• Journal of Magnetics
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• 제21권3호
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• pp.425-430
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• 2016

The aim of this study was to measure the setup variation for X (lateral), Y (longitude), and Z (vertical) by taking magnetic megavoltage computed tomography (MVCT) before treating the brain, oropharynx, lung, and prostate patients on helical tomotherapy. In this study, 30 patients were chosen for each of the treatment areas, and their skin was labeled with a mark on a treatment planning reference point when taking CT. We preceded MVCT prior to tomotherapy and then conducted an auto registration based on the bony landmarks; image registration was used for automatically matching the patient's setup. Lastly, we confirmed and evaluated the translation coordinates of the images for 30 patients. The following shows the comparison result of the setup errors of each part: X (lateral) showed the highest setup errors with $3.44{\pm}2.05$ from Lung; Y (longitude) showed the highest setup errors showing $3.40{\pm}2.87mm$ from Prostate; and Z (vertical) showed the highest setup errors showing $6.62{\pm}4.38mm$ from Lung. This result verifies that the setup error can be prevented by taking MVCT before the treatment, and Planning Target Volume (PTV) margins can be reduced by referring to the resulting value of each treatment part. Ultimately, the dosage of the normal organs can be decreased as well as any side effects.

• Asian Pacific Journal of Cancer Prevention
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• 제15권18호
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• pp.7891-7895
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• 2014

Background: Tobacco products continue to be used in large quantities in India despite the mandatory inclusion of pictorial health warnings (PHWs) on all tobacco packaging. The circumstances as to how people could continue the use of tobacco to the point of developing head and neck cancer despite enhanced awareness about the ill effects of tobacco is the main focus of this study. Materials and Methods: This study concerned patients with least 5-years history of tobacco use, having been diagnosed with histopathologically proven malignancies of the hypopharynx, larynx, oropharynx and oral cavity presenting at the Government Medical College-Haldwani, Nainital, India. A total of 183 patients were eligible for inclusion during July 1 2013 - June 30 2014. Of these, 59 patients used smoked tobacco exclusively, 22 patients used smokeless tobacco exclusively, and 102 patients used both forms of tobacco. Among users of smoked forms, 75.2% (n=121) were beedi users, and 24.8% (n=40) were cigarette users. Patients were asked direct questions as to whether they had noticed the presence of PHWs upon tobacco products. The reasons as to why PHWs were not effective in stopping the patients from tobacco use were investigated. Results: Of the 183 patients, 146 reported being aware about the presence of PHWs, and when they were asked reasons as to why they continued tobacco despite being aware of ill-effects, the commonest reason chosen (by 53.4%) was that patients had not regarded themselves as using tobacco heavy enough to cause cancer. Among the 36 patients who reported as being oblivious to the presence of PHWs on tobacco products, 63.9% reported that the products they used never displayed any PHWs, and 36.1% reported never having paid attention to the packaging. The awareness about PHWs was higher among cigarette smokers in comparison to beedi smokers (100% vs 76.1%, p=0.0002). Conclusions: Locally produced and marketed tobacco products such as beedis and oral tobacco often fail to display PHWs. The presence of PHWs without doubt enhances awareness about the carcinogenic risks of tobacco. However, enhanced awareness alone may not be enough, and as elucidated by this study, some persons continue to use tobacco to the point of developing malignancies. The need of the hour is the implementation of legal and economic sanctions discouraging the use of tobacco products.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.611-616
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• 2009

Purpose: The rate of fistulas occuring followed by resection of oral cavity, oropharyngeal, hypopharyngeal, and laryngeal cancer are reported to be 9 ~ 23% according to various documents. Neglected treatment of the fistula can result in a setback in proper treatment with restrictions in oral intake leading to delayed return to daily life. Furthurmore, in severe cases, it may injure important vessels and adjacent structures of the neck area. The author reviewed previously reported cases of treatment methods for fistulas recurring after diverse head and neck operations and with sharing the treatment experiments of our patients, we tried to present a treatment algorism for different fistula types. Methods: Our study was based on retrograde analysis of 64 patients who were clinically diagnosed with fistula after operation for cancer of the head and neck from 1997 to 2008 at Severance Hospital. Their primary sites of cancer were 8 oral cavity, 22 oropharynx, 25 hypopharynx, and 9 larynx. The patients were aged 45 to 75 years and the male to female ratio was 11 to 1. The patient's operation records and progress notes were evaluated for determination of degree of fistula and treatment methods. Results: Most fistulas were clinically suspected after postoperative 5 days and symptoms noted for detection of the fistula were erythema, purulent discharge, edema, tenderness, and fluctuation. The fistula was definitely diagnosed at postoperative 2 weeks with barium test and treatment method ranging from conservative management to operative procedure were applied to each patients. Total 21 patients were managed with conservative protocol. In 15 cases, direct repair of the fistula was done and more stable repair of the fistula was possible with using of TachoComb$^{(R)}$. Pharyngostoma was performed in 14 patients. Among them, 4 patients healed spontaneously, 5 patients were taken direct closure, 4 patients were taken pectoralis major musculocutaneous flap, and one patient was taken esophageal transfer. The other 14 patients were taken 11 pectoralis major musculocutaneous flaps and 3 free flaps without pharyngostoma formation. Conclusion: Fistula is a troublesome complication resulting after resection of head and neck cancer. Early detection and adequate treatment according to the period and condition of the fistula may prevent further complications and reduce the pain of the patient.

