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ABSTRACT: To investigate the biological factors related to the onset of Bell's palsy, we sought to identify differentially expressed genes in peripheral blood mononuclear cells (PBMCs) and plasma of patients with Bell's palsy and Ramsay Hunt syndrome (RHS).
We carried out DNA microarray analyses using PBMCs taken from patients with Bell's palsy at their initial visit and 2 to 4 weeks later. To validate these analyses, we measured the relative messenger RNA levels of alpha-defensin in paired PBMCs by reverse transcription-polymerase chain reaction. The plasma concentrations of alpha-defensin in patients and healthy volunteers were quantified by enzyme-linked immunosorbent assay.
The DNA microarray analysis identified alpha-defensin as a candidate gene related to the onset of Bell's palsy. Reverse transcription-polymerase chain reaction analysis showed that the relative alpha-defensin messenger RNA levels in PBMCs from the later visit were increased at least twofold in 9 of 13 patients (69%) with Bell's palsy and in 4 of 6 patients (67%) with RHS. The plasma alpha-defensin concentrations in the patients with RHS were significantly higher than those in healthy volunteers (p = 0.0013) and in the patients with Bell's palsy (p = 0.0306). Elevations of plasma alpha-defensin were observed in 5 of the 9 patients with Bell's palsy who demonstrated alpha-defensin overexpression in PBMCs.
alpha-Defensin may be one of the biological factors related to the onset of Bell's palsy and RHS.
The Annals of otology, rhinology, and laryngology 06/2012; 121(6):419-25. · 1.05 Impact Factor
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ABSTRACT: There is an increased risk of wound complications in patients undergoing salvage laryngectomy following chemoradiotherapy. To reduce the rate of wound complications after a salvage total laryngectomy, a fresh tissue reinforcement of the pharyngeal suture line (pharyngeal interposition graft) has been reported to be useful. In the present study, wound complications after a salvage total laryngectomy with a pectoralis major muscle flap as a pharyngeal interposition graft were analyzed. Four patients with recurrent laryngeal cancer (three with supraglottic, and one with glottic cancer) after chemoradiotherapy underwent salvage total laryngectomy using a pectoralis major muscle interposition flap. Minor wound complications were observed in three of the four patients, with an infection around the tracheostoma, a minor subcutaneous abscess, and a superficial skin necrosis in one patient each. These complications were managed with local wound care. No patients had major wound complications such as pharyngocutaneous fistulas. There were no necroses or wound complications of the pectoralis major muscle flap. This study has suggested that the pectoralis major muscle flap as a pharyngeal interposition graft is safe and useful for prevention of wound complications in salvage total laryngectomy following chemoradiotherapy.
Nippon Jibiinkoka Gakkai Kaiho 01/2010; 113(1):9-14.
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ABSTRACT: Although the effectiveness of stereotactic radiosurgery for nonacoustic schwannomas is currently being assessed, there have been few studies on the efficacy of stereotactic radiotherapy (SRT) for these tumors. We investigated the long-term outcome of SRT for nonacoustic intracranial nerve schwannomas.
Seventeen patients were treated between July 1994 and December 2006. Of these patients, 7 had schwannomas located in the jugular foramen, 5 in the trigeminal nerve, 4 in the facial nerve, and 1 in the oculomotor nerve. Radiotherapy was used as an initial treatment without surgery in 10 patients (59%) and after initial subtotal resection in the remaining patients. The tumor volume ranged from 0.3 to 31.3 mL (mean, 8.2 mL). The treatment dose was 40 to 54 Gy in 20 to 26 fractions. The median follow-up period was 59.5 months (range, 7.4-122.6 months). Local control was defined as stable or decreased tumor size on follow-up magnetic resonance imaging.
Tumor size was decreased in 3 patients, stable in 13, and increased in 1 after SRT. Regarding neurologic symptoms, 8 patients (47%) had improvement and 9 patients were unchanged. One patient had an increase in tumor size and received microsurgical resection at 32 months after irradiation. No patient had worsening of pre-existing neurologic symptoms or development of new cranial nerve deficits at the last follow-up.
