Contrary to some reports, the voice quality is minimally affected by laser surgery for T1a glottic carcinoma, and outcome is similar to radiotherapy. The average fundamental frequency is higher than normal after laser surgery, but the effect on the quality of life was trivial.
Except in one patient, no postoperative complications such as swelling or infection followed either harvesting or injection. After injection, phonation showed notable improvement that was maintained throughout follow-up.
Assessments using CT revealed that the decrease in volume of injected fat tissue was smaller in cases treated using b-FGF than in cases using the conventional method. No severe complications were encountered using this method.
Buccal fat cells were relatively smaller than abdominal fat cells and were not influenced by body mass index (BMI), showing less individual differences according to the physical features of the patient. Numbers of vascular endothelial cells tended to be higher in buccal fat tissues. The percentage of cases showing continuous effects for more than 6 months was slightly higher in cases using buccal fat.
Laryngeal lesions can be diagnosed by intralaryngeal ultrasonography using the filling method. Although it does not replace the combination of conventional endoscopy and a critical evaluation of the clinical symptoms of the individual disease, it can profitably complement them. Intralaryngeal ultrasonography can help in determining the extent of tumor involvement during microscopic laser surgery performed under general anesthesia. Confirmation of the results of this pilot study with a larger series of patients is desirable.
We examined the reliability of the use of lymphoscintigraphy (LS) and a hand-held gamma probe (GP) to identify the sentinel lymph node (SLN), and sequentially determined the feasibility of SLN radiolocalization in clinical neck node-negative oral squamous cell carcinoma (SCC) patients. A radiolabel with the unfiltered 99mTc tin colloid was injected submucosally around the primary site followed by LS at 2-hour intervals. Preoperative localization was performed with GP. After en bloc removal of the regional lymphatics, histopathologic results for the nodes were compared with the SLN radiolocalization. The LS and GP counts were well correlated, and there was concordance between SLN and neck node status in 7 of 8 cases (87.5%). We thus considered that our concept in this study was valid in determining the necessity for neck dissection for those node-negative oral SCC patients.
We developed a method for performing intralaryngeal ultrasonography. Normal larynges were obtained from 10 cadavers and examined using an intraluminal ultrasonic tomography apparatus connected to a radial scanning 20 MHz miniaturized probe. The larynx was placed in a bath filled with physiologic saline. and the probe was inserted through the forceps channel of the fiberscope (6 mm diameter). A horizontal ultrasonic image of the vocal fold was obtained. Histologic sections of the larynx were compared with the ultrasonic images. The mucosa in the membranous region of the vocal fold was comprised of three layers ultrasonographically. The epithelium and superficial layer of the lamina propria were visualized as a high echo (hyperechoic) region, the intermediate layer of the lamina propria was visualized as a low echo (hypoechoic) region and the deep layer of the lamina propria was seen as a hyperechoic region. The vocal fold structure can be visualized by intralaryngeal ultrasonography using the filling method. This method may be clinically useful for the detection of tumors involving the vocal folds.
Objective: The purpose of this study was to determine the efficacy of concurrent chemoradiotherapy using conventional radiotherapy combined with low-dose daily 5-fluorouracil (5FU) and cisplatin (CDDP) for the locally unresectable head and neck cancer patients. Patients and Methods: From September 1996 through December 2000, we carried out a phase II study of concurrent chemoradiotherapy with low-dose CDDP plus 5FU for the treatment of patients with unresectable squamous cell carcinoma of the head and neck. Chemoradiotherapy consisted of irradiation with 1.6–2.0 Gy/day for 5 days per week up to a total dose 68 Gy and CDDP 3 mg/m2 by intravenous infusion over 1 h plus 5FU 150 mg/m2 by intravenous infusion over 24 h per day for 5 days per week. Results: Ninety percent of the patients had stage IV disease, including 65% of patients with T4 disease. Thirty-three patients (83%) received the full treatment as planned; 39 (98%) received full-dose radiotherapy and 33 (83%) full-dose chemotherapy. Of the 40 patients evaluable for response, 20 (50%) achieved complete response (CR) and 12 (30%) partial response with an overall response rate of 80%. Among the 20 CR patients, 15 underwent endoscopic blind biopsies and 4 had positive lesions. The most frequently observed toxicity was mucositis. Ten patients developed grade III mucositis, and 3 patients required enteral nutritional support through a feeding tube. Grade III leukopenia, anemia and thrombocytopenia were observed in 28, 25 and 20% of the patients, respectively. The median duration of follow-up at the time of analysis was 18 months. The median survival time was 23 months. The responders survived longer (34 months) than the nonresponders (4 months; p < 0.05). Conclusion: This regimen is safe and efficacious in the treatment of patients with advanced unresectable head and neck cancer.
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