• Asian Pacific Journal of Cancer Prevention
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• 제16권16호
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• pp.7025-7029
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• 2015

Background: The optimal sequence and extent of multimodality therapy remains to be defined for extrapulmonary small cell carcinoma because of its rarity. The purpose of our study was to assess the response to neoadjuvant chemotherapy followed by chemoradiation/radiation in patients with extrapulmonary small cell carcinoma. Materials and Methods: Four consecutively diagnosed patients were included in this study. The primary tumor site was oropharynx in three patients and esophagus in one. The patients with the limited disease were treated with chemotherapy followed by concurrent chemoradiation (n=2) or radiotherapy (n=1). The patient with the extensive disease with the primary site in vallecula was treated with chemotherapy and palliative radiotherapy to the metastatic site. Results: The median follow-up was 22.5 months (range, 8-24 months). Three patients with the limited disease (base of tongue, n=2; esophagus, n=1) were in complete remission. The patient with the extensive disease died of loco-regional tumor progression at 8 months from the time of diagnosis. Conclusions: The combination of chemotherapy and radiotherapy is the preferred therapeutic approach for patients with extrapulmonary small cell carcinoma. Induction chemotherapy followed by concurrent chemoradiation or radiation provides a good loco-regional control in patients with limited disease.

• Archives of Plastic Surgery
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• 제44권6호
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• pp.530-538
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• 2017

Background A pharyngocutaneous fistula is a common and difficult-to-manage complication after head and neck reconstruction. It can lead to serious complications such as flap failure, carotid artery rupture, and pharyngeal stricture, and may require additional surgery. Previous radiotherapy, a low serum albumin level, and a higher T stage have been proposed as contributing factors. We aimed to clarify the risk factors for pharyngocutaneous fistula in patients who underwent flap reconstruction and to describe our experiences in treating pharyngocutaneous fistula. Methods Squamous cell carcinoma cases that underwent flap reconstruction after cancer resection from 1995 to 2013 were analyzed retrospectively. We investigated several significant clinical risk factors. The treatment modality was selected according to the size of the fistula and the state of the surrounding tissue, with options including conservative management, direct closure, flap surgery, and pharyngostoma formation. Results A total of 127 cases (18 with fistulae) were analyzed. A higher T stage (P=0.048) and tube-type reconstruction (P=0.007) increased fistula incidence; other factors did not show statistical significance (P>0.05). Two cases were treated with conservative management, 1 case with direct closure, 4 cases with immediate reconstruction using a pectoralis major musculocutaneous flap, and 11 cases with direct closure (4 cases) or additional flap surgery (7 cases) after pharyngostoma formation. Conclusions Pharyngocutaneous fistula requires global management from prevention to treatment. In cases of advanced-stage cancer and tube-type reconstruction, a more cautious approach should be employed. Once it occurs, an accurate diagnosis of the fistula and a thorough assessment of the surrounding tissue are necessary, and aggressive treatment should be implemented in order to ensure satisfactory long-term results.

