Multiple head and neck neoplasia following radiation for benign disease during childhood

Results of Treatment of Squamous Cell Carcinoma of Maxillary Sinus: A 26-Year Experience

BACKGROUND

Five-year survival in squamous cell carcinoma of maxillary antrum is low. This article examines the results of various approaches to treatment as given in our hospital in past 26 years.

METHODS

From 1979 to 2005, 379 patients with squamous cell carcinoma of maxillary antrum managed with curative intent were studied. Twenty-eight patients had T2, 237 patients had T3, and 114 had T4 tumors. The N classification was N0 in 316 patients, N1 in 21 patients, N2a in 28 patients and N2b in 14 patients. Treatment to the primary site comprised of surgery (Sx) and radiation therapy (RT) in 284 patients, RT alone in 57 patients and chemotherapy (CTx) with radiotherapy in 38 patients.

RESULTS

There was a difference in survival between patients who underwent Sx with RT compared with patients who received RT alone or CTx with RT. The most common pattern of recurrence was in the primary site, 187 (49.3%) patients. Local control at 3 and 5 years was 71% and 63.8% respectively in Sx with RT, 31.6% and 28% respectively in RT, and 28.9% and 26% in CTx with RT group.

CONCLUSIONS

The type of treatment to the primary site is an important determinant of survival and local control. Surgery with radiation is a better treatment option.

Systematic esophageal endoscopy screening in patients previously treated for head and neck squamous-cell carcinoma

BACKGROUND

An attempt was made to improve metachronous oesophageal cancer prognosis through bi-annual systematic esophageal endoscopy screening in patients treated for head and neck cancer.

PATIENTS AND METHODS

Bi-annual esophageal endoscopy, without a staining procedure, was performed in 1560 patients from 1987 to 1997. The distribution of previous head and neck cancer was oral cavity (20%), oropharynx (30%), hypopharynx (34%), and larynx (16%). All patients had initial panendoscopic inspection before HNSCC treatment. Esophageal tumors were considered to be second synchronous primaries when discovered within the first six months of initial tumor diagnosis.

RESULTS

Fifty metachronous esophageal asymptomatic cancers (42 T1 and 7 in situ carcinomas) were diagnosed by endoscopy. The median time between the HNC and the esophageal carcinoma was 43 months (7-137 months). Metachronous esophageal carcinoma was discovered in 2.6% of patients with oral cavity tumor, 5.7% of patients with oropharynx tumor, 2.3% of patients with hypopharynx tumor, and 1.7% of patients with larynx tumor. Causes of death were: 41.1% related to esophageal tumor with tumor progression, metastatic evolution, or treatment toxicity; 28.9% related to non malignant causes; 26.6% related to a cancer that was not of esophageal origin.

CONCLUSIONS

Over a 10-year period, systematic bi-annual esophageal endoscopy uncovered metachronous esophageal tumors in 3.2% of 1560 patients originally treated for head and neck carcinoma, developing in a median time of 47 months. Patients with initial oropharyngeal tumors had a significantly higher risk of metachronous esophageal SCC, compared to the other tumor sites (P < 0.02 with Fisher exact test). Given the elevated death rate not related to the esophageal cancer and the median survival of 16 months, any potential benefit from this time-consuming procedure is debatable.

Thyroid and thymic malignancy following childhood irradiation

Synchronous thyroid and thymic malignancy following childhood thymic irradiation has only been reported in two known cases previously, with a third case identified here. A rationale is presented for following these radiated patients as they age with thyroglobulin and thyroid-stimulating hormone (TSH) levels as a measure of risk of the development of nodular thyroid disease and, if such occurs, for an aggressive surgical approach. There exists a growing population at risk attributable to the success of radiation treatment of Hodgkin's and pediatric head and neck tumors. The question is raised regarding the theoretical benefits of thyroid suppressive therapy in this group at risk. With the instructive case presented, radical surgery for either thymic or thyroid carcinoma and careful monitoring for decades-late local recurrences of thymoma are suggested.

Effect of radiotherapy on oral mucosa assessed by quantitative exfoliative cytology

The effect of radiotherapy on normal buccal mucosa was investigated using the quantitative techniques of cytomorphology (measurement of nuclear and cytoplasmic area) and DNA cytophotometry. These techniques were applied to smears obtained before, during, and after irradiation. Nuclear area and cytoplasmic area increased and DNA values were abnormal in most cases as a result of radiotherapy, returning to within normal limits one month after treatment. This contrasts strongly with the changes seen in smears from previously irradiated uterine cervices, where changes in cytomorphology may persist for several years.