Comprehensive head and neck oncology health status assessment

BACKGROUND

This article presents the validation of the Head and Neck Cancer Inventory (HNCI), a health status assessment instrument with a small number of multiple-item domains that captures patients' ratings of functional status and attitude about that function.

METHODS

The HNCI was administered to patients with upper aerodigestive tract carcinoma. An initial, cross-sectional study assessed feasibility and reliability. A subsequent, longitudinal study's factor analysis identified ineffective items and confirmed domain cohesiveness. Construct and criterion-related validity and sensitivity to detect change across time were evaluated.

RESULTS

The HNCI was highly reliable. Criterion-related validity was demonstrated through comparisons with other HNC-specific instruments. Construct validity was demonstrated based on significant differences between patient groups (HNC/non-HNC, employment status, clinical stage, and type of treatment). Domain scores were sensitive to change across time. The domains' functional and attitudinal scores were significantly different.

CONCLUSIONS

The HNCI is a reliable, valid instrument that evaluates the functional and attitudinal components of health status in HNC patients. This survey is recommended for self-reported health status evaluation in HNC clinical trials.

Bilateral sternocleidomastoid tumor of infancy

The sternocleidomastoid tumor of infancy (STOI), also known as fibromatosis colli, presents as a firm well circumscribed mass within the sternocleidomastoid muscle (SCM) in infants of 1-8 weeks of age. Some of these lesions are associated with torticollis, facial and cranial asymmetry. Incidence of STOI is approximately 0.4% of live births and usually 90% of the patients will have a good prognosis if therapy is initiated and continued for the appropriate period of time. This paper presents two cases of bilateral involvement of STOI, which is very rare. The bilateral nature of the masses added to the uncertainty of the clinical diagnosis and the unusual features of these cases are discussed.

Combination nonviral interleukin 2 gene therapy and external-beam radiation therapy for head and neck cancer

OBJECTIVES

To demonstrate that the combination of nonviral murine interleukin 2 (mIL-2) gene therapy and external-beam radiation therapy (XRT) have an enhanced therapeutic effect for the treatment of head and neck squamous cell carcinoma (HNSCC) in an orthotopic murine model and to elucidate the mechanism of action.

METHODS

Randomized, controlled studies in the murine orthotopic model of HNSCC. Squamous cell carcinoma VII cells were injected into the floor of the mouth to establish tumors in immunocompetent mice. The intervention groups were treated with mIL-2, radiation therapy, empty plasmid, no treatment, combination mIL-2/XRT, and combination empty plasmid/XRT. Nonviral mIL-2 gene transfer was performed on days 5 and 9. The XRT was administered to the assigned groups 24 hours after first mIL-2 delivery. The mice were killed on day 13. Tumors and local lymph nodes were harvested and evaluated. Primary and secondary cytokine expression, cytotoxic T-lymphocyte activity, and apoptosis were assayed.

RESULTS

The combination mIL-2/XRT demonstrated a significant increase in antitumor effects compared with single therapy or controls. Increased expression levels of primary and secondary cytokines were found in the group treated with mIL-2, and this effect was preserved when mIL-2 treatment was combined with XRT. Combination therapy significantly increased apoptosis compared with monotherapy.

CONCLUSIONS

The present study demonstrates that combination mIL-2/XRT generates potent antitumor immune responses and significantly increases apoptosis in an orthotopic murine model of HNSCC. Further optimization of this strategy is warranted as well as consideration for human clinical trials.

[Chronobiological considerations for the management of human head and neck cancer]

The authors reviewed experimental and clinical data (ie, cell kinetics and its circadian control by cyclins, circadian expression of clock genes, chronotolerance to anticancer agents.) justifying to consider the temporal dimension in the medical treatment of human head and neck cancer. A complex infusional chronotherapyschedule (with 5-fluorouracil, folinic acid and carboplatin) was administered to 48 patients. Excellent tolerance and interesting tumour outcome allowed to conclude to an optimised therapeutic index.

