[Radiofrequency ablation as a palliative therapy option in ENT tumors: in vivo and in vitro testing]

BACKGROUND

High frequency thermotherapy (HFTT) is an established palliative therapy for hepatic malignancies. An in vivo and in vitro trial examined the preconditions for the application of HFTT with liquid-cooled wet electrodes for minimally invasive palliation of head and neck tumors.

MATERIAL AND METHOD

HFTT was applied with needle electrodes, cooled with isotonic saline solution, and a high-frequency generator (Elektrotom HiTT 106, Berchtold, Tuttlingen) to porcine tongue and narcotized, juvenile domestic pigs to the tongue and neck, and monitored in realtime by B-mode ultrasound.

RESULTS

The direction of spread of the hyperthermic zone is well observed using ultrasound. Determining the direction of spread is not possible with cooled-tip electrode needles. Severe complications were not observed during the application.

CONCLUSION

RFA with liquid-cooled needle applicators is not safely applicable for the therapy of head and neck tumors.

[Influence of ML-1 standardized mistletoe extract on the quality of life in head and neck cancer patients]

BACKGROUND

ML-1 standardized mistletoe extracts have been recommended for increasing the health-related quality of life in cancer patients.

PATIENTS AND METHODS

The EORTC questionnaire QLQ-C30((V2)) was given to a randomly chosen subgroup of 399 patients of a prospective, randomized, open, multi-center trial. A total of 200 patients from this trial were randomized for ML-1 treatment (1 ng/kg body weight ML-1 was injected subcutaneously twice weekly over a 60-week period. Treatment cycles of 12 weeks were followed by a break of 4 weeks (between weeks 12-16, 28-32, and 44-48)). The remaining 199 patients formed the control group.

RESULTS

Patients completed questionnaires before the start of their treatments at week 0 and continued until week 156. The compliance rate was high: 3611 questionnaires were available, which equals a median of nine longitudinal measurements per patient between weeks 0 and 156. Analysis did not indicate any improvement in the quality of life for either group. A significant decrease in quality of life, however, was seen in patients undergoing radiotherapy. In these patients, the global state of health was reduced and four symptom scales were significantly worse.

CONCLUSION

Our results demonstrated no improvement in the quality of life in head and neck cancer patients when treated with ML-1 extract.

[Laryngo-hypopharyngo-esophagectomy in advanced hypopharyngeal carcinoma. Is radical surgery intervention still justified today?]

Minimal invasive laser surgery with preservation of the organs is well established in the treatment of hypopharynx carcinoma. In cases of advanced tumors of the hypopharynx, which can not be managed by laser surgery, the combined radio-chemo therapy becomes the treatment of choice because of the low morbidity and the comparable results. The indication for an operative procedure, which means loss of larynx and oesophagus, is seen more and more restrictively. From 1993 to 1997 101 patients with advanced neoplasm of the hypopharynx or larynx (larynxcarcinoma T4; hypopharynx carcinoma T3-T4 with N > 2b) were treated in the Department of Otolaryngology of the University of Regensburg. 5 of these patients underwent a laryngohypopharyngoesophagectomy. Only patients with a severe dysfunction of the larynx (dyspnea, dysphagia, aspiration) were selected for this procedure. Postoperative complications were: one insufficiency of anastomosis with secondary bleeding and five pleura effusions. In all cases postoperative radiation began within six weeks after the operation. All patients were nourished orally when they were discharged from hospital. The mean follow up was 21 months. During this time none of the patients died. In one case pulmonary metastasis was found after 11 months. In another case a regional recurrence was diagnosed after 11 months and was removed by operation. No local recurrence was found at that time. This operative procedure can be done only in experienced and well trained medical centers. Furthermore excellent cooperation of the operating teams and strong regard to the selection criteria is obligatory.

The effect of an adjuvant mistletoe treatment programme in resected head and neck cancer patients: a randomised controlled clinical trial

The effect of an adjuvant mistletoe extract treatment was tested in a prospective, randomised controlled clinical trial involving 477 patients with head and neck squamous cell carcinoma. The patients were stratified into two treatment groups that underwent surgery or surgery followed by radiotherapy and both groups were randomised for additional treatment with mistletoe extract. Patients treated with a mistletoe lectin-1 (ML-1) standardised mistletoe preparation had no lower risk of local/locoregional recurrences, distant metastases or second primaries. In the main analysis based on 202 patients treated with surgery and 275 patients treated with surgery and radiotherapy the adjusted hazard ratio for the disease-free survival (DFS) was 0.959 (95% confidence interval (CI) 0.725-1.268). The 5-year survival rates of patients from the mistletoe group were no better than the survival rates of patients from the control group. Furthermore, no significant changes in the cellular immune reaction or in quality of life could be detected. We conclude that the used mistletoe preparation has no indication in the adjuvant treatment of patients with head and neck cancer.