• Asian Pacific Journal of Cancer Prevention
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• 제15권10호
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• pp.4147-4152
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• 2014

Standard therapy for advanced head and neck cancer consists of a combination of surgery and radiation. However, survival of this patient population has not improved during the past 20 years. Many different multimodality treatment schedules have been proposed, and chemotherapy is often used with the intent of organ preservation. The present study was intended to establish the efficacy of concomitant chemoradiation with a single agent carboplatin in advanced head and neck cancers.The objectives were to investigate the feasibility of concomitant administration of carboplatin, monitor acute toxicity during radiotherapy, and determine subacute side effects, such as wound healing following surgery after chemoradiotherapy. A prospective study was conducted wherein a total of 40 patients with stage III and IV squamous cell carcinomas of oral cavity, oropharynx, hypopharynx and larynx were enrolled. All patients were treated with external beam radiotherapy and weekly carboplatin area under curve (AUC of 5). Radiotherapy was given in single daily fractions of 1.8-2 grays (Gy) to a total dose of 66-72 Gy. Salvage surgery was performed for any residual or recurrent locoregional disease. Neck dissection was recommended for all patients with neck disease showing less than a complete response after chemoradiation. A total of 40 patients were enrolled of whom 32 were males and 8 were females. Highest incidence of cancer was seen in the 5th-6th decades of life with a median age of 47.7 years. Oropharyngeal tumours constituted a maximum of 21 patients followed by hypopharynx in 10, larynx in 7 and oral cavity in 2. 80% of the patients had a neck node on presentation of which 40% had N2-N3 nodal status. TNM staging revealed that 58% of patients were in stage III and 43% in stage IV. Evaluation of acute toxicity revealed that 50% had grade II mucositis, 25% grade III mucositis, 2.5% grade IV mucositis. 50% of patients had grade I skin reactions, 65% of patients had grade I thrombocytopenia, and 24% of patients had grade I anaemia. After completion of treatment 65% of patients had complete response at the primary and regional sites, and 35% of patients had a partial response of whom 23% underwent neck dissection and 5% of them underwent salvage surgery at the primary site. At the end of one year there were six deaths and four recurrences and 70% were free of disease. Concurrent chemoradiation with carboplatin provided good locoregional control for locally advanced head and neck cancers. This regimen, although toxic, is tolerable with appropriate supportive intervention. Primary site conservation is possible in many patients. Chemoradiotherapy appears to have an emerging role in the primary management of head and neck cancers.

• Archives of Plastic Surgery
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• 제40권4호
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• pp.353-358
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• 2013

Background Robots have allowed head and neck surgeons to extirpate oropharyngeal tumors safely without the need for lip-split incision or mandibulotomy. Using robots in oropharyngeal reconstruction is new but essential for oropharyngeal defects that result from robotic tumor excision. We report our experience with robotic free-flap reconstruction of head and neck defects to exemplify the necessity for robotic reconstruction. Methods We investigated head and neck cancer patients who underwent ablation surgery and free-flap reconstruction by robot. Between July 1, 2011 and March 31, 2012, 5 cases were performed and patient demographics, location of tumor, pathologic stage, reconstruction methods, flap size, recipient vessel, necessary pedicle length, and operation time were investigated. Results Among five free-flap reconstructions, four were radial forearm free flaps and one was an anterolateral thigh free-flap. Four flaps used the superior thyroid artery and one flap used a facial artery as the recipient vessel. The average pedicle length was 8.8 cm. Flap insetting and microanastomosis were achieved using a specially manufactured robotic instrument. The total operation time was 1,041.0 minutes (range, 814 to 1,132 minutes), and complications including flap necrosis, hematoma, and wound dehiscence did not occur. Conclusions This study demonstrates the clinically applicable use of robots in oropharyngeal reconstruction, especially using a free flap. A robot can assist the operator in insetting the flap at a deep portion of the oropharynx without the need to perform a traditional mandibulotomy. Robot-assisted reconstruction may substitute for existing surgical methods and is accepted as the most up-to-date method.

• Asian Pacific Journal of Cancer Prevention
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• 제14권8호
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• pp.4769-4774
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• 2013

This paper is the first to present the incidence and overall survival of patients with squamous cell carcinoma of the head and neck (SCCHN) from the extreme northern part of the Philippines. We retrospectively retrieved the records of patients with histologically-confirmed squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx and larynx at the Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines, from 2003 to 2012 and analysed prognostic factors associated with survival. Of the 150 cases, only 80 (53.3%) were still living when the study was terminated. Median age at initial diagnosis was 61.5 years and the male to female ratio was 7:3. The majority of the cases had tumours in the oral cavity (50.7%), followed by the larynx (36.7%). Sex (log rank=1.94, p value/${\alpha}$=0.16), tumor site (log rank=0.02, p value/${\alpha}$=0.90), tumor grade (log rank=1.74, p value/${\alpha}$=0.42), and node stage (log rank=0.07, p value/${\alpha}$=0.80) were not shown to be associated with the survival of our cases. Only 45 (30.0%) had no regional lymph node involvement (N0) at presentation and 12 (8.0%) had already developed distant metastases. Among the 150 patients, 71 (47.3%) were not able to receive treatment of any kind. Oddly, treatment (log rank=1.65, p value/${\alpha}$=0.20) was also shown to be not associated with survival. The survival rate of those who underwent surgery, radiotherapy, or both was not statistically different from those who did not receive any treatment. Only the tumor stage (log rank=4.51, p value/${\alpha}$=0.03) was associated with patient survival. The overall mean survival was 49.3 months, with survival rate diminishing from 88.3% during the 1st year to 1.80% by end of the study. This relatively low survival rate of our cases only reflects their poor access to quality diagnostic and treatment facilities.