Comparison of the comet assay and the oxygen microelectrode for measuring tumor oxygenation in head-and-neck cancer patients

PURPOSE

To compare the Eppendorf PO2 histograph and the alkaline comet assay as methods of measuring tumor hypoxia in patients with head-and-neck squamous cell carcinomas.

MATERIALS AND METHODS

As part of a larger clinical trial, 65 patients with head-and-neck squamous cell carcinoma nodal metastasis underwent tumor oxygenation measurements with Eppendorf PO2 histographs and comet assays, performed on fine-needle aspirates at 1 and 2 min after 5 Gy. Fifty-four patients had sufficient tumor cells for comet analysis at 1 min and 26 at both 1 and 2 min. Individual cells were examined for DNA single-strand breaks by alkaline gel electrophoresis, and the distribution of values was quantified using median tail moment (MTM). Nonirradiated tumor cells from pretreatment fine-needle aspirates received 5 Gy in vitro to establish the oxygenated response.

RESULTS

There was a significant correlation between the 1- and 2-min MTM (slope = 0.77 +/- 0.03). There was no relationship between DNA damage in tumor cells irradiated in vitro and in vivo. No correlation was found between Eppendorf PO2 measurements and comet MTM. There was a statistically significant correlation between the treatment response in the node studied and comet MTMs, whereas no correlation was observed between treatment response and Eppendorf measurements.

CONCLUSIONS

Comet assays are reproducible, as shown by biopsies at 1 and 2 min. Intertumor variation in the MTM is not a result of intrinsic radiosensitivity but of tumor hypoxia. There was no correlation between Eppendorf PO2 measurements and comet MTM. Comet assays were better than Eppendorf in predicting treatment response as an end point for short-term outcome. Longer follow-up is needed to determine the role of the comet assay as a predictor for locoregional tumor control and survivals.

Quality of life measurement in the head and neck cancer radiotherapy clinic: is it feasible and worthwhile?

Quality of Life (QOL) is now a standard end-point in clinical trials. The aim of this non-cohort study was to assess the practical issues surrounding the collection of QOL data in a non-trial setting, and to determine whether it is feasible and worthwhile. Ninety-two patients attending clinics before, or at least 3 months after radiotherapy for head and neck cancer were asked to complete the University of Washington QOL questionnaire (Version 4) and the Hospital Anxiety and Depression Scale. The three most important QOL domains cited by patients after radiotherapy related to saliva production, swallowing and taste. Most patients were able to complete both questionnaires in less than 10 min and reported little difficulty in understanding and completing them. The questionnaires indicated possible clinically significant levels of anxiety and depression in 31% and 16%, respectively. We perceived several benefits of routine QOL data collection in the clinic and this has now been adopted in our own practice.

Prognostic implications of hemoglobin levels before and after surgery as well as before and after radiochemotherapy for head and neck tumors

