The combined endovascular and surgical treatment of paragangliomas is acceptably safe and effective for treating these highly vascular neoplasms. Adequate resection may often require sacrifice of one or more cranial nerves, and appropriate rehabilitation is important in the treatment regimen.
Mutation of the p53 tumor-suppressor gene is recognized as one of the most common genetic alterations in human malignancy to date (1). Approximately 60% of human tumors are thought to possess mutation at the p53 locus. Transient overexpression of the wild-type p53 gene in various malignancies has been considered a potential molecular intervention strategy (2 -7). This strategy is based on the role that wild-type p53 plays as a tumor-suppressor gene and inducer of cell-cycle arrest and apoptosis (1 ,8-11).
The integration of planned neck dissection into the multidisciplinary management of patients with locoregionally advanced SCCHN is highly effective in controlling cervical metastatic disease. Modified and selective neck dissection procedures can be performed in the majority of patients, regardless of the response in the neck subsequent to concomitant radiochemotherapy. We recommend a planned neck dissection(s) in all patients staged (pretreatment) with N2 or greater neck disease and in select N1 cases.
Hypothesis:Patients with primary squamous cell carcinomas of the upper respiratory and digestive tracts with a greater than 20% probability of occult cervical metastases but with nodes clinically negative for metastatic disease warrant elective treatment of the neck for prognostic, diagnostic, and therapeutic purposes.
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