[Radiosensitivity and/or radioresistance of head and neck cancers: Biological angle]. / Radiosensibilité et/ou résistance des cancers ORL: aspects biologiques.

Radiation therapy is a cornerstone of head and neck cancer management. Technological improvements in recent years in radiation therapy, with intensity-modulated techniques, reinforce even more its role. However, both local and locoregional relapses are still observed. Understanding biological mechanisms of treatment resistance is a topic of major interest. From the cancer cell itself, its ability to repair and proliferate, its microenvironment and oxygenation conditions, migratory and invasive capacity, to biological parameters related to the patient, there are many mechanisms involving radiosensitivity and/or radioresistance of head and neck cancer. The present study explores the main biological mechanisms involved in radiation resistance of head and neck cancer, and describes promising therapeutic approaches.

Pharmacotherapy for adverse events reduces the length of hospital stay in patients admitted to otolaryngology ward: a single arm intervention study.

BACKGROUND: To determine whether adverse events extend the duration of hospitalization, and to evaluate the effectiveness of medical intervention in ameliorating adverse events and reducing the prolonged hospital stay associated with adverse events. METHODS: A single arm intervention study was conducted from October 2012 to March 2014 in the otolaryngology ward of a 614-bed, university-affiliated hospital. Adverse events were monitored daily by physicians, pharmacists and nurses, and recorded in the electronic medical chart for each patient. Appropriate drug management of adverse events was performed by physicians in liaison with pharmacists. The Kaplan-Meier method was used to assess the length of hospitalization of patients who underwent medical intervention for adverse events. RESULTS: Of 571 patients admitted to the otolaryngology ward in a year, 219 patients (38.4%) experienced adverse events of grade ≥2. The duration of hospitalization was affected by the grade of adverse events, with a mean duration of hospital stay of 9.2, 17.2, 28.3 and 47.0 days for grades 0, 1, 2, and 3-4, respectively. Medical intervention lowered the incidence of grade ≥2 adverse events to 14.5%. The length of hospitalization was significantly shorter in patients who showed an improvement of adverse events after medical intervention than those who did not (26.4 days vs. 41.6 days, hazard ratio 1.687, 95% confidence interval: 1.260-2.259, P<0.001). A multivariate Cox proportional hazard analysis indicated that insomnia, constipation, nausea/vomiting, infection, non-cancer pain, oral mucositis, odynophagia and neutropenia were significant risk factors for prolongation of hospital stay. CONCLUSION: Patients who experienced adverse events are at high risk of prolonged hospitalization. Medical intervention for adverse events was found to be effective in reducing the length of hospital stay associated with adverse events.

[Experience on treatment of children with otorhinolaryngological diseases by low intensity laser irradiation].

Among diseases of children of young age dominate pathologies of otorhinolaryngological profile. Due to good blood circulation characteristics of these organs and also predominantly inflammatory or allergic nature of these diseases, laser therapy is considered to be an effective therapeutic procedure in the otorhinolaryngology. It is well known, that one of the characteristics of laser irradiation is the improvement of microcirculation in the cases of diseases involving inflammatory and allergic mechanisms. Treatment of 445 children and teenagers aged 2-15 with the following diseases: pollinosis (68), adenoiditis and rhino-sinusitis (198), tonsillitis (64) and otitis (115) was carried out simultaneously with infrared and red laser irradiations. The positive results were achieved in 85% of patients. The results achieved by us with simultaneous irradiations using infrared and red lasers prove the effectiveness of these methods for treatment of otorhinolaryngological diseases.

Selected laser-based therapies in otolaryngology.

This article has discussed selected applications of laser therapies in otolaryngology. Lasers are the treatment of choice for PWS lesions, but new advances are needed to achieve complete blanching in the majority of cases. Noninvasive in vivo imaging and laser therapy coupled with PDT are two areas showing promise to improve outcome. PDT has the potential to offer new, cost-effective treatment options, and possibly cure, to cancer patients who are not candidates for traditional surgery, chemotherapy, and radiotherapy.

Cancer incidence after nasopharyngeal radium irradiation.

BACKGROUND: From 1940 until 1970, nasopharyngeal radium irradiation was used to treat children and military personnel suffering from Eustachian tube failure attributable to local lymphoid hyperplasia. METHODS: We studied cancer incidence in a cohort of 4339 Dutch patients treated with nasopharyngeal radium irradiation, mostly in childhood, and 4104 frequency-matched nonexposed subjects. Average doses to the nasopharynx, pituitary gland, brain, and thyroid gland were 275, 10.9, 1.8, and 1.5 cGy, respectively. We assessed cancer incidence from cancer registry linkage (1989-1996), self-report including medical verification (1945-1988), and death certificates (1945-1996). RESULTS: During 18-50 years of follow-up, four thyroid malignancies (standardized incidence ratio [SIR] = 2.8; 95% confidence interval [CI] = 0.8-7.2) and five malignant brain tumors (SIR = 1.3; CI = 0.4-3.1) were observed. Increased risks were observed for malignancies of lymphoproliferative and hematopoietic origin (SIR = 1.9; CI = 1.2-2.8) and breast cancer (SIR = 1.5; CI = 1.1-2.1). Strong dose-response trends could not be demonstrated for any cancer outcome, although relative risk estimates were elevated in the highest-dose category for head and neck cancer and breast cancer. CONCLUSIONS: These data provide little evidence for a high excess risk of cancer associated with nasopharyngeal radium irradiation treatment as applied in the Netherlands. Inconsistent findings across studies and public concern warrant the continuing follow-up of available cohorts.

[Low-intensity laser irradiation in otorhinolaryngology]. / Nizkoénergeticheskoe lazernoe izluchenie v otorinolaringologii.

Low-intensity laser irradiation is a modality widely practiced in otorhinolaryngology. Basing on extensive personal experience and literature data the authors provide ENT specialists with relevant techniques and parameters of the radiation for different otorhinolaryngological diseases.

[Light-guide instruments for low-intensity laser therapy in ORL practice]. / Svetovodnye instrumenty dlia nizkointensivnoi lazernoi terapii v LOR-praktike.

Manipulators with monofibre light-guides have been specially designed for otorhinolaryngologic instruments commonly used in routine drug therapy for intracavital treatments. Quartz enclosed in a protective polyethylene sheath is used as the monofibre light-guide with a light conductor 400 microns in diameter and 2 to 3 m in length. It can be built in the following instruments: an ear catheter, a maxillary sinus lavage cannula, a subclavian artery catheter, and a laryngeal bougie. The use of monofibres allows considerable widening the application field of the low power laser therapy in otorhinolaryngologic practice. Moreover, in compliance with human engineering requirements it managed to preserve most standard manipulations otolaryngologist makes use in the course of routine clinical practice with conventional instruments.

[Complications after surgery of ENT-tumors. A comparison between preoperatively irradiated and nonirradiated patients]. / Komplikationen nach Tumoroperationen im HNO-Bereich. Ein Vergleich präoperativ ausbestrahlter mit primär operierten Patienten.

Complications after preoperative high-dosage radiation of head and neck cancer are reported: 1. Preoperative radiation leads to complications in 42% compared to surgery alone in 20%. The results are statistically significant (alpha = 2%). 2. The complications after preoperative radiation are more severe (three ruptures of the carotid artery, three defects, which could only be managed by flap rotation). These results indicate the preoperative high-dosage radiation implies the risk of major surgical complications.