SRT is an effective alternative to surgical resection for patients with nonacoustic intracranial nerve schwannomas with respect to not only long-term local tumor control but also neuro-functional preservation.
International journal of radiation oncology, biology, physics 05/2009; 75(5):1415-9. · 4.59 Impact Factor
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Nobuhiko Oridate,
Akihiro Homma,
Seigo Suzuki,
Yuji Nakamaru,
Fumiyuki Suzuki,
Hiromitsu Hatakeyama,
Shigenari Taki,
Tomohiro Sakashita,
Noriko Nishizawa, Yasushi Furuta,
Satoshi Fukuda
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ABSTRACT: To determine patient-perceived voice-related quality of life in patients treated with various methods based on the results of Voice-Related Quality of Life (VRQOL) and Voice Handicap Index-10 (VHI-10) questionnaires.
The VRQOL and VHI-10 questionnaires.
University hospital.
One hundred thirty-seven patients who had received definitive treatment of laryngeal cancer were followed-up at Hokkaido University Hospital, Sapporo, Japan, and were alive with no evidence of malignancy at the time of the survey.
Patient-perceived voice-related quality of life based on the results of the VRQOL and VHI-10 questionnaires.
The mean VRQOL scores for patients who had undergone radiotherapy (n = 63), chemoradiotherapy (n = 29), laser surgery (n = 14), or total laryngectomy (n = 27) as final treatment of laryngeal cancer were 92.6, 92.9, 85.5, and 68.4, respectively; the mean VHI-10 scores were 2.87, 2.34, 5.43, and 11.26, respectively.
The VRQOL and VHI-10 questionnaires are important in judging the overall effectiveness of treatment options for laryngeal cancer.
Archives of otolaryngology--head & neck surgery 05/2009; 135(4):363-8. · 1.92 Impact Factor
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Tomohiro Sakashita,
Nobuhiko Oridate,
Akihiro Homma,
Yuji Nakamaru,
Fumiyuki Suzuki,
Hiromitsu Hatakeyama,
Shigenari Taki,
Yutaka Sawamura,
Yuhei Yamamoto, Yasushi Furuta,
Satoshi Fukuda
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ABSTRACT: Objectives: To evaluate the risk factors for perioperative complications among patients undergoing craniofacial resection for the treatment of skull base tumors. Design: Retrospective analysis. Participants: The study group comprised 29 patients with skull base tumors (22 malignant and 7 benign) who underwent 30 craniofacial resections at Hokkaido University Hospital between 1989 and 2006. Of these cases, 21 had undergone prior treatment by radiation (16 cases), surgery (7 cases), or chemotherapy (1 case). Moreover, 19 needed extended resection involving the dura (11 cases), brain (5 cases), orbit (12 cases), hard palate (5 cases), skin (3 cases), or cavernous sinus (2 cases). Main outcome measures: Perioperative complications and risk factor associated with their incidence. Results: Perioperative complications occurred in 12 patients (40%; 13 cases). There was a significant difference between complication rates for cases with and without prior therapy (52.4% vs. 11.1%). The complication rate for dural resection cases was 81.8%. There was a significant difference between complication rates for cases with and without dura resection. No postoperative mortality was reported. Conclusions: Craniofacial resection is a safe and effective treatment for skull base tumors. However, additional care is required in patients with extended resection (especially dural) and those who have undergone prior therapy.
Skull Base Surgery 04/2009; 19(2):127-32. · 0.66 Impact Factor
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ABSTRACT: Surgical complication rates of total laryngectomy vary according to the preoperative treatments performed and patient factors. Wound complications after salvage laryngectomy following concurrent chemoradiotherapy (CCRT) were analyzed.
Eighty-six patients who had undergone total laryngectomy for laryngeal cancer at Hokkaido University Hospital, Japan, between 1990 and 2006 were divided into three groups according to preoperative treatments received: group I (n = 35) without radiotherapy (RT) or CCRT, group II (n = 17) RT alone, and group III (n = 34) low-dose CCRT. Salvage total laryngectomy was performed as a consequence of residual or recurrent disease after completion of the treatments. Wound complications such as pharyngocutaneous fistulas, bleeding, infections, and skin necrosis were retrospectively analyzed in each group.
