Concomitant cisplatin and hyperfractionated external beam irradiation for advanced malignancy of the head and neck

Article Abstract:

Cancer of the head and neck can usually be successfully treated by surgery or radiation treatment when it is in the early stages. But for the many patients who are first seen when the cancer is advanced or when there is cancer spread to the regional lymph nodes, surgery followed by radiation treatment results in three-year survival rates of only 10 to 40 percent. Chemotherapy, although often capable of shrinking tumors, has not been shown to improve survival. Specific antineoplastic (anti-tumor) drugs, used as radiosensitizers, can be used simultaneously with radiotherapy to enhance the radiobiologic effects. A report is presented of 30 patients with advanced (stage III or IV) squamous cancer of the head and neck who were treated with cisplatin (an antineoplastic drug) and hyperfractionated radiation. Hyperfractionalization radiation uses multiple small-dose fractions of radiation, which permits overall larger dosages. Patients were followed for an average of 19 months. Complete early response at the primary tumor site occurred in 27 of 29 patients (93 percent); one patient had an unknown primary site. Treatment related toxicities were generally acceptable; the most common side effects were mucositis (inflammation of the mucosa) and weight loss. Repeat biopsy at six to eight weeks after treatment showed three patients with residual cancer in both primary site and lymph nodes, and one patient with residual cancer only in the primary site. Currently, 24 of 29 patients (83 percent) have controlled primary cancer. The authors suggest that this experimental combination treatment provides the best possible chance of cancer control for these patients, and that it warrants further evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Cisplatin, Head and neck cancer

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Long-term effects of radiotherapy in childhood and adolescence

Article Abstract:

Before reaching the age of 15, 1 in 600 children will develop cancer, with a 60 percent chance of cure. This high cure rate for malignant soft tissue has been achieved by the use of radiotherapy and chemotherapy. These cancer treatments carry the risk of multiple organ system morbidity, as well as development of a second cancer outside the treated area. In order to study the late effects of non-surgical cancer treatment of childhood cancer, the records of 50 survivors were reviewed. The average age of treatment was five years, with an average follow-up of 13 years. Thirty-seven patients had primary tumors of the head and neck; these included 27 cases of rhabdomyosarcoma (highly malignant tumor of muscle cells), eight with retinoblastoma (hereditary tumor developing from retinal germ cells in the eye), and two with cancer of the nose and pharynx. Forty-one of the 50 patients (82 percent) had undergone chemotherapy before or after radiotherapy. The most serious side effects were seen in the areas that had received radiation; these included underdevelopment of the jaw, orbit of the eye or hemi-face with wasting of the overlying soft tissue. Other abnormalities included endocrine, dental and psychiatric problems. With childhood cancers, the potential of longevity is different from that of an adult. The extended period of survival (a child cured at the age of five may still have 70 years or more to live) permits adverse effects of treatment to emerge over a long period of time. It is noted that 1 in every 1,000 adults older than 20 today is likely to be a survivor of childhood cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Cancer in children, Childhood cancer

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Lymph node metastasis from papillary-follicular thyroid carcinoma in young patients

Article Abstract:

Children who have cancer of the thyroid have a better prognosis than do adults, despite the fact that children usually are diagnosed at a later stage of the disease. There is controversy about the pathology, treatment and prognostic factors of this cancer in children. A review was undertaken of 117 young patients (under 20 years of age, average age 16) with thyroid cancer who were treated over a 39-year period. Twenty percent of the patients had a prior history of irradiation given for chronic inflammation of the adenoids, hyperplasia of the thymus gland, or acne. The percent of patients who had prior irradiation varied by year of treatment for thyroid cancer; the peak occurred in 1959, after which this percentage dropped sharply. The most common symptom was the presence of a painless neck mass. In 40 percent of the patients, the mass was located in the thyroid itself, and in 60 percent this represented lymph node metastasis. Of the patients who had negative lymph node examinations clinically, 26 percent were found to have metastasis (cancer spread) upon tissue diagnosis of the nodes. There were no deaths due to thyroid cancer. There is a high rate of recurrence (20 to 30 percent) in the lymph nodes in the thyroid region. Because of this, a modified neck dissection with removal of nearly all the thyroid tissue should be performed at the time of initial surgery. It is recommended that this be followed by iodine-131 radiation treatment (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Irradiation, Irradiation (Radiation exposure), Thyroidectomy, Thyroid cancer

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