Several studies have shown that tumor cells may develop resistance to radiotherapy, proliferating under hypoxic conditions. Following surgery, patients may develop low hemoglobin levels, which may cause low oxygen conditions. This retrospective analysis was undertaken to determine the impact of low hemoglobin levels in patients with head and neck tumors treated with combined-modality therapy (surgery and postoperative radiochemotherapy). We studied 120 patients with mostly advanced head and neck tumors (88% stage III/IV) who had undergone macroscopically complete resections of their primary tumors and lymph node metastases. At 20-277 days after surgery (median: 51.3 days), these patients received postoperative chemoradiotherapy (56.7 Gy of radiation over 28-49 days and cisplatin 6 mg/m(2) body surface area on radiation treatment days with a cumulative dose of 96 mg/m(2)). Normal hemoglobin levels were considered to be 12 g/dl for females and 13 g/dl for males. Decreased hemoglobin levels before or after surgery and before or after chemoradiotherapy were correlated with the prognosis. Preoperatively, 99 of 114 patients (87%) had normal levels of hemoglobin compared with only 20 of 107 patients (19%) postoperatively. At the onset of radiochemotherapy, the hemoglobin levels of 82 of 116 patients (71%) were within the normal range. After radiochemotherapy, however, 62 of 114 patients (54%) had normal hemoglobin levels. Univariate analysis (Kaplan-Meier method and log-rank test) showed that patients with decreased pre- or postoperative hemoglobin levels had significantly worse locoregional control ( P=0.032 and P=0.0001, respectively) and lower overall survival ( P=0.0013 and P=0.0002, respectively) than patients with normal hemoglobin levels. The 3-year locoregional control rates in patients with preoperative hemoglobin levels that were normal, were reduced by 1-2 g/dl or were reduced by more than 3 g/dl, respectively, were 78%, 55% and 50%. Correlated with normal and diminished postoperative hemoglobin levels, the 3-year locoregional control rates were 90%, 84% and 50%, respectively. There was no correlation between prognosis and hemoglobin level at the onset or after radiochemotherapy. On multivariate analysis, only the postoperative hemoglobin level remained a prognostic factor for locoregional control ( P=0.0241) and overall survival ( P=0.0080). We conclude that low postoperative hemoglobin levels resulting from blood loss may influence the efficacy of postoperative radiochemotherapy in patients with head and neck cancer. Early intervention to raise the postoperative hemoglobin level may result in better tumor control and overall survival after combined-modality therapy.

Clinical investigation: Reliability and validity of the Japanese version of quality of life radiation therapy instrument (QOL-RTI) for Japanese patients with head and neck malignancies

PURPOSE

To evaluate the reliability and validity of the Japanese translation of Quality of Life Radiation Therapy Instrument (QOL-RTI) and the head and neck module (H&N) for Japanese patients being treated with radiotherapy for head and neck malignancies.

MATERIALS & METHODS

The QOL-RTI/H&N was translated into Japanese by a preliminary QOL research working group of JASTRO and was used in this clinical trial. From 1998 to 2001, 70 patients with head and neck malignancies for whom radical radiotherapy was planned were entered into this study. Patients were requested to answer the questions before radiotherapy at baseline, twice during week 4 of therapy (for test-retest reliability), at the end of treatment, and 3 months, 6 months, 1 year and 2 years from the beginning of radiotherapy. Internal consistency was assessed by Cronbach's alpha coefficient. Validity was assessed by comparing the results with EORTC-QLQ-C30 and with QOL questionnaire for cancer patients treated with anticancer drugs (QOL-ADC). Patient compliance and test sensitivity were also analyzed.

RESULTS

Cronbach's alpha coefficient was 0.79 to 0.93 depending on the time point for the evaluation. Test-retest reliability was acceptable, with a Pearson coefficient of 0.83 for QOL-RTI and 0.92 for H&N module. Compliance with this scheme was 98.2%. The QOL-RTI was sensitive enough to detect significant changes in the QOL score during and after the course of radiotherapy. Agreement with the EORTC-C30 was good with a high Pearson correlation coefficient of 0.648 and that with QOL-ADC was also good with a coefficient of 0.566. The factors analyzed consisted of 11 functional/health-oriented questions, 5 emotional/ psychological, 5 socio-economic/ family and 2 general.

CONCLUSION

The Japanese version of QOL-RTI with H&N module was found to be reliable and sensitive enough to evaluate variation of QOL in patients with head and neck malignancies during and after radiotherapy.

Hypotensive endovascular test occlusion of the carotid artery in head and neck cancer

Object

To evaluate the reliability of balloon test occlusion with hypotensive challenge (BTO and HC) as a predictor of neurological complications before internal carotid artery (ICA) sacrifice in patients with advanced head and neck cancer, the authors retrospectively reviewed the medical records of patients presenting to their institutions between 1992 and 1997 in whom this preoperative assessment was performed.