A considerable (not statistically significant) difference in the incidence of major wound complications was observed between groups I and III (11.4% vs 29.4%, P = 0.078), but not between groups II and III. In stage III/IV patients, a significant increase in the incidence of wound complications was observed in group III compared to group I. Pharyngocutaneous fistulas were the most common complication, occurring in 8/34 (23.5%) of the group III patients. Additional pharyngeal reconstruction surgery was performed in 5 of the 8 (62.5%) group III patients with pha ryngocutaneous fistulas, while no such patients (0/3) in group I required reconstruction surgery.
There was an increased risk of wound complications in patients undergoing salvage laryngectomy following CCRT. Patients who developed pharyngocutaneous fistulas after CCRT tended to require surgical reintervention for repair. These findings should be taken into account before the initiation of CCRT and salvage surgery.
International Journal of Clinical Oncology 01/2009; 13(6):521-7. · 1.41 Impact Factor
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ABSTRACT: It is widely accepted that laryngopharyngeal reflux requires more aggressive and prolonged therapy than gastro-esophageal reflux disease. Otolaryngologists often observe that laryngopharyngeal symptoms, such as throat clearing, hoarseness, cough, and globus pharyngeus, are slower to resolve than esophageal symptoms, such as heartburn and regurgitation. The aim of this was to provide empirical evidence to support this observation and to carry out a detailed investigation of the differences between these symptoms. Forty-five patients with laryngopharyngeal and esophageal symptoms received acid-suppression therapy that involved the continuous administration of a proton-pump inhibitor for up to 6 months. We investigated the differences in response to acid-suppression therapy between patients suffering from laryngopharyngeal and esophageal symptoms, respectively, who received upper gastrointestinal endoscopy and were assayed for serum Helicobacter pylori antibodies. The significance of the rate of symptom improvement was estimated by Kaplan-Meier analysis and the logrank test. Laryngopharyngeal symptoms improved significantly more slowly than esophageal symptoms following acid-suppression therapy (49.8 vs. 78.3%, 60 days after the start of acid suppression; P = 0.003). These differences were observed both in patients with erosive esophagitis (P = 0.008) and in H. pylori-seronegative patients (P = 0.001).
Digestive Diseases and Sciences 09/2008; 53(8):2033-8. · 2.12 Impact Factor
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ABSTRACT: Detecting the risk factors for late neck metastasis (LNM) in early tongue and oral floor cancer is important for establishing an accurate prognosis, as well as for increasing survival rates. Patients with either stage I or II tongue and oral floor cancer underwent either a resection of the primary tumor or interstitial radiotherapy without neck dissection. We measured the short- and long-axis diameters of lymph nodes on initial CT images. Of the 38 patients, 20 had LNM and 18 did not. CT images showed a total of 161 lymph nodes. Twenty-five "occult lymph nodes" developed into LNM, whereas the remaining 136 "reactive lymph nodes" did not. Comparison between "occult" and "reactive" lymph nodes revealed significant differences in the short-axis diameters (p=0.01). The measure of short-axis diameters of neck lymph nodes on initial CT images is a useful predictor of LNM in patients with early tongue and oral floor cancer.
Oral Oncology 09/2008; 44(8):793-7. · 2.86 Impact Factor
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ABSTRACT: The current study aimed to evaluate the significance of an immunohistochemical assessment of tumor suppressor p53 as a prognostic marker in head and neck squamous cell carcinoma (HNSCC) patients treated with docetaxel and radiotherapy.
The expression of tumor suppressor p53 and its phosphorylated form at the Ser392 residue was retrospectively evaluated by immunohistochemistry in 51 Stage T1-3N0-2M0 (except T1N0 glottis) HNSCC patients who were treated with 10mg/m(2)/week docetaxel four to six times and received concurrent chemoradiotherapy.
