Three-dimensional Doppler ultrasonography in assessing nodal metastases and staging head and neck cancer.

OBJECTIVES/HYPOTHESIS: This study built a simple prediction system by three-dimensional (3D) Doppler ultrasonography to evaluate the metastases of cervical lymph nodes and the preoperative initial stage of head and neck cancer. STUDY DESIGN: Retrospective review of cervical lymph node ultrasound features and prospective nodal staging of head and neck cancer. METHODS: One hundred thirty-nine suspicious cervical lymph nodes, receiving 3D Doppler ultrasonography, were used to establish a predictive model. Then nodal metastasis was initially staged from 27 patients with head and neck cancer by this model. RESULTS: The prediction system was constructed by major (internal matting, vascularity pattern) and minor (age ≥ 40 years, short/long ratio ≥ 0.5) sign categories. Cervical lymph node was regarded as metastasis with the presence of one major and any of the other factors. The predictive model resulted in sensitivity of 91.9%, specificity of 88.2%, and accuracy of 89.2%. Then we evaluated the initial staging of patients with head and neck cancer by this model, and the rate of correct N staging was 92.6%. CONCLUSIONS: According to this prediction system, 3D Doppler ultrasonography definitely provides a rapid and reliable method for initial staging of head and neck cancer.

MRI-derived tumor thickness: an important predictor of outcome for T4a-staged tongue carcinoma.

The objectives of this paper are to evaluate the heterogeneity of magnetic resonance imaging (MRI)-derived tumor thickness within tumors of the same T4a-staged tongue carcinoma and to elucidate the effects of tumor thickness on treatment outcomes. A sequential and prospectively maintained head and neck cancer database was retrospectively searched for newly diagnosed tongue carcinoma treated with surgery between 2003 and 2006. Fifty-eight patients with newly diagnosed T4a-staged tongue carcinoma were included in this study. Tumor thickness was obtained from preoperative magnetic resonance imaging. The mean MRI-derived tumor thickness was 22.29 mm. The patients with long tumor thickness (>26 mm) were associated with a significantly poor disease-specific survival (P = 0.015). The 2-year disease-specific survival rates were 72% in patients with short tumor thickness and only 27% in patients with long tumor thickness within the same T4a-staged disease. A substantial variation in MRI-derived tumor thickness was present within the same T4a-staged tongue carcinoma, and tumor thickness represented an important prognostic factor.

Primary tumor volume measured by FDG PET and CT in nasopharyngeal carcinoma.

BACKGROUND: The prognostic value of CT-derived primary tumor volume in patients with nasopharyngeal carcinoma (NPC) has been demonstrated in our previous serial studies. The purpose of the present study is to compare the primary tumor volume measured by FDG PET and traditional CT in NPC, and to ascertain their prognostic value. MATERIALS AND METHODS: From 2007 to 2008, 32 patients with newly diagnosed NPC were prospectively studied. All patients underwent a CT scan, followed by a FDG PET/CT scan. CT-derived primary tumor volume (VolumeCT) was measured using the summation-of-area technique. PET-volume was measured using 3 methods: delineating the contour of tumor with the threshold of standardized uptake value (SUV) ≧2.5 (Volume2.5), ≧40% of maximal SUV (Volume40%), and ≧50% of maximal SUV (Volume50%). The primary tumor volumes derived from the 4 methods, VolumeCT, Volume2.5, Volume40%, and Volume50%, were compared. Univariate Cox regression was used to identify the above parameters as prognosticators. RESULTS: The volumes derived from the VolumeCT, Volume2.5, Volume40%, and Volume50% methods were 16.48 ± 12.46 cm(3), 25.87 ± 16.96 cm(3), 13.66 ± 6.90 cm(3), and 8.25 ± 4.52 cm(3), respectively. There was decent correlation between VolumeCT and Volume2.5 (r = 0.64, P = 0.0001), and Volume2.5 was systemically larger than VolumeCT. No significant difference was noted between VolumeCT and Volume40% (P = 0.24), but the correlation was poor (r = 0.15, P = 0.39). For VolumeCT and Volume50%, the difference was significant (P = 0.0006) and the correlation was poor (r = 0.23, P = 0.20). Larger tumor volumes presented as VolumeCT, Volume2.5, and Volume50% were associated with shorter overall survival. CONCLUSION: PET-derived primary tumor volumes are substantially different from CT-derived tumor volumes, only decent correlation is noted between VolumeCT and Volume2.5. Volume2.5 and Volume50% seem to be reasonable alternatives for VolumeCT in predicting the patient outcomes.

Primary tumor volume is an independent predictor of outcome within pT4a-staged tongue carcinoma.