Methods

Eleven patents who were candidates for extended comprehensive neck dissection (ECND) and potential ICA sacrifice were included in the study. Eight patients tolerated the test and underwent endovascular occlusion or surgical ligation of the ICA before ECND (four patients), preservation of the ICA at the time of surgery (three patients), or palliative therapy (one patient). Of three patients in whom BTO and HC failed, one patient received palliative treatment only; the other two underwent ECND with preservation of the ICA. In the group of patients who passed the test and underwent ICA occlusion or ligation before ECND, fatal thromboembolic stroke occurred within 24 hours of permanent balloon occlusion in one patient, resulting in a combined neurological morbidity/mortality rate of 25% in this subset of patients and an overall complication rate of 9% in this series.

Conclusions

The authors found that BTO and HC offers a simple and reliable method of preoperative risk assessment when ICA resection is planned for regional control of disease in advanced head and neck cancer. This management option, however, is associated with a potential for neurological complication that must be weighed against the natural course of the disease and the risks and benefits of other treatment modalities.

Nutrition and head and neck cancer

The role of nutrition in patients with head and neck cancer, specifically squamous cell carcinoma, is underappreciated. The composition of the diet can contribute to carcinogenesis, and specific nutrients may offer some protection in the presence of known carcinogens (ie, tobacco). Patients with head and neck cancer are frequently malnourished, which may have prognostic implications for the morbidity and outcome of therapies. Although the benefits of preoperative nutritional supplementation have been demonstrated only in severely malnourished patients, the use of immune-enhancing formulas may prove to be beneficial. Special consideration should be given to the nutritional needs and possible interactions of diet and therapy in patients receiving radiation and chemotherapy. Physicians should be cognizant of the widespread use of alternative diets and nutritional supplements that can be harmful and may interact with standard treatments. New knowledge regarding the role of nutrition in cancer offers hope for the nutritional chemoprevention of head and neck cancers.

Opposite responses in two DNA repair capacity tests in lymphocytes of head and neck cancer patients

Genomic instability has long been recognized as the main feature of neoplasia and a factor modulating individual cancer susceptibility. There are attempts to find effective assays of both individual DNA repair capacity and genetic instability, and their relation to the cancer risk. Genetic predisposition plays an important role in the etiology and development of head and neck squamous cell carcinoma (HNSCC). The aim of our study was to search for a correlation between chromosomal instability and DNA repair capacity in HNSCC patients and healthy controls. The chromosomal instability was measured by the number of bleomycin (BLM)-induced chromosomal aberrations and diepoxybutane (DEB)-induced sister chromatid exchanges. The DNA repair capacity was assessed using the DEB-induced adaptive response (AR). The HNSCC patients in our study showed a significant increase in chromosomal instability after a preterminal exposure of their lymphocytes to either BLM for the last 5 h or DEB for the last 24 h of incubation. However, the AR was higher in HNSCC patients than in the control group, suggesting an increase in the DNA repair capacity in the cancer patients as compared to the control. There is no correlation between the DNA repair capacity estimated on the basis of preterminal exposures to BLM and DEB and the DNA repair capacity estimated on the basis of the adaptive response to DEB. The preterminal exposure and the adaptive response test may activate different DNA repair mechanisms.

Evaluation of speech in people with head and neck cancer: a pilot study

BACKGROUND

A paucity of information exists on the effects of cancer on speech, with what little literature exists focussing on the effects of treatment. Baseline assessment of speech in head and neck cancer patients before treatment is important to distinguish accurately the effects of treatment from the effects of the cancer itself.

AIMS

This prospective study had four major foci: (1) to determine if speech intelligibility and motor speech functions of patients with head and neck cancer before treatment differed from the normal population; (2) to determine if impairments in speech intelligibility and motor speech functions were specific to the original site of cancer; (3) to determine which motor speech functions were most related to overall speech intelligibility; and (4) to determine whether there was a relationship between self-report of speech intelligibility, motor speech functions and the clinical assessment thereof. This study aimed incidentally to determine whether the Frenchay Dysarthria Assessment is a practicable, valid and reliable tool for assessing speech functions in the head and neck cancer population.