Kaplan-Meier univariate analysis revealed that no difference in rates for overall and disease-free survival (DFS) between patients with p53-positive and -negative tumors (p=0.786 and p=0.924, respectively). The prognostic significance of phosphorylated p53 at the Ser392 residue was neither observed.
An immunohistochemical assessment of the expression of p53 and its phosphorylated form might not be of clinical use in defining subgroups of patients with poor prognosis.
Auris, nasus, larynx 06/2008; 36(1):57-63. · 0.58 Impact Factor
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ABSTRACT: Carotid body tumors are uncommon neoplasms that arise at the bifurcation of the common carotid artery. Surgical resection is generally recommended, but entails an inherent risk of cranial nerves injury and excessive blood loss. Preoperative embolization has been reported to decrease blood loss and shorten resection time. In this study, we analyzed the benefits of preoperative embolization and the postoperative complications when preoperative embolization was performed. Six patients with seven tumors were treated between 1990 and 2005. Each patient's preoperative evaluation included CT, MRI, US, and angiography, and preoperative embolization was performed in four patients with five tumors. Blood loss, in the patients who underwent preoperative embolization, ranged from 20 ml to 900 ml (mean: 291ml), and operation time ranged from 4 hours 34 minutes to 6 hours 40 minutes (mean: 4 hours 55 minutes). In the group that did not undergo preoperative embolization, blood loss ranged from 642 ml to 1390 ml (mean: 1016 ml), and operation time ranged from 9 hours 48 minutes to 10 hours 45 minutes (mean: 10 hours 17 minutes). Five patients had postoperative cranial nerve dysfunction, and it involved cranial nerve IX in one patient (14.3%), cranial nerve X in two patients (28.5%), and cranial nerve XII in five patients (71.4%). Resection of bilateral carotid body tumors in one patient resulted in baroreflex failure syndrome. In conclusion, preoperative embolization tends to decrease blood loss and shorten operation time, resulting in lower postoperative neurologic morbidity.
Nippon Jibiinkoka Gakkai Kaiho 04/2008; 111(3):96-101.
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ABSTRACT: The purpose of the study was to evaluate upper abdominal symptoms in laryngopharyngeal reflux (LPR) patients and changes in both upper abdominal and LPR symptoms before and after acid-suppression therapy.
In 100 patients with LPR symptoms, upper abdominal and LPR symptoms were evaluated by using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) and the LPR symptom scoring system, respectively. In the 52 assessable patients, changes in these symptoms before and after acid-suppression therapy were evaluated.
Upper abdominal symptoms were reported by 96/100 LPR patients: 89 responded positively to at least one of the questions about acid reflux-related symptoms and 89 to at least one of those about dysmotility-like symptoms. There was poor correlation between positive rates to FSSG upper abdominal symptom questions and the frequency of reported laryngopharyngeal symptoms. There were significant reductions in the frequency of acid reflux-related symptoms, dysmotility-like symptoms, and laryngopharyngeal symptoms after acidsuppression therapy. The LPR symptom score decreased to less than half the pretreatment score in 25 subjects (therapeutic response group). The pretreatment frequency of dysmotility-like symptoms seemed to be higher in the nonresponse group than in the response group, although the difference was not significant. There was no significant difference between the two groups in the pretreatment frequency of acid reflux-related symptoms.
The majority of these Japanese LPR patients experienced some form of upper abdominal symptoms. The frequency of dysmotility-like symptoms was similar to that of acid reflux-related symptoms. The pretreatment frequency of dysmotility-like symptoms, but not of acid reflux-related symptoms, might be a predictor of patient response to acid-suppression therapy.
Journal of Gastroenterology 01/2008; 43(7):519-23. · 4.16 Impact Factor
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ABSTRACT: The current study aimed to evaluate the significance of the cell-cycle-control proteins cyclin D1 and p16 as prognostic markers in head and neck squamous cell carcinoma (HNSCC) patients treated with docetaxel and radiotherapy.
