Hayes Martin lecture. Radiation-associated head and neck tumors

Photodynamic therapy of malignant and premalignant lesions in patients with 'field cancerization' of the oral cavity

The management of patients with 'field cancerization' of the oral mucosa, with multicentric foci of invasion, presents a considerable problem for the head and neck surgeon. Surgical resection of synchronous or metachronous primary squamous cell carcinomas, along with adjacent premalignant lesions, is likely to be associated with considerable mutilation. Photodynamic therapy (PDT) has been shown to be of value in the treatment of superficial tumours in the upper aerodigestive tract, with excellent healing of treated areas. This study reports the use of PDT to treat 11 patients with 'field cancerization' occurring in the oral cavity. Six patients had multiple primary cancers and five had single primary tumours. All had associated areas of leukoplakia. Each received Photofrin 2 mg/kg 48 hours prior to photoirradiation with 50-100 J/cm2 red laser light by surface illumination. Six to eight weeks later treated areas in 10 of the 11 patients showed a complete response to PDT; one patient had areas of residual leukoplakia. Two patients developed further areas of leukoplakia or erythroplakia within 12 months but no patient has had evidence of recurrent invasive carcinoma in the treated areas. Longer term follow-up will be necessary to exclude further recurrence. It is concluded that PDT offers an effective repeatable treatment option, whether on its own or as an adjunct to local excision, for patients with 'field cancerization' of the oral cavity.

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

A woman received radiation therapy to the adenoids for benign disease at the age of 10 years and subsequently developed an adenocarcinoma of the middle ear, a parathyroid adenoma, and a papillary carcinoma of the thyroid gland in adulthood. This appears to be the first such case on record. The literature of neoplasia after head and neck irradiation is briefly reviewed.

Salivary glands

A review of the more common inflammatory and neoplastic conditions affecting salivary glands has been presented. The use of hydration, massage, antibiotics, and steroids is effective initial treatment for suppurative sialadenitis and usually negates the need for surgical drainage. Total excision of the salivary gland and its duct is necessary in procedures for recurrent infection. Our technique for closure of the floor of the mouth after excision of the submandibular gland and Wharton's duct is described. Salivary neoplasms involving the parotid gland, the submandibular gland, and the minor salivary glands are treated on the basis of their histologic and local findings. Stepwise illustrations of our technique of parotidectomy and surgical considerations, including the counseling of a patient with a parotid mass, are presented to assist surgeons who care for patients with salivary disorders.

Radiation-induced basal-cell carcinoma

Four patients developed 129 basal-cell carcinoma (BCC) in areas of prior radiation without evidence of radiation damage. The time lag between radiation and appearance of the cancers was 20 years. It is proposed that we are dealing with a subset of the population not previously recognized. These patients were not related to other groups, such as the nevoid basal-cell carcinoma syndrome.

Radiation carcinogenesis in man: new primary neoplasms in fields of prior therapeutic radiation

Nine patients are presented in whom new malignant neoplasms developed in fields of prior irradiation. The prior irradiation had been administered to these patients for previously confirmed cancers, lesions suspected of being cancer (but never confirmed as such), and for non-neoplastic disorders. Each of these cases is relatively unique and several present the first association between prior radiation therapy and the subsequent neoplasm or neoplasms which developed.

Head and neck cancer: early detection

Tumors of the head and neck have a wide variety of presentations. Simply stated however, a sore or soreness that persists, a lump that persists, particularly if non-tender, or evidence of nerve dysfunction such as hoarseness, facial weakness, or dysphagia should alert the astute observer to the probable existence of a neoplastic rather than an inflammatory process. High-risk factors brought out in a careful history enhance the probability. Careful inspection and palpation may reveal the probable diagnosis. A skillful biopsy is essential. In this regard, aspiration needle biopsy as well as large gauge needle biopsy are receiving renewed interest. Our colleagues in biochemistry, radiology, and nuclear medicine are providing increasing support in detection and delineation of extent of tumor for the physician. Biochemical studies, particularly for the detection and delineation of extent of tumor for the physician. Biochemical studies, particularly for the detection of thyroid cases, are important. Ultrasound equipment is being developed that may give much improved delineation of lesion consistency. Xerography is superior in some instances to radiography. Nuclear scanning remains integral in the evaluation of thyroid nodules. Modifications upgrading computerized axial tomography apparatus show promise of giving better delineation of the extent of disease. Arteriography remains essential in the diagnosis of carotid body tumors.

The pathology of head and neck tumors: salivary glands, part 1

The surgical pathology of the head and neck is perhaps the most demanding of all subdivisions of pathology. It is demanding both for the pathologist and for the head and neck surgeon--who, as a team, must provide optimal patient care. Beginning with this issue of HEAD & NECK SURGERY, a series will be presented dealing with the clinicopathologic aspects of head and neck tumors. The authors have chosen to begin with the salivary glands, and in this report they present a concept of histogenesis and classification as well as an analysis of (1) salivary-gland tumors in children, (2) the relationship between breast carcinoma and salivary-gland carcinoma, (3) the status of radiation induction of salivary-gland tumors, and (4) the clinicopathologic aspects of tumors of the salivary oncocyte.