Sub-50 fs pulses around 2070 nm from a synchronously-pumped, degenerate OPO,” Opt

Abstract: We report generation of 48 fs pulses at a center wavelength of 2070 nm using a degenerate optical parametric oscillator (OPO) synchronously-pumped with a commercially available 36-MHz, femtosecond, mode-locked, Yb-doped fiber laser. The spectral bandwidth of the output is ~137 nm, corresponding to a theoretical, transform-limited pulse width of 33 fs. The threshold of the OPO is less than 10 mW of average pump power. By tuning the cavity length, the output spectrum covers a spectral width of more than 400 nm, limited only by the bandwidth of the cavity mirrors. Griebner, "175 fs Tm:Lu 2 O 3 laser at 2.07 µm mode-locked using single-walled carbon nanotubes," Opt. Express 20(5), 5313-5318 (201

Messages from completed randomized trials in head and neck cancer

During the last three decades numerous randomized trials have been conducted in head and neck squamous cell carcinoma. The issue of pre- vs post-operative radiotherapy in advanced cancers was settled in the late 70s in favour of the latter approach and new fractionation schemes are currently being investigated, with no definite answers as yet. There is no uniform policy regarding the problem of elective neck dissection in early stage anterior oral cavity carcinoma. Often some chemotherapeutic regimen is involved in clinical trials in an attempt to improve on the standard of surgery and radiotherapy. Neoadjuvant chemotherapy has never been proven to benefit patients with advanced squamous cell carcinoma of the head and neck despite being able to decrease the rate of distant metastases. Chemotherapy given prior to or simultaneously with definite radiotherapy seems to offer the best chances for preserving vital organs, such as the larynx. Methotrexate is still the least toxic and most potent drug in recurrent or metastastic disease. The chemoprotective effect of low-dose isotretinoin on multiple primaries in the head and neck has yet to be evaluated

Discontinuous vs In-Continuity Neck Dissection in Carcinoma of the Oral Cavity

• We compared the results of transoral excision of the primary tumor with discontinuous neck dissection with the results of in-continuity dissection of primary tumor and neck nodes in anteriorly localized squamous cell carcinoma of the oral cavity. We analyzed 27 patients who underwent 28 discontinuous dissections and 34 patients who underwent 40 in-continuity dissections for T2 anterior tongue or floor-of-mouth carcinoma. The overall ipsilateral neck recurrence rate was 11%. The discontinuous dissection group did significantly worse than the in-continuity dissection group, with a neck recurrence rate of 19%. Consequently, the actuarial 5-year survival of patients who underwent a discontinuous dissection was substantially decreased (63%) compared with patients who were treated by an in-continuity dissection (80%). Discontinuous neck dissection, thus, is not to be recommended in oral cancer. (Arch Otolaryngol Head Neck Surg. 1991;117:1003-1006

Laryngeal suspension and upper esophageal sphincter myotomy as a surgical option for treatment of severe aspiration

Severe aspiration remains a difficult condition to treat without sacrificing the laryngeal functions of respiration and phonation. Upper esophageal sphincter (UES) myotomy as a sole treatment proves to be insufficient in many cases. Deglutative laryngeal elevation can be considered the most important factor responsible for opening of the esophageal inlet during deglutition. Therefore, a combination of laryngeal suspension procedure and a UES myotomy may be an alternative for treatment of severe aspiration without separating the airway and alimentary tract. Laryngeal suspension has in the past been proposed as a reconstructive procedure in major ablative surgery involving the floor of the mouth and the hyoid. Ten patients with severe aspiration and insufficient laryngeal elevation and constrictor pharyngeal muscle activity during deglutition were surgically treated with a laryngeal suspension procedure and upper esophageal sphincter myotomy. Five of the 10 patients had a good result, enabling them to have an oral intake sufficient to fulfill their nutritional needs. Two other patients have improved after the procedure, but are still dependent on gastrostomy feeding. Three patients eventually underwent a total laryngectomy, 2 of them after initial successful prevention of aspiration. In these 2 cases, aspiration recurred as a result of progression of the muscular disease. Life-threatening aspiration can often successfully be corrected by UES myotomy and laryngeal suspension. After a high initial success rate, long-term overall success can be anticipated in approximately 50% of the cases because of relapses in some patients caused by progression of underlying diseases