Cyclin D1 and/or p16 protein expression was retrospectively evaluated by immunohistochemistry in 53 patients with stage T1-3N0-2M0 (except T1N0 glottis) HNSCC who were treated with 10 mg/m(2)/week docetaxel 4 to 6 times and received concurrent chemoradiotherapy.
Kaplan-Meier univariate analysis revealed that patients with cyclin D1-positive tumors or p16-negative tumors had a worse prognosis compared with those with cyclin D1-negative tumors or p16-positive tumors (p = .0004 and p = .025, respectively). The prognostic significance of cyclin D1 expression, not p16 expression, was confirmed using a proportional hazard regression model.
An assessment of cyclin D1 and p16 levels might be of clinical use in defining subgroups of patients with poor prognosis.
Head & Neck 11/2007; 29(10):940-7. · 2.40 Impact Factor
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ABSTRACT: We sought to determine the value of preoperative staging by magnetic resonance imaging (MRI) assessment in the surgical management of sinonasal inverted papillomas (IPs).
Preoperative MRI staging was used to assess 22 patients with IPs. In addition to the Krouse staging system, T3 cases were categorized as subgroup T3-B if tumors extended into the frontal sinus or the supraorbital recess; otherwise, they were categorized as T3-A. Standard endoscopic sinus surgery (ESS) was the first choice for T1 and T2 cases. Endoscopic approaches, including ESS combined with endoscope-assisted transantral approach and endoscopic medial maxillectomy, were considered in T3-A cases, and external approaches were considered in T3-B cases. Patients were followed for a minimum of 1 year after surgery.
Preoperative MRI staging and postoperative staging were coincident in 21 of the 22 patients (95%). All 8 T2 cases were treated by an endoscopic approach. Of 10 T3-A cases, 9 (90%) were treated by an endoscopic approach and 1 (residual case) was treated by an external approach. All 3 of the T3-B cases underwent an external approach. One T4 case with malignant transformation underwent an external approach followed by radiotherapy. After a median follow-up period of 22 months, none of the 22 patients had had a recurrence. No major complications were observed after endoscopic approaches, but epiphora or hemorrhage requiring transfusion occurred in 3 of the 5 patients (60%) who underwent external approaches.
Preoperative staging of IP by MRI is useful for selecting cases that can be managed by endoscopic approaches, resulting in lower rates of tumor recurrence and morbidity.
The Annals of otology, rhinology, and laryngology 10/2007; 116(9):674-80. · 1.05 Impact Factor
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ABSTRACT: We report 3 cases of muscle tension dysphonia (MTD), all involving women 44 to 68 years old, recovered using proton pump inhibitors (PPI). Case 1 had open posterior commissure (MTD Type I) and Cases 2 and 3 supraglottis compression (MTD Type II, III). It is generally assumed that functional dysphonia with maladjustment of laryngeal muscle tension is caused by improper phonation and/or emotional disorder. Our cases, however, suggest that laryngopharyngeal reflux (LPR) may also relate to the occurrence of MTD.
Nippon Jibiinkoka Gakkai Kaiho 06/2007; 110(5):416-9.
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ABSTRACT: We analyzed the clinical characteristics, pathological findings, and treatment outcomes of patients with recurrent sinonasal inverted papilloma (IP).
This retrospective study consisted of 13 patients with recurrent IP. Patient data were collected on prior treatment, sites of recurrence, surgical procedures, pathological findings, and postoperative time to recurrence.
Eleven of the 13 patients (85%) had recurrence in the ethmoid sinus, particularly at the lamina papyracea (n = 8; 62%). Inverted papilloma with severe dysplasia (SD) was observed in 4 patients, 3 of whom showed malignant transformation of the recurrent tumor. Craniofacial resection was performed in 2 of the 4 patients, resulting in no further recurrence. However, the tumor was not managed in the remaining 2 patients. In the 9 patients without SD, lateral rhinotomy was performed in 6 patients and endoscopic sinus surgery was selected in 3 patients who had a small tumor without scar formation. No further recurrence was observed in the 9 patients.
