sublevels IIa and IIb in case of selective radiation therapy (RT). METHODS AND MATERIALS: To validate the radiologically defined level contours, clips were positioned intraoperatively at the level boundaries defined by surgical anatomy. In 10 consecutive patients, clips were placed, at the time of a neck dissection being performed, at the most cranial border of the neck. Anterior-posterior and lateral X-ray films were obtained intraoperatively. Next, in 3 patients, neck levels were contoured on preoperative contrast-enhanced CT scans according to the international consensus guidelines. From each of these 3 patients, an intraoperative CT scan was also obtained, with clips placed at the surgical-anatomy-based level boundaries. The preoperative (CT-based) and intraoperative (surgery-defined) CT scans were matched. RESULTS: Clips placed at the most cranial part of the neck lined up at the caudal part of the transverse process of the cervical vertebra C-I. The posterior border of surgical level IIa (spinal accessory nerve [SAN]) did not match with the posterior border of CT-based level IIa (internal jugular vein [IJV]). Other surgical boundaries and CT-based contours were in good agreement. CONCLUSIONS: The cranial border of the neck, i.e., the cranial border of level IIa/IIb, corresponds to the caudal edge of the lateral process of C-I. Except for the posterior border between level IIa and level IIb, a perfect match was observed between the other surgical-clip-identified levels II-V boundaries (surgical-anatomy) and the CT-based delineation contours. It is argued that (1) because of the parotid gland overlapping part of level II, and (2) the frequent infestation of occult metastatic cells in the lymph channels around the IJV, the division of level II into radiologic sublevels IIa and IIb may not be relevant. Sparing of, for example, the ipsilateral parotid gland in selective RT can even be a treacherous undertaking with respect to regional tumor control. In contrast, the surgeon's reasoning for preserving the surgical sublevel IIb is that the morbidity associated with dissection of the supraspinal accessory nerve compartment of level II is reduced, whereas there is evidence from the surgical literature that no extra risk for regional tumor control is observed. Therefore, in selective neck dissections, the division into surgical sublevels IIa/IIb makes sense

Development and (pre-) clinical assessment of a novel surgical tool for primary and secondary tracheoesophageal puncture with immediate voice prosthesis insertion, the Provox Vega Puncture Set

Development and (pre-) clinical assessment were performed of a novel surgical tool for primary and secondary tracheoesophageal puncture (TEP) with immediate voice prosthesis (VP) insertion in laryngectomized patients, the Provox Vega Puncture Set (PVPS). After preclinical assessment in fresh frozen cadavers, a multicenter prospective clinical feasibility study in two stages was performed. Stage-1 included 20 patients, and stage-2 had 27. Based on observations in stage-1, the PVPS was re-designed (decrease in diameter of the dilator from 23.5 to 18 Fr.) and further used in stage-2. Primary outcome measure was immediate VP insertion without requiring additional instruments. Secondary outcome measures for comparison of the new with the traditional TEP procedure were: appreciation, ease of use, time consumption, estimated surgical risks and overall preference. A mini-max two-stage study design was used to establish the required sample size. In stage-1, dilatation forces were considered too high in patients with a fibrotic TE wall. With the final thinner version of the PVPS, VPs were successfully inserted into the TEP in 'one-go' in 24/27 (89%) of TEPs: 20 primary and 7 secondary. Participating surgeons rated appreciation, ease of use, time consumption and estimated surgical risks as better. Related adverse events were few and minor. The new PVPS appeared to be the preferred device by all participating surgeons. This study shows that the novel, disposable PVPS is a useful TEP instrument allowing quick and easy insertion of the VP in the vast majority of cases without requiring additional instruments.status: publishe

Optical image-guided cancer surgery: Challenges and limitations

Optical image-guided cancer surgery is a promising technique to adequately determine tumor margins by tumor-specific targeting, potentially resulting in complete resection of tumor tissue with improved survival. However, identification of the photons coming from the fluorescent contrast agent is complicated by autofluorescence, optical tissue properties, and accurate fluorescent targeting agents and imaging systems. All these factors have an important influence on the image that is presented to the surgeon. Considering the clinical consequences at stake, it is a prerequisite to answer the questions that are essential for the surgeon. What is optical image-guided surgery and how can it improve patient care? What should the oncologic surgeon know about the fundamental principles of optical imaging to understand which conclusions can be drawn from the images? And how do the limitations influence clinical decision making? This article discusses these questions and provides a clear overview of the basic principles and practical applications. Although there are limitations to the intrinsic capacity of the technique, when practical and technical surgical possibilities are considered, optical imaging can be a very powerful intraoperative tool in guiding the future oncologic surgeon toward radical resection and optimal clinical results