METHODS & PROCEDURES

Twenty participants, between 47 and 76 years of age and all newly diagnosed with a cancer of the head and neck, participated in the pilot study. In examining speech, participants completed a self-report questionnaire pertaining to speech intelligibility and motor speech functions and were then assessed clinically using subscales of the Frenchay Dysarthria Assessment before the start of cancer treatment. The motor speech functions examined included: respiratory ability and functions of the lip, soft palate, larynx and tongue.

OUTCOMES & RESULTS

Results indicated that participants with head and neck cancer had a greater reduction in both speech intelligibility and in almost all aspects of speech when compared with the normal population. Results further demonstrated that the site of the cancer dictated the type of impairment experienced with respect to speech function. Not all motor speech characteristics correlated with overall speech intelligibility and, lastly, self-report and clinical assessment were significantly correlated with respect to motor speech characteristics, but they differed slightly in the assessment of speech intelligibility.

CONCLUSIONS

This pilot study has highlighted the critical importance of collecting baseline measures and reporting functional results according to the cancer site in future research. It has also shown the usefulness of the Frenchay Dysarthria Assessment as a practicable, valid and reliable protocol of motor speech assessment for the head and neck cancer population.

Epidermal growth factor family receptors and inhibitors: radiation response modulators

Growing evidence suggests that epidermal growth factor family receptors (HERs) play a significant role in radiation response. EGFR expression levels and activation by ligand correlate with radioresistance, and exogenous HER2 expression alters radiation response. Preclinical studies of anti-EGFR anti-HER2 antibodies, and kinase inhibitors that inhibit EGFR, both EGFR and HER2, or all 4 family members show potential for clinical radiosensitization. Early-phase clinical trials of the anti-EGFR antibody, C225, prove the combination of C225 and radiotherapy to be well tolerated and promising. A phase 3 randomized trial in head and neck cancer is underway, and clinical investigation of other HER inhibitors is in progress. The mechanisms(s) of radiation response modulation by HERs appear complex and diverse. Signal transduction initiated by receptor activation promotes survival and proliferation after ionizing radiation, and HER inhibitors affect cellular responses to ionizing radiation (IR) in diverse ways, including inducing apoptosis, cell cycle arrest, and impeding DNA repair. HER signaling and inhibition also affect tumor-stroma interactions, particularly angiogenesis and endothelial survival after IR. Further investigation of the radiation response modulation by EGFR family members and their inhibitors will lead to optimization of this promising therapeutic approach.

Hepatocyte growth factor/scatter factor stimulates mitogenesis and migration of a head and neck squamous cell carcinoma cell line

OBJECTIVE

We sought to assess the effect of extracellular matrix and hepatocyte growth factor/scatter factor (HGF/SF) on the growth and motility of cultured squamous cell carcinoma of the head and neck (SCCHN) cells.

METHODS

Cultured cells were incubated in the presence of HGF/SF. The effect of HFG/SF on cell growth, motility, and phosphorylation of the signaling proteins FAK and Erk was determined.

RESULTS

HGF/SF is both mitogenic and motogenic to the human SCCHN cell line FaDu. Incubation of FaDu cells in the presence of HGF/SF led to a rapid increase in phosphorylation of both FAK and the growth-promoting kinase Erk. HGF/SF-induced phosphorylation of FAK and Erk was observed in both detached and attached SCCHN cells. However, phosphorylation was much greater in attached cells.

CONCLUSIONS AND SIGNIFICANCE

The mitogenic and motogenic activities of HGF/SF may contribute to the pathogenesis of SCCHN in vivo.

