Paragangliomas of the head and neck are rare, slow-growing, generally benign tumors of neuroendocrine cells associated with the peripheral nervous system that commonly involve the carotid body, ...jugular bulb, vagal ganglia, and temporal bone. Treatment options include surgery, radiotherapy (RT), stereotactic radiosurgery (SRS), and observation. This article briefly reviews our 45-year institutional experience treating this neoplasm with RT.
From January 1968 through March 2011, 131 patients with 156 benign paragangliomas of the temporal bone, carotid body, jugular bulb, or glomus vagale were treated with RT at a median dose of 45 Gy in 25 fractions. The mean and median follow-up times were 11.5 years and 8.7 years, respectively.
Five tumors (3.2%) recurred locally after RT, all within 10 years of treatment. The overall local control rates at 5 and 10 years were 99% and 96%, respectively. The cause-specific survival rates at 5 and 10 years were 98% and 97%, respectively. The distant-metastasis free survival rates at 5 and 10 years were 99% and 99%, respectively. The overall survival rates at 5 and 10 years were 91% and 72%, respectively. There were no severe complications.
RT for benign head and neck paragangliomas is a safe and efficacious treatment associated with minimal morbidity. Surgery is reserved for patients in good health whose risk of associated morbidity is low. SRS may be suitable for patients with skull base tumors <3 cm where RT is logistically unsuitable. Observation is a reasonable option for asymptomatic patients with a limited life expectancy.
Management of T1–T2 glottic carcinomas Mendenhall, William M.; Werning, John W.; Hinerman, Russell W. ...
Cancer,
1 May 2004, Letnik:
100, Številka:
9
Journal Article
Objectives/Hypothesis:
To discuss our experience with the diagnostic evaluation in patients with squamous cell carcinomas (SCCAs) of the head and neck metastatic to the cervical lymph nodes from an ...unknown primary site.
Methods:
Between June 1983 and December 2008, 236 patients were evaluated with lymph node biopsy, computed tomography (CT), and/or magnetic resonance imaging (MRI) of the head and neck, and panendoscopy with directed biopsies. Additional studies included fluorodeoxyglucose–single photon emission computed tomography (FDG‐SPECT) in 26 patients and FDG‐positron emission tomography (FDG‐PET) or FDG‐PET/CT in 21 patients. Seventy‐nine patients underwent an ipsilateral (72) or bilateral (seven) tonsillectomy.
Results:
An occult primary site was detected in 126 patients (53.4%); six patients had two synchronous primary cancers. The most common primary sites were in the tonsillar fossa (59 patients; 44.7%) and the base of tongue (58 patients; 43.9%). The primary site was found in 21 (29.2%) of the 72 patients with no suspicious findings on physical exam and/or radiographic evaluation compared with 105 (64.0%) of 164 remaining patients. Tonsillectomy revealed the primary cancer in 35 (44.3%) of 79 patients. FDG‐SPECT and FDG‐PET or FDG‐PET/CT was the sole method of primary site detection in only one patient (2.1%) of 47 patients.
Conclusions:
Diagnostic evaluation should include a thorough physical examination, CT and/or MRI of the head and neck, and panendoscopy with directed biopsies. Unilateral or bilateral tonsillectomy should be performed on patients with adequate lymphoid tonsillar tissue. FDG‐PET or FDG‐PET/CT should be considered for those with indeterminate findings on physical examination and/or head and neck CT and/or MRI if those sites are located outside of the oropharynx. Laryngoscope, 2009
Adenoid cystic carcinoma of the head and neck Balamucki, Christopher J., MD; Amdur, Robert J., MD; Werning, John W., MD ...
American journal of otolaryngology,
09/2012, Letnik:
33, Številka:
5
Journal Article
Recenzirano
Abstract Purpose To report our experience using radiotherapy alone or combined with surgery to treat adenoid cystic carcinoma of the head and neck. Materials and methods Radiotherapy alone or ...combined with surgery was used to treat 120 previously untreated patients with adenoid cystic carcinoma (ACC) of the head and neck from August 1966 to March 2008. Patients were treated with curative intent. American Joint Committee on Cancer stage distribution was,T0 (n = 1), T1 (n = 26), T2 (n = 25), T3 (n = 14), T4 (n = 54), N0 (n = 113), N1 (n = 2), N2a (n = 1), N2b (n = 2), and N2c (n = 2). Treatment included surgery with postoperative radiotherapy (n = 71), radiotherapy alone (n = 46), and preoperative radiotherapy and surgery (n = 3). Incidental and clinical perineural invasion was found in 41 (34%) and 35 (29%) patients, respectively. Median follow-up was 8.6 and 11.6 years overall and among living patients, respectively. Results The10-year overall, cause-specific, and distant metastasis-free survival rates, respectively, were as follows: radiotherapy alone, 37%, 46%, and 76%; surgery and radiotherapy, 57%, 71%, and 62%; and overall, 50%. The10-year local control rates were as follows: radiotherapy alone, 36%; surgery and radiotherapy, 84%; and overall, 65%. The 10-year neck control rates were as follows: elective nodal irradiation (ENI), 98%; no ENI, 89%; and overall, 95%. Conclusions Surgery and adjuvant radiotherapy offer the best chance for cure for patients with resectable adenoid cystic carcinomas of the head and neck. Some patients with advanced, incompletely resectable disease can be cured with radiotherapy alone. ENI should be considered for primary sites located in lymphatic-rich regions.