MRI detection of olfactory bulb and tract

Thirty healthy volunteers underwent MRI with 3D MP-RAGE, 3D CISS and 2D turbo spin echo sequences to compare the detectability of olfactory fibers, bulb, tract, and sulcus. The overall detectability was slightly better using MP-RAGE compared with CISS. Both 3D sequences were superior to 2D turbo spin echo. We therefore recommend including the MP-RAGE sequence in an MR imaging protocol of the olfactory nerve.

[Cervical thymic cysts in the differential diagnosis of lateral neck tumors. Case report]

Cervical thymic cysts belong to the rare causes of neck masses and therefore are frequently not included in a preoperative differential diagnosis. Here we report our experience in managing a 7-year-old boy who presented with a three-month history of a lateral neck mass causing stridor during sleep. Clinical findings and macroscopic and histopathological features are described and reviewed with respect to the available literature. The inclusion of a cervical thymic cyst in a preoperative differential diagnosis is important for determining the extent of the neck mass and planning any surgical procedure.

[Comparative voice quality evaluation after laser surgical versus fronto-lateral partial laryngectomy in T1b and T2 vocal cord carcinoma]

BACKGROUND

We conducted a study to compare the voice quality after transoral endolaryngeal laser surgery versus anterolateral partial laryngectomy in terms of ability to communicate effectively.

MATERIAL AND METHODS

Two groups each of 8 patients were reexamined at least 6 months after either a laser surgical or a partial anterolateral laryngectomy for a T1b or T2 vocal chord carcinoma was performed by the same surgeon. The following examinations were conducted: video-laryngoscopy, video-stroboscopy, phonetogram when reading a standard text or when speaking and shouting, voice load test, respiratory flow measurement, auditive voice rating following the RBH model, and auditive rating of the voice by the patients according to a questionnaire.

RESULTS

A voice disorder with a medium-grade dysphony and an essential limitation of the speaking and shouting voice function and voice quality was detected in both groups of patients. No significant differences were observed in any of the parameters evaluation in both groups of patients.

CONCLUSIONS

Both surgical techniques appear to be equivalent in terms of postoperative voice function. However, the tracheotomy was avoided in the patients undergoing laser surgery.

Delayed facial palsy following uneventful middle ear surgery: a herpes simplex virus type 1 reactivation?

In rare cases, a facial palsy appears a few days after uneventful middle ear surgery. The reason for this delayed palsy is unclear. One hypothesis is that it results from a reactivation of herpes simplex virus type 1 (HSV-1) in the geniculate ganglion of the facial nerve. From 1987 to 1996, in the course of over 1,800 middle ear operations, we observed 7 ipsilateral delayed facial palsies and investigated 5 of them using immunologic and virologic methods, including the polymerase chain reaction (PCR). We could detect HSV-1 genome with the nested primer PCR in the tongue swabs of 4 of the 5 examined patients with delayed facial palsy. The immunologic changes in these palsies are also compatible with a reactivation of HSV-1. We conclude that minimal stimulation of the facial nerve during middle ear surgery could result in a reactivation of HSV-1 in the geniculate ganglion, which may in turn lead to a facial palsy.

MRI of the hypopharynx with provocative maneuvers

The purpose of this study was to assess the validity of magnetic resonance (MR) functional images of the hypopharynx. Following T2-weighted spin-echo sequences during quiet respiration, contrast enhanced 2D-Turbo-FLASH sequences were obtained during Valsalva-maneuver, quiet respiration, A- and U-phonation, respectively. Tumor detection was clearly improved using functional MRI (sensitivity of 97.4%, specificity 83.3%, accuracy 95.5%) when compared with MRI during quiet respiration (sensitivity of 87.1%, specificity 33.3%, accuracy 80%). Rapid MR sequences such as 2D-Turbo FLASH allow functional imaging of the hypopharynx, thereby improving MR diagnosis of hypopharyngeal tumors.