Screening for distant metastases in patients with head and neck cancer

Objectives The detection of distant metastases at initial evaluation may alter the selection of therapy in patients with head and neck squamous cell carcinoma (HNSCC). In this study the value of screening for distant metastases is evaluated. Study Design Retrospective analysis. Methods The results of screening for distant metastases were retrospectively analyzed in 101 consecutive HNSCC patients with high-risk factors who were scheduled for major surgery. All patients had computed tomography (CT) scan of the thorax, bone scintigraphy, examination of the liver by ultrasound and/or CT scan, and blood tests. Results Distant metastases were found in 17% of the patients. Patients with four or more clinical lymph node metastases or low jugular lymph node metastases had the highest incidence of distant metastases (33%). CT scan of the thorax detected in 12 patients, lung metastases; in 4, mediastinal lymph node metastases; and in 2, primary lung tumors. Bone scintigraphy detected in four patients bone metastases; in all four patients lung or mediastinal lymph node metastases were also found. Ultrasound and/or CT scan of the liver revealed one patient with metastases. Blood tests did not show any significant difference between patients with or without bone or liver metastases. Conclusions Screening in patients with three or more lymph node metastases, bilateral lymph node metastases, lymph nodes of 6 cm or larger, low jugular lymph node metastases, locoregional tumor recurrence, and second primary tumors revealed distant metastases in 10% or more. CT scan of the thorax is currently the single most important diagnostic technique for screening of distant metastases

Cervical necrotizing fasciitis with thoracic extension after total laryngectomy

Cervical necrotizing fasciitis (CNF) with thoracic extension is rare. It has never been reported in laryngectomized patients. A case of fatal CNF in a laryngectomized patient equipped with a voice prosthesis is presented. Diagnosis and treatment are discussed. CNF with thoracic extension was diagnosed on clinical picture, computed tomography (CT) and biopsies were taken just above the tracheostoma. Antibiotic treatment was started and extensive debridement of the affected tissues performed. A minor extension to the left pleura was considered irresectable. Irradical debridement and the impossibility of administering hyperbaric oxygen therapy caused death within two day after presentation. CNF is a rare disease and to our knowledge, has never been reported after total laryngectomy. This case emphasizes the need for early antibiotic treatment and radical surgical resection of the affected tissues

External validation of a risk group defined by recursive partitioning analysis in patients with head and neck carcinoma treated with surgery and postoperative radiotherapy

Background. Several clinical trials have proved that concurrent chemoradiotherapy is more efficacious than radiotherapy alone among high-risk patients with head and neck squamous cell carcinoma (HNSCC) who undergo surgery. A risk-group classification defined according to a recursive partitioning analysis (RPA) for these patients has been recently proposed. The objective of the present study was to carry out an external validation of this RPA-derived classification system. Methods. A retrospective study of 442 HNSCC patients treated with surgery and postoperative radiotherapy was conducted. The external validity of the RPA-derived classification system was assessed, and its ability to stage patients and to predict locoregional control of the disease was compared with the TNM system. Results. The RPA-derived classification system succeeded in obtaining a monotonic prognosis gradient in locoregional control of the disease with increasing stage, and achieved greater differences in survival between stages than the TNM and pTNM classifications. Besides, the RPA method had a better homogeneity of the categories included in each stage, and in the heterogeneity between stages. Conclusions. The RPA-derived classification system allowed for the clear definition of prognostic groups in surgically treated HNSCC patients, improving the prognostic capacity of the TNM and pTNM classifications. The RPA-derived classification system is a useful tool in the definition of patients who, given a poor prognosis, should be considered candidates to adjuvant chemoradiotherapy

Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma

Background. The incidence of distant metastases in head and neck cancer patients is rising because of greater locoregional control of the disease. Methods. The relative risks for having distant metastases as first site of failure relative to the regional lymph node involvement were determined. Results. The overall incidence was 10.7%, with a clear relationship between the number of involved lymph nodes and extranodal spread on one hand, and distant spread on the other hand. The group with histopathologic presence of disease in the neck had twice as much distant metastases as did those with histopathologic absence (13.6% versus 6.9%). Patients with more than three histologically positive lymph nodes were most at risk for having distant metastases (46.8%). The presence of extranodal spread meant a threefold increase in the incidence of distant metastases, compared with patients without this feature (19.1% versus 6.7%). Conclusions. Patients with three or more positive nodes and with extranodal spread may benefit from adjuvant systemic therapy

Recurrence at the primary site in head and neck cancer and the significance of neck lymph node metastases as a prognostic factor

Background. Biologic aggressiveness of head and neck carcinoma is reflected in its capability to metastasize to regional lymph nodes and its propensity to recur after treatment. Methods. The authors report on 244 patients treated at the Department of Otolaryngology‐Head and Neck Surgery of the Free University Hospital, Amsterdam, The Netherlands, with excision of primary tumor with incontinuity neck dissection with or without postoperative radiation therapy between January 1973 and July 1986. All patients had surgical margins free of tumor. Results. The overall recurrence rate was 12.3%. Stages T3–4 and the presence of more than three positive nodes on histopathologic examination were associated with a 16.2% and 26.2% incidence in recurrence at the primary site, respectively. No prognostic influence arose from primary tumor localization, three or fewer positive nodes, extranodal spread, and postoperative radiation therapy. Conclusions. Patients with T3–4 disease and those with more than three positive lymph nodes may benefit from novel adjuvant treatment modalities