To determine how to use node response on computed tomography (CT) to indicate the need for neck dissection.
Five hundred fifty patients with lymph node-positive head and neck cancer were treated ...between 1990 and 2002 with radiotherapy (RT) at a median dose of 74.4 Gy; 24% of these patients (n = 133) were treated with chemotherapy. Three hundred forty-one patients (62%) underwent planned post-RT neck dissection. Physical examination and contrast-enhanced CT were performed 30 days after completion of RT. CT images were reviewed in 211 patients for lymph node size (largest axial dimension) and presence of a focal abnormality (lucency, enhancement, or calcification). By correlating post-RT CT to neck dissection pathology, criteria associated with a low likelihood of residual disease were identified. A subset of patients who fit these criteria of radiographic response who did not undergo post-RT neck dissection was observed for recurrence.
Radiographic complete response (rCR) was defined as the absence of any large (> 1.5 cm) or focally abnormal lymph node. Correlation of response with neck dissection pathology indicated a negative predictive value of 77% for complete clinical response and 94% for rCR. In 32 patients (median follow-up time, 3.2 years) with rCR who did not undergo post-RT neck dissection, the 5-year ultimate neck control rate (100%) and cause-specific survival rate (72%) were not significantly different from the rates of patients with a negative post-RT neck dissection.
Patients with rCR 4 weeks after RT can be spared from a post-RT neck dissection regardless of initial node stage.
The aim of this study was to evaluate the long-term effectiveness and complications of radiotherapy (RT) in the treatment of patients with mucosal melanomas of the head and neck.
The medical records ...of 21 patients treated with definitive or postoperative (RT) between 1974 and 2011 at the University of Florida Department of Radiation Oncology in Gainesville, FL, and the University of Florida Proton Therapy Institute in Jacksonville, FL, were retrospectively reviewed under an Institutional Review Board-approved protocol. Primary sites included nasal cavity, oropharynx, and paranasal sinuses. Sixteen patients (76%) received surgery and postoperative RT and 5 patients (24%) received RT alone. Seventeen patients received photon RT alone, whereas 4 patients received combined photon-based and proton-based RT. Median follow-up for all patients was 1.05 years (range, 0.36 to 12.97 y); median follow-up for survivors was 2.2 years (range 0.9 to 13.0 y).
The 5-year outcomes were: local control, 79%; regional control, 85%; local-regional control, 65%; distant metastasis-free survival, 20%; cause-specific survival, 22%; and overall survival, 22%. Three patients (14%) experienced severe complications including bilateral blindness and skin necrosis.
Definitive or postoperative RT for mucosal melanoma of the head and neck yields fairly good local-regional control of disease. The prognosis for patients treated with definitive RT is less promising than for those who receive surgery and postoperative RT.
Introduction: Metastatic spread to parotid‐area lymph nodes (PALN) occurs in 1% to 3% of patients with cutaneous squamous cell carcinoma of the head and neck. Presented herein is the University of ...Florida experience using radiation therapy (RT) to treat patients with PALN metastases from a skin primary.
Methods and Materials: From November 1969 to February 2005, 121 parotids in 117 patients received irradiation for nonmelanotic skin carcinoma metastatic to PALN. Patients were staged by the O'Brien staging system. Of the 121 parotids receiving RT, 17 (14%) were treated preoperatively, 87 (72%) postoperatively, and 17 with RT alone.
Results: Five‐year actuarial probabilities of local (parotid) control, local‐regional control, disease‐free survival and overall survival were 78%, 74%, 70%, and 54%, respectively. When patients were separated by O'Brien P‐stage, statistically significant differences were seen among the groups for local (parotid) control, local‐regional control, and disease‐free survival. A statistically significant decrease in local control was seen in patients treated with positive surgical margins (92% vs. 76%) and in local‐regional control for patients treated with preoperative RT or RT alone when compared with postoperative RT (59% and 47% vs. 83%, respectively). The 5‐year actuarial probability of freedom from distant metastases was 92%. Three (2.6%) patients suffered severe complications.
Conclusions: PALN metastases from a cutaneous head and neck primary site are best treated with surgery and postoperative RT. Our data support the hypothesis that the O'Brien staging system is superior to the American Joint Committee on Cancer system for the staging of cutaneous metastases to PALN. Positive surgical margins confer a worse prognosis in terms of local‐regional control and disease‐free survival. Patients treated with preoperative RT seem to have a worse prognosis than those treated postoperatively, likely a result of patient selection and the surgeon's inability to accurately assess viable tumor extent after preoperative RT. Severe complications are uncommon after surgery and RT for PALN metastases.
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