Careful management of IP around the lamina papyracea is essential during initial surgery. Recurrent IP without SD can be successfully managed by lateral rhinotomy in most cases, and by endoscopic sinus surgery in selected cases. However, more aggressive treatment, including craniofacial resection, should be considered in IP with SD, which is associated with a high rate of recurrence and malignant transformation.
The Annals of otology, rhinology, and laryngology 05/2007; 116(4):297-303. · 1.05 Impact Factor
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Naohito Hato,
Hiroyuki Yamada,
Hisashi Kohno,
Shuichi Matsumoto,
Nobumitsu Honda,
Kiyofumi Gyo,
Satoshi Fukuda, Yasushi Furuta,
Fumio Ohtani,
Hiroshi Aizawa,
Masaru Aoyagi,
Hiroo Inamura,
Tsutomu Nakashima,
Seiichi Nakata,
Shingo Murakami,
Jun Kiguchi,
Koji Yamano,
Taizo Takeda,
Masashi Hamada,
Kazuhiro Yamakawa
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ABSTRACT: To investigate the effects of valacyclovir and prednisolone in comparison with those of placebo and prednisolone for the treatment of Bell's palsy, excluding zoster sine herpete.
Prospective, multicenter, randomized placebo-controlled study.
Six academic tertiary referral centers.
Ultimately, 221 patients with Bell's palsy who were treated within 7 days of the onset. Serological and polymerase chain reaction examinations were performed to distinguish Bell's palsy from zoster sine herpete.
The patients were treated with either valacyclovir (dosage, 1,000 mg/d for 5 days) plus prednisolone (VP [n = 114]) or placebo plus prednisolone (PP [n = 107]) administered orally.
Recovery from the palsy was defined as a score higher than 36 using Yanagihara 40-point scoring system without facial contracture or synkinesis. The patients were followed up until complete recovery occurred or for more than 6 months in cases with a poor prognosis.
The overall rate of patient recovery among those treated with VP (96.5%) was significantly better (p < 0.05) than the rate among those treated with PP (89.7%). The rate of patient recovery was also analyzed by classifying the initial severity of facial palsy. In cases of complete or severe palsy, the rates of patients treated with VP and PP who recovered were 95.7% (n = 92) and 86.6% (n = 82), respectively; the recovery rate for treatment with VP was significantly better than that with PP (p < 0.05).
The valacyclovir and prednisolone therapy was more effective in treating Bell's palsy, excluding zoster sine herpete, than the conventional prednisolone therapy. To our knowledge, this is the first controlled study of an antiviral agent in the treatment of a sufficient number of Bell's palsy cases based on an etiologic background.
Ontology & Neurotology 05/2007; 28(3):408-13. · 1.90 Impact Factor
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ABSTRACT: This study sought to evaluate the efficacy and safety of a novel treatment regimen, intra-arterial cisplatin infusion plus external/high-dose-rate radiotherapy.
Superselective intra-arterial infusion of cisplatin (100-120 mg) was performed concomitantly with external radiotherapy in four patients with locally advanced carcinoma of the tongue. A high-dose-rate brachytherapy boost was performed after combination therapy in all patients. Brachytherapy was performed after external radiotherapy, and the treatment schedule was twice daily, with a fraction of 600 cGy up to a total of 30-48 Gy.
All patients completed the therapy as scheduled. There were no vascular or neurological complications. Grade III acute radiation mucositis developed in all patients but this did not necessitate a treatment break. With a mean follow-up period of 35 months, loco-regional control was obtained for all patients.
The combination of weekly administration of intra-arterial cisplatin plus external/high-dose-rate radiotherapy seems effective for advanced carcinoma of the tongue.