Practical methods for compensating for missed treatment days in radiotherapy, with particular reference to head and neck schedules

Unscheduled interruption of a radiotherapy treatment can lead to significant loss in local tumour control, particularly in tumours that repopulate rapidly. General guidelines for dealing with such treatment gaps have been issued by the Royal College of Radiologists and more specific advice on the use of compensation methods has been published previously [Hendry et al., Clin Oncol 1996;8:297-307; Slevin et al., Radiother Oncol 1992;24:215-220]. This article further elaborates on the practical application of these methods. It sets out the main considerations arising in the especially critical case of head and neck treatments and simple calculations are used to illustrate the approaches which may be adapted for particular situations. Radiobiological parameter values are suggested for use in the calculations, but these may require modification in the light of further research in this important area.

Phase 1 study to identify tumour hypoxia in patients with head and neck cancer using technetium-99m BRU 59-21

The aim of this study was to assess the safety and biodistribution of technetium-99m BRU 59-21, a novel radioactively labelled 2-nitro-imidazole hypoxic marker, in head and neck cancer patients and to correlate uptake with pimonidazole staining. (99m)Tc-BRU 59-21 was administered intravenously (mean dose 824 MBq, range 780-857 MBq) to ten head and neck cancer patients scheduled for primary surgery, and whole-body images and SPET scans were then obtained. Uptake of radioactivity in the regions of interest was determined and tumour to normal tissue ratios were calculated after correlative evaluation with MRI/CT. Twelve to 16 h before surgery (up to 2 weeks after the scan), patients received pimonidazole intravenously. Tumour sections were stained immunohistochemically for pimonidazole binding. No serious adverse events were reported. In five patients there were ten adverse events, which were mild in intensity and resolved completely without intervention. Uptake of (99m)Tc-BRU 59-21 was observed in eight of the ten primary tumours. Tumour to normal tissue ratios on the SPET scans for primary tumour and lymph nodes increased from 1.8 (range 0.9-2.7) to 2.1 (range 0.8-3.7) between 30 min and 3 h post injection. Tumour to normal tissue ratios in the primary tumour were significantly correlated with pimonidazole staining for SPET scans performed 30 min and 3 h post injection ( P=0.016 and P=0.037, respectively). When primary tumour and involved lymph nodes were considered in conjunction, correlation between the tumour to normal tissue ratio and pimonidazole staining was observed for early ( P<0.001) but not for late SPET scans ( P=0.076). However, late scans showed better tumour delineation than early scans. Administration of (99m)Tc-BRU 59-21 in head and neck cancer patients appears to be safe and feasible. Uptake and retention in tumour tissue was observed, suggestive of tumour hypoxia, and this was supported by correlations with staining for the hypoxic marker pimonidazole.

Cyclooxygenase-2: a novel molecular target for the prevention and treatment of head and neck cancer

Cyclooxygenase-2 (COX-2), an enzyme that catalyzes the synthesis of prostaglandins, is overexpressed in a variety of premalignant and malignant conditions, including oral leukoplakia and squamous cell carcinoma of the head and neck. Increased levels of COX-2 may contribute to carcinogenesis by modulating xenobiotic metabolism, apoptosis, immune surveillance, and angiogenesis. In experimental models, newly developed selective COX-2 inhibitors suppress the formation of tumors, including tongue cancer. These findings provided a rationale for a number of chemoprevention trials that are underway. Selective COX-2 inhibitors also suppress the growth and metastases of established tumors and enhance the anticancer activity of both radiotherapy and chemotherapy in experimental animals. In this review, evidence is presented that inhibition of COX-2 represents a promising strategy to prevent or possibly treat human head and neck cancers.