Herpes simplex virus type I reactivation as a cause of a unilateral temporary paralysis of the vagus nerve

Infection by neurotropic viruses, as exemplified by the herpes family, is universally accepted as a cause of palsies of the cochleo-vestibular and facial nerve. Palsies of the vagus nerve with a possible viral etiology have been described, although viruses have been identified in only a few selected cases. We report a 52-year-old man with unilateral otalgia, hoarseness and dysphagia. Examination revealed unilateral (left-sided) pharyngeal dysfunction, and paralysis of the left vocal cord fixed in the paramedian position. A barium swallow documented dysfunction of the left pharyngeal constrictor muscles. These findings suggested the lesion to be located either at the inferior ganglion of the vagus nerve or cranially. At direct laryngoscopy a smear was obtained from a 4-mm mucosal ulcer at the region of the left arytenoid cartilage. This smear demonstrated antibodies to herpes simplex virus (HSV) type I by immunofluorescence. On follow-up 19 months after the initial infection there was complete remission of the paralysis of the left vocal cord and normal pharyngeal function. The demonstration of HSV type 1 antibodies from a mucosal lesion in the distribution of the superior laryngeal nerve suggests that reactivation of HSV type I was the most likely explanation for the temporary nerve palsy seen.

Characterization of sugar receptor expression by neoglycoproteins in oral and oropharyngeal squamous cell carcinomas

Recognition of the carbohydrate part of cellular glycoconjugates by sugar receptors like lectins may contribute to biosignaling and interactions between normal and transformed cells. Such recognitions may be essential for establishing phenotypic characteristics in neoplastic cells, including metastasis-associated properties. To evaluate various glycoconjugates in tumor diagnosis and clinical therapy, a panel of 18 biotinylated neoglycoproteins was prepared. This included conjugates of a histochemically inert carrier protein and crucial sugar moieties such as D-glucuronic acid, alpha- and beta-N-acetyl-galactosamine, beta-N-acetyl-glucosamine, melibiose, lactose, maltose, cellobiose, mannose, mannose-6-phosphate, fucose, rhamnose, and xylose. In so doing the diazo derivative of the respective p-aminophenyl glycosides was coupled with galactose, beta-N-acetyl-galactosamine or beta-N-acetyl-glucosamine via an epoxy group-containing aliphatic spacer. Other glycoconjugates used were the proteoglycan heparin and the sulfated fucan fucoidan. Labeling was effected with cyanogen bromide activation and aminoalkylation for specific detection of endogeneous sugar receptors, especially lectins. Tissues studied were paraformaldehyde-fixed, paraffin-embedded surgical biopsies from patients with different stages of squamous cell carcinomas (SCCs) of the oral cavity (n = 16) and oropharynx (n = 17), including three lymph node metastases from oropharyngeal primary tumors. Semiquantitative binding differences of probes to tumor stages were evaluated statistically by the Mann-Whitney U-Wilcoxon rank sum W test. Specific binding of a probe to cytoplasmic and nuclear structures was detected with apparent quantitative differences. Overall, the cytoplasmic compartment revealed a higher intensity of histochemical reaction than did nuclear structures, indicating a comparatively higher density of specific carbohydrate receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Will neoadjuvant chemotherapy affect the capacity of head and neck squamous cell carcinoma to bind neoglycoproteins?

Evidence is growing that the carbohydrate portion of glycoconjugates is not merely an inert structural addition to the protein or lipid background, but is involved in normal and altered physiological processes. Conjugation of the potentially bioactive carbohydrate ligand to an inert labeled carrier generates the tools to histochemically monitor the presence of sugar receptors like lectins in tissue sections. In head and neck squamous cell carcinoma endogenous lectins have been systematically characterized by a selected panel of conjugates of such synthetic probes. In this investigation we provide evidence that the antineoplastic agents carboplatin and 5-fluorouracil influence the expression of carbohydrate-binding receptors. In cases with a statistically significant alteration, an increasing loss of binding capacity from treatment cycle to cycle was observed in cytoplasmic areas. This means that the extent of binding of beta-N-acetyl-galactosamine, cellobiose, galactose, and sialic acid was affected. The pattern of diminished binding capacity in nuclear structures encompassed beta-N-acetyl-galactosamine, beta-N-acetyl-glucosamine, sialic acid as carbohydrate part of the neoglycoprotein. Thus, exposure to certain chemotherapeutic agents clearly influences the capacity of tumor cells to mediate protein-carbohydrate interactions. Concomitant with the elucidation of the functions of such an interplay the significance of this down-regulation will be apparent.