BACKGROUND: We evaluated the heterogeneity of primary tumor volume (PTV) within tumors of the same pT4a-staged tongue carcinoma and to elucidate the effects of PTV on treatment outcomes in patients with pT4a-staged tongue carcinoma. METHODS: Fifty-eight patients with newly diagnosed pT4a-staged tongue carcinoma who received surgery were enrolled onto this study. Magnetic resonance imaging-derived PTV was measured by the summation-of-area technique. RESULTS: The mean PTV was 24.55 ml, with a range of 5.32 to 119.64 ml. The receiver operating characteristic curve was applied, and the optimal cutoff volume was 23 ml. Large PTV was associated with a significantly poor disease-specific survival (P = 0.010) by the log rank test. The Cox regression model also revealed that large PTV (P = 0.026) and positive lymphatic node metastasis (P = 0.004) were statistically significant in the prognosis of T4a-staged tongue carcinoma. CONCLUSIONS: A substantial variation of PTV was present within the same pT4a-staged tongue carcinoma, and PTV represented an important prognostic factor. In the light of these findings, we suggest that taking the PTV into account in pT4a-staged tongue carcinoma would better refine the newest revised T classification, and the treatment strategies may be different.

Expression of bcl-2 correlates with poor prognosis and modulates migration of nasopharyngeal carcinoma cells.

BACKGROUND: The role of bcl-2 expression, bcl-2 inhibitor HA14-1, and matrix metalloproteinase (MMP)-2 is still unclear in nasopharyngeal carcinoma (NPC). METHODS: From 1996 to 2000, 145 patients with newly diagnosed NPC who were treated with high dose radiotherapy were enrolled. The relationship between bcl-2 expression, TNM stage, and disease-specific survival was analyzed. Furthermore, the NPC cell line HONE-1 was used to confirm the relationship between bcl-2 and cell metastasis. RESULTS: Among the 145 patients, 47 (32.4%) of them were bcl-2 positive. The expression of bcl-2 was significantly correlated with neck lymph node metastasis (p=0.006), and patients with negative bcl-2 expression had better disease-free survival (p=0.007). A Cox regression model revealed that only bcl-2 expression (p=0.023) and stage IV (p=0.043) were statistically significant in the prognosis of NPC. In vitro analysis also showed that treatment with the bcl-2 inhibitor HA14-1 exerted an inhibitory effect on migration and expression of MMP-2 in HONE-1 cells. CONCLUSIONS: Bcl-2 expression represents an important and easily assayed prognostic factor, and it may play an important role in lymph node metastasis. Inhibition of the migration mediated by MMP-2 may be a key feature for the prevention of cancer metastasis.

Symptoms treatment for allergic rhinitis using diode laser: results after 6-year follow-up.

Allergic rhinitis is a very common chronic disease. The purpose of this study was to measure the outcome of treating allergic rhinitis with diode laser, over a long-term follow-up of 6 years. Forty-two consecutive patients with newly diagnosed allergic rhinitis that was refractive to conservative medical therapies were enrolled in the study. Treatment was with a diode laser (wavelength 805 nm, laser parameter 12 W, in 'contact' mode) under local anesthesia between September 1999 and May 2000. A quality of life questionnaire was used after a follow-up period of 6 years to assess the outcome of diode laser surgery. All 42 patients suffered from either perennial or persistent-type allergic rhinitis. Twenty-five out of 42 patients (60%) replied to the questionnaire 6 years after laser surgery. The mean operation time was 1 min 28 s for each patient. No complications were observed (e.g., major bleeding), and no nasal packing was necessary. Statistical analysis revealed significant improvements in symptom score, medication score and total score 6 years after laser surgery. A total of 60% of the patients described improvements in symptom scores, and 68% of the patients described improvements in total score 6 years after laser treatment. It was evident that the effectiveness of laser surgery persisted through the 6 years of follow-up. Long-term follow-up after 6 years confirmed that diode laser surgery for allergic rhinitis is a useful procedure that has a long-lasting effect and can be performed in an outpatient surgery under local anesthesia. Minimal discomfort, long-term effectiveness and short operation time are other reasons why this treatment should be selected for patients with allergic rhinitis that is refractive to conservative management.

Prognostic impact of bcl-2 expression on advanced nasopharyngeal carcinoma.

BACKGROUND: Our aim was to evaluate the prognostic impact of bcl-2 expression on patients with advanced nasopharyngeal carcinoma (NPC). METHODS: One hundred five patients with advanced NPC treated with high-dose radiotherapy were included. The relationship between bcl-2 expression, TNM stage, and disease-specific survival was analyzed. RESULTS: Within the same stage III and IV, patients with negative bcl-2 expression had better disease-free survival. The disease-free survival of patients with stage IV NPC with negative bcl-2 expression was paradoxically better than that of patients with stage III NPC with positive bcl-2 expression. In the advanced NPC, the disease-free survival of patients with stage III cancer was better than that of patients with stage IV cancer (p = .06); in contrast, patients with bcl-2-positive tumors had a worse disease-free 5-year survival (p = .02). The Cox regression model revealed that only bcl-2 expression was statistically significant (p = .03). CONCLUSION: In advanced staged NPC, bcl-2 expression represented an important prognostic factor.