STAT3 activation abrogates growth factor dependence and contributes to head and neck squamous cell carcinoma tumor growth in vivo

Epidermal growth factor receptor (EGFR) is up-regulated and contributes to the loss of growth control in squamous cell carcinoma of the head and neck (SCCHN). Previously, we reported an association between autocrine stimulation of EGFR and constitutive signal transducers and activators of transcription (STAT) 3 activation in SCCHN cells in vitro and in vivo. Here, we evaluated the role of activated STAT3 in tumor progression and EGFR-independent mitogenic signaling. We found that SCCHN cells stably transfected with a dominant active STAT3 construct expressed elevated levels of STAT3 target genes, including Bcl-X(L) and cyclin D1, and demonstrated increased proliferation in vitro and more rapid tumor growth rates in vivo. Cell cycle analysis demonstrated an increased proportion of STAT3 construct transfectants in G(2)-M. These findings provide evidence that constitutive STAT3 activation contributes to tumor growth in SCCHN, independent of the EGFR autocrine axis.

Defects in G1-S cell cycle control in head and neck cancer: a review

Tumors gradually develop as a result of a multistep acquisition of genetic alterations and ultimately emerge as selfish, intruding and metastatic cells. The genetic defects associated with the process of tumor progression affect control of proliferation, programmed cell death, cell aging, angiogenesis, escape from immune control and metastasis. Fundamental cancer research over the last thirty years has revealed a multitude of genetic alterations which specify more or less separate steps in tumor development and which are collectively responsible for the process of tumor progression. The genes affected play in normal cells a crucial role in control over cell duplication and the interaction between cells, and between cells and their direct surrounding. This is illustrated on control during the G1/S phase of the cell cycle by its ultimate regulators: cyclins and cyclin dependent kinases. These proteins not only control the transition through the G1/S phase of the cell cycle, but also serve as mediators of the interaction between cells, and between cells and their surrounding. Defaults in the regulation of these proteins are associated with tumor progression, and, therefore, serve as targets for therapy. Defaults in those genes are found in various tumor types, although some of those prevail in particular tumor types. In this review emphasis is given to the defaults that occur in head and neck cancer.

Combined IL-2 and IL-12 gene therapy for murine head and neck squamous cell carcinoma

OBJECTIVE

To evaluate the efficacy of combined interleukin (IL)-2 gene and IL-12 gene therapy in murine model with head and neck squamous cell carcinoma (HNSCC).

METHODS

HNSCC model was established in the mouth floor of C3H/HeJ mice with SCCVII cell line. Lipid-IL2 and lipid-IL12 plasmid complexes were introduced either alone or in combination into the tumor by direct intratumor gene injection. Tumor size was measured before and after the treatment to evaluate the response of the different treatment and control groups. Enzyme-linked immunosorbent assay (ELISA) was used to measure the IL-2 and IL-12 expression. Lactic dehydrogenase (LDH) assay was used to evaluate the activity of Cytotoxic T-Lymphocyte (CTL) and natural killer (NK) cells.

RESULTS

Growth of HNSCC was significantly inhibited in combined IL-2 and IL-12 gene therapy group as compared with the other groups (P < 0.01). Increased level of IL-2 and IL-12 protein expression was found in both combined and single treatment groups. Greater activity of CTL and NK was also observed in these two groups as compared with the controls.

CONCLUSION

Both IL-2 and IL-12 gene therapy is able to inhibit the growth of HNSCC and induce the host antitumor immune response efficiently in the murine model. Combination of the two in gene therapy may be additive or synergistic in antitumor effect.

Effects of tracheotomy on respiratory mechanics in spontaneously breathing patients

