Resolution of pain and complete healing of mandibular osteoradionecrosis using pentoxifylline and tocopherol: a case report.

The radiation-induced fibroatrophic process (RIF) is a time-dependent adverse sequela to high-dose radiotherapy that can result in irreversible tissue death and bone exposure in the irradiated tissue. Osteoradionecrosis (ORN) is a late effect of RIF, described as bony exposure present for more than 3 months that can occur in 20% of patients irradiated for head and neck cancer. The intractable characteristics of ORN make both management and resolution of the disease process challenging, with 25% of cases recurring despite aggressive treatment with resection and reconstruction of the necrotic bone. In this article, we present a case of a 66-year-old man with unevoked ORN of the left posterior lingual mandibular cortex that was successfully treated and resolved with 6 months of pentoxifylline 400 mg twice a day and tocopherol 1000 IU every day.

Swallowing function after transoral laser microsurgery (TLM) ± adjuvant therapy for advanced-stage oropharyngeal cancer.

OBJECTIVES/HYPOTHESIS: To perform a longitudinal description of swallowing function following transoral laser microsurgery (TLM) ± adjuvant therapy for advanced-stage oropharyngeal cancer (OPC) and identify prognostic factors associated with swallowing performance. STUDY DESIGN: Retrospective analysis and longitudinal descriptive study of swallowing outcomes. METHODS: Patients treated with TLM for AJCC stage III-IV OPC at Washington University from 1996 to 2008 were included. A search of medical records and direct patient contact were performed to obtain swallowing function at multiple time points. Persistently poor swallowing at 2 year after surgery was the primary outcome measure. Two year swallowing outcomes stratified by tumor site and T stage are presented. RESULTS: One hundred eighteen patients met criteria for the study (median follow-up 53.9 months). There were 44 T1's, 41 T2's, 23 T3's and 10 T4's. Forty seven percent received radiotherapy and 41% received chemoradiotherapy. Ninety-eight percent underwent neck dissection. Patients tolerated TLM well with 82% enjoying good swallowing at 1 month after surgery. During adjuvant therapy, at 3 months, good swallowing dropped to 55%. At 1 and 2 years after TLM, 89% and 88% of patients had good swallowing function, respectively. At 2 years, 9 patients had persistently poor swallowing function. 93% of patients with T1 through T3 enjoyed good swallowing at 2 years. T4 base of tongue disease was associated with persistently poor swallowing function in multivariate analyses (P = 0.0023), with 40% having good swallowing at 2 years. Preexisting comorbidities and conversion to an open procedure were associated with delayed return of swallowing function, but not with persistently poor swallowing. Seven patients developed late-onset swallowing dysfunction. CONCLUSIONS: Treatment of advanced stage OPC with TLM ± adjuvant therapy results in excellent swallowing outcomes for patients with either T1 to T3 tonsil or T1 to T3 base of tongue resections. A detailed, longitudinal swallowing profile is presented to assist in preoperative counseling.

Positron emission tomography scan to determine the need for neck dissection after chemoradiation for head and neck cancer: timing is everything.

UNLABELLED: We present a case of a negative positron emission tomography (PET) scan in a patient with pathologic viable cancer at neck dissection. STUDY DESIGN: Case Report. METHODS: A 69-year-old man presented with clinical stage T2N2c squamous cell cancer of the left tonsil and was treated with definitive chemoradiation. Left-sided adenopathy decreased but remained palpable after therapy. RESULTS: PET scan performed 23 days after completion of treatment showed no suspicious uptake in the left neck. Neck dissection performed at 2 months post-therapy revealed viable tumor in left cervical nodes. CONCLUSIONS: Persistent adenopathy after chemoradiation for head and neck cancer remains a clinical dilemma. A negative PET scan is accurate but only if the scan is performed 3 to 4 months after therapy.

[Results of a prospective randomized trial with induction chemotherapy for cancer of the oral cavity and tonsils]. / Primäre Chemotherapie bei Mundhöhlen- und Tonsillenkarzinomen. Ergebnisse einer prospektiv randomisierten Studie.