Japanese Journal of Clinical Oncology 01/2007; 36(12):822-6. · 1.78 Impact Factor
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ABSTRACT: Macrophage migration inhibitory factor (MIF) plays an important role in inflammatory diseases. It has been reported that anti-MIF treatment and mif-gene disruption ameliorate joint inflammation in a mouse model of arthritis induced by anti-type II collagen monoclonal antibodies and lipopolysaccharide (anti-IIC mAb/LPS). In the present study, using the anti-IIC mAb/LPS system, we have analyzed arthritis in MIF-transgenic (MIFTg) and wild-type C57BL/6 (WT) mice. We found that MIFTg mice developed more severe arthritis than WT mice. The histopathological scores were significantly higher in MIFTg mice and significantly increased numbers of CD69+ T cells were detected in the spleens of these arthritic MIFTg mice, compared with WT mice. Natural killer T (NKT) cells from MIFTg mice, compared with WT mice, produced reduced amounts of IL-4 upon stimulation with agr;-galactosylceramide (alpha-GalCer). Further, repeated administration of alpha-GalCer to MIFTg mice resulted in a profound reduction of both clinical and histopathological scores of arthritis, with a significant decrease in IL-6. The present findings demonstrate that overexpression of MIF exacerbates inflammation in this arthritis model and that NKT cells play an ameliorating role upon stimulation with alpha-GalCer in the inflammatory process in MIFTg mice.
International Journal of Molecular Medicine 12/2006; 18(5):829-36. · 1.98 Impact Factor
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ABSTRACT: Chemoradiotherapy (CRT) is becoming more widely used for head and neck cancer. However, there are conflicting theories regarding the best management options for patients with advanced nodal disease.
From 1990 to 1999, we treated 96 patients with N1-N2 neck disease by concomitant CRT for organ preservation, using weekly carboplatin or a low daily dose of cisplatin, followed by a "watch-and-see" policy for the neck. In the present study, we retrospectively analyzed the treatment outcome in 63 of these patients who received definitive CRT for primary and neck diseases and were monitored for neck disease for more than 2 years.
In 12 of the 22 (55%) N1 patients, CRT successfully controlled the neck disease. CRT was successful in 18 of the 41 (44%) patients with N2 disease. In 6 (60%) of 10 patients with residual or recurrent N1 disease, salvage surgery was successful. Of the 23 patients with residual or recurrent N2 disease, salvage surgery was successful in 8 patients (35%). The group of patients who showed a clinical complete response (CCR) to CRT had an overall survival rate of 62.4% (33 patients), whereas for those with a less than complete response (<CCR), the figure was 13.3% (30 patients; P < 0.001). Among the <CCR-neck group, patients who underwent neck dissection (ND) as well (n = 20) did not have a significantly better overall survival than those who did not undergo ND (n = 10; P = 0.069).
We propose a treatment plan for neck disease that involves observing the neck closely following CRT. ND should be planned only when there is evidence that neck disease exists.
International Journal of Clinical Oncology 12/2006; 11(6):441-8. · 1.41 Impact Factor
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ABSTRACT: Olfactory neuroblastoma is such a rare malignancy that no consensus has been reached on its management. We analyzed 17 patients with olfactory neuroblastoma treated between April 1980 and March 2004--9 men and 8 women, aged 16 to 76 years old(mean: 50.4 years). Follow-up of current survivors was 1 year 8 months to 16 years 6 months (average: 7 years 9 months). Initially, 2 were treated with surgery alone, 5 with surgery and radiotherapy, and 2 with a combination of these and chemotherapy. Without surgery, radiotherapy alone was conducted in 3 and combined of radiation and chemotherapy in 5. Three of the 5 patients treated with surgery and radiotherapy survive without locoregional recurrence as do 2 with chemotherapy added. All 5 initially treated with craniofacial resection survived more than 5 years. Combined radiotherapy and chemotherapy without surgery was effective in 2. 5- and 10-year overall survival for all patients were 75.5% and 64.7%. Overall 5-year survival of 8 patients with low-grade tumors was 87.5% and of 6 with high-grade tumors 33.3%. In conclusion, combined craniofacial resection plus radiotherapy and chemotherapy seemed to improve survival. Histopathological grading is a prognostic factors.
Nippon Jibiinkoka Gakkai Kaiho 06/2006; 109(5):433-9.