Tracheotomy is a method of intubating the trachea, which is employed in several clinical settings, including the treatment of head and neck neoplasms. Tracheotomy is believed to facilitate weaning through changes in respiratory mechanics. Existing information concerning functional changes associated with tracheotomy are limited to comparisons with orotracheal intubation. In this study, respiratory mechanics were monitored in seven spontaneously breathing patients, before and after an elective tracheotomy was performed for surgical treatment of cancer. Campbell diagrams were constructed by plotting pressure, obtained with an oesophageal balloon catheter, against volume, obtained from a pneumotachograph placed at the airway opening. Work of breathing was calculated as the internal area of the Campbell diagram and was partitioned into its elastic and inspiratory and expiratory resistive components. Oesophageal pressure was also used to quantify intrinsic positive end-expiratory pressure (PEEPi) and the pressure-time product (PTP), which is considered to be proportional to the oxygen cost of breathing. PTP was divided into its resistive and elastic components. Inspiratory resistive work, PEEPi, inspiratory PTP, as well as its resistive and elastic components were significantly reduced by tracheotomy. Tracheotomy significantly reduces work of breathing and pressure-time product in spontaneously breathing patients.

Swallow function and perception of dysphagia in patients with head and neck cancer

BACKGROUND

The relationship between subjective complaints of dysphagia and objective measures of swallow function in patients with cancers of the oral cavity, pharynx, or larynx, treated with radiotherapy +/- chemotherapy has not been well documented in the literature.

METHODS

Swallowing function in 132 patients with various lesions was evaluated using videofluoroscopy and analyzed by patient complaint of dysphagia grouping.

RESULTS

Patients with complaints of dysphagia demonstrated significantly worse swallow function as indicated by lower oropharyngeal swallow efficiency (OPSE), longer transit times, larger residues, and more swallows with aspiration. Patients with complaints of dysphagia also tended to take less of their nutrition by mouth and less variety of food consistencies in their diet compared with those without complaint.

CONCLUSIONS

Patients were able to perceive decrements in their swallowing function as dysphagia and may have limited their oral intake in response to that perception. The ability to accurately perceive swallowing function may be useful for self-monitoring changes in dysphagia status during a course of swallow therapy.

Functional assessment using Constant's Shoulder Scale after modified radical and selective neck dissection

BACKGROUND

Constant's Shoulder Scale is a validated and widely applied instrument for assessment of shoulder function. We used this instrument to assess which treatment and demographic variables contribute to shoulder dysfunction after neck dissection in head and neck cancer patients.

METHODS

A convenience sample of 54 patients with 64 neck dissections and minimum follow-up of 11 months were evaluated. Thirty-two accessory nerve-sparing modified radical (MRND) and 32 selective neck (SND) dissections were performed. Multivariable regression analysis was used to determine the variables that were predictive for shoulder dysfunction. Clinical variables included age, time from surgery, handedness, weight, radiation therapy, neck dissection type, tumor stage, and site.

RESULTS

Patients receiving MRND had significantly worse shoulder function than patients with SND (p =.0007). Radiation therapy contributed negatively, whereas weight contributed positively (p =.0001).

CONCLUSIONS

The critical factors contributing to shoulder dysfunction after neck dissection were weight, radiation therapy, and neck dissection type.

The influence of clinical factors on human stimulated parotid flow rate in cancer and other patients

Reduced salivary secretion can produce a wide variety of complaints, having a negative impact on the daily life of a patient. Multiple causes of salivary hypofunction are described, however, there are no consistent data about the influence of clinical parameters on parotid gland function. We studied a group of patients with head and neck malignancies before treatment with radiotherapy. We used Lashley cups to collect stimulated parotid saliva simultaneously from both parotid glands. Sizes of the parotid gland, gender, age, tobacco and alcohol consumption, and tumour characteristics were related to the function of the parotid gland. A considerable variability in parotid output was found with a range of 0.03-1.66 ml/min (mean 0.34 ml/min). None of the variables were correlated with parotid flow. These results are important, especially when evaluating effects of radiation on parotid gland function.

Targeting hypoxia in head and neck cancer

The idea of 'targeting' hypoxia stems from recognition of the fact that oxygen (or its lack) is central to the practice of radiation oncology. Targeting embraces the alternative goals of trying to overcome hypoxia on the one hand and trying to exploit it on the other. This presentation briefly reviews these two approaches with major emphasis on the latter.