Although induction chemotherapy administered prior to local therapy produces encouraging initial response rates in head and neck cancer, randomized studies have failed to demonstrate an improvement in survival rates. All randomized studies included only patients with advanced stage III and IV disease. In our opinion, this is the main reason for the low rate of complete responses demonstrated in the randomized trials (maximum 18%). Frei et al. estimate that a 40%-50% complete response rate is necessary before improved survival rates are seen. To date, such complete response rates with induction chemotherapy have only been attainable in resectable T2-T3, N0-N2 disease. Therefore, we initiated a prospective randomized trial including only patients with the mentioned disease stages. Patients (pts) were randomized to receive either induction chemotherapy with three cycles of carboplatin/5-FU prior to surgery and radiotherapy (arm A, 70 pts) or standard treatment with surgery and radiotherapy (arm B, 74 pts). Patients were classified according to primary tumour site and neck disease. The observed remission rate after chemotherapy confirmed the primary estimated rate for this subgroup of patients with head and neck cancer (CR: 43%, PR: 37%, NR: 15%, PD: 5%). After a follow-up of 12-96 months overall survival was 58% in arm A and 45% in arm B (n.s.). Disease-free survival in arm A (61%) is statistically significantly better than in arm B (43%, P=0. 03). Therefore, we recommend further controlled trials to investigate the role of induction chemotherapy in patients with primary resectable carcinomas of the oral cavity and tonsils and stage T2-T3 and N0-N2 disease prior to surgery.

[Adjuvant treatment of patients with neoplastic lesions using the combination of a vitamin complex and an amino acid. Apropos of a series of 17 cases of epidermoid carcinoma of the upper aerodigestive tract]. / Traitement adjuvant de sujets atteints de lésions néoplasiques par l'association d'un complexe vitaminique et d'un acide aminé. A propos d'une série de 17 carcinomes épidermoïdes des voies aérodigestives supérieures.

The aim of the work reported here was to evaluate the effects of an adjuvant treatment composed of an association of vitamins with an amino acid: beta-alanine, in cancer patients. This adjuvant therapy has been given to 17 subjects with a squamous cell carcinoma of upper aerodigestive tract treated by radiotherapy most cases were T3 (according to the TNM-UICC). After a 63 months follow-up, 7 patients are alive and sterilized, 4 are alive but no sterilized, 2 died, 4 were excluded from the study. Besides a physical comfort improved in all our patients, we note a restoration of the immune defenses, both humoral and cellular, disturbed by radiotherapy. At last, we note an increase of survival in the patients treated by the adjuvant therapy, compared to a reference population of patients with squamous cell carcinoma of upper aerodigestive tract. Despite the limits of the study, it was interesting to report the positive effects of the therapeutical association, vitamins and beta-alanine, after a combined radio-surgical treatment of patients with squamous cell carcinoma of upper aerodigestive tract.

[Experiences with intratumor application of bleomycin-oil suspension (BOS) in cancers of the mouth, oropharynx and maxillary sinus]. / Erfahrungen mit intratumoraler Applikation von Bleomycin-Ol-Suspension (BOS) bei Karzinomen der Mundhöhle, des Oropharynx und Sinus maxillaris.

Bleomycin can be administered intravenously, intramuscularly and also locally into the tumor. Bleomycin in oil suspension (BOS) remains longer in the tumor-region with higher levels. In 6 patients with squamous cell carcinomas of the mouth, oropharynx and maxillary sinus, the intratumorous BOS-therapy was performed. The maximum dosage given was 180 mg. The results included: Progression (1), no-response (2), minor response (2), partial remission (1).

Kinetically-based multiple drug treatment for advanced head and neck cancer.

A multiple drug regimen was given to 36 patients with advanced carcinomas of the head and neck. In 19 of the 24 patients who were assessable the tumour regressed more than 50%; in one it regressed by 25%; and in four it did not respond at all. Multiple drug chemotherapy should be given much earlier in the course of these cancers, preferably as an adjuvant to surgery or radiotherapy.