• Asian Pacific Journal of Cancer Prevention
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• 제16권8호
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• pp.3333-3338
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• 2015

Background: This study was conducted to analyze positron emission tomography (PET) / computed tomography (CT) and magnetic resonance imaging (MRI) performance with oropharyngeal non-Hodgkin's lymphoma (ONHL).Materials and Methods: The complete image data of 30 ONHL cases were analyzed, all patients were performed PET / CT and MRI examination before the treatment, with the time interval of these two inspections not exceeding 14 days. The distribution, morphology, MRI signal characteristics, enhancement feature, standardized uptake value (SUV) max value and lymph node metastasis way of the lesions were analyzed. Results: Among the 30 cases, 23 cases were derived from the B-cell (76.7%), 5 cases were derived from the peripheral T cells (16.7%) and 2 cases were derived from the NK/T cells (6.7%). 19 cases exhibited the palatine tonsil involvement (63.3%). As for the lesion appearance, 10 cases appeared as mass, 8 cases were the diffused type and 12 cases were the mixed type. 25 cases exhibited the SUVmax value of PET / CT primary lesions as 11 or more (83.3%). MRI showed that all patients exhibited various degrees of parapharyngeal side-compressed narrowing, but MRI still exhibited the high-signal fat, and the oropharyngeal mucosa was intact. 25 cases were associated with the neck lymph node metastasis, among who 22 cases had no necrosis in the metastatic lymph nodes, while the rest 3 cases exhibited the central necrosis in the metastatic lymph nodes. Conclusions: PET / CT and MRI have important value in diagnosing and determining the lesion extent of ONHL.

• Radiation Oncology Journal
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• 제21권2호
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• pp.112-117
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• 2003

Purpose: The effects of hypefractionation radiation therapy, such as the failure pattern and survival, on the treatment results in advanced stage head and neck cancer were studied. Materials and Methods: Between September 1990 and October 1998, 24 patients with advanced stage (III, IV) head and neck cancers, were treated using hyperfractionation radiation therapy in the Department of Radiation Oncology at the Keimyung University Dongsan Medical Center. The male to female ratio was 7 : 1, and the age range from 38 to 71 years with the median of 56 years. With regard to the TNM stage, 11 patients were stage III and 13 were stage IV. The sites of primary cancer were the nasopharynx in six, the hypopharynx in 6, the larynx in five, the oropharynx in three, the maxillary sinus in three, and the oral cavity in one patient. The radiotherapy was delivered by 6 MV X-ray, with a fraction size of 1.2 Gy at two fractions a day, with at least 6 hours inter-fractional interval. The mean total radiation doses was 72 Gy, (ranging from 64.4 to 75.8 Gy). Follow-up periods ranged between 3 and 136 months, with the median of 52 months. Results: The overall survival rates at 3 and 5 years in all patients were 66.7$\%$, and 52.4$\%$. The disease-free survival rates at 3 and S years (3YDFS, 5YDFS) in all patients were 66.7$\%$ and 47.6$\%$. The 3YDFS and 5YDFS in stage III patients were 81.8$\%$ and 63.6$\%$, and those in stage IV patients were 53.8$\%$ and 32.3$\%$. Ten patients were alive with no local nor distant failures at the time of analyses. Six patients (25$\%$) died due to distant metastasis and 12.5$\%$ died due to local failure. Distant metastasis was the major cause of failure, but 2 patients died due to unknown failures and 3 of other diseases. The distant metastasis sites were the lung (3 patients), the bone (1 patient), and the liver (2 patients). One patient died of second esophageal cancer. There were no severe late complications, with the exception of 1 osteo-radionecrosis of the mandible 58 months after treatment. Conclusion: Although this study was peformed on small patients group, we considered hypefractionated radiation therapy for the treatment of advanced stage head and neck cancer might improve the disease free survival and decrease the local failure with no increase in late complications despite of the slight Increase in acute complications.