A. J. M. Balm

Sentinel node biopsy for melanoma in the head and neck region

Lymphatic drainage in the head and neck region is known to be particularly complex. This study explores the value of sentinel node biopsy for melanoma in the head and neck region.

Hypoxia in head and neck cancer: How much, how important?

Hypoxia develops in tumors because of a less ordered, often chaotic, and leaky vascular supply compared with that in normal tissues. In preclinical models, hypoxia has been shown to be associated with treatment resistance and increased malignant potential. In the clinic, several reports show the presence and extent of tumor hypoxia as a negative prognostic indicator. This article reviews the biology and importance of hypoxia in head and neck cancer.

Radiation-induced tumours of the head and neck

In order to study the induction of malignancy in normal tissues due to ionizing radiation, we reviewed the files of 2500 patients with a tumour of the head and neck treated at the Netherlands Cancer Institute (Antoni van Leeuwenhoek Ziekenhuis), Amsterdam, from 1977 to 1993. We then checked whether or not these patients had been previously irradiated. Patients with a thyroid carcinoma or skin cancer were excluded from the study, since it is generally known that previous irradiation is a risk factor in these tumours. Eighteen patients were found to have a malignancy within a previously irradiated area (0.70 per cent). The mean interval between radiation and diagnosis of the head and neck tumour was 36.5 years. There were five soft tissue sarcomas, nine squamous cell carcinomas and four salivary gland tumours. Fourteen patients were operated upon whereas four received palliative treatment only. The median survival of the total group was 3.5 years. Particularly, in young patients because of the better cancer therapy and prolonged survival one must be aware of the increased risk of radiation-induced tumours.

Prognostic index for patients with parotid carcinoma: international external validation in a Belgian-German database.

Prognostic indices for recurrence‐free interval in patients with parotid carcinoma were developed and validated in a nationwide database. International validation would increase generalizability.

Immunoperoxidase detection of polycyclic aromatic hydrocarbon-DNA adducts in mouth floor and buccal mucosa cells of smokers and nonsmokers

Tobacco smoking is a major risk factor for oral cancer; mouth floor and buccal mucosa are among the most and least cancer‐prone subsites, respectively, in the oral cavity. We investigated the applicability of immunohistochemistry of smoking‐induced DNA adducts in oral cells for assessing the exposure to carcinogens, and estimating the risk for oral cancer. Polycyclic aromatic hydrocarbon (PAH)‐DNA adducts were measured in mouth floor and buccal mucosa cells of smokers (n = 26) and nonsmokers (n = 22) by means of a semiquantitative immunoperoxidase assay. Smokers had elevated levels of PAH‐DNA adducts compared to nonsmokers in their mouth floor cells (0.045 ± 0.022 versus 0.022 ± 0.016, P = 0.0008 arbitrary units of immunohistochemistry) as well as in their buccal mucosa cells (0.058 ± 0.028 versus 0.028 ± 0.012, P = 0.001). Also, there was a correlation between the levels of PAH‐DNA adducts in mouth floor cells and those in buccal mucosa cells (r = 0.4, P = 0.01). Furthermore, PAH‐DNA adduct levels in both mouth floor and buccal mucosa cells were significantly related to current smoking indices (amount of tar and number of cigarettes consumed per day). Expectedly, the levels of PAH‐DNA adducts neither in mouth floor cells nor in buccal mucosa cells, both being short‐lived cells, were related to smoking history index (pack years). The levels of PAH‐DNA adducts, however, in mouth floor cells as the cancer prone cells were lower than those in buccal mucosa cells (0.037 ± 0.023 versus 0.044 ± 0.026, P = 0.04). We conclude that immunohistochemistry of PAH‐DNA adducts in oral cells can be used for exposure assessment of tobacco‐related carcinogens, however, it cannot be used for oral cancer risk estimation. Environ. Mol. Mutagen. 36:127–133, 2000.

Sentinel Node Detection in Head and Neck Malignancies: Innovations in Radioguided Surgery

Sentinel node mapping is becoming a routine procedure for staging of various malignancies, because it can determine lymph node status more precisely. Due to anatomical problems, localizing sentinel nodes in the head and neck region on the basis of conventional images can be difficult. New diagnostic tools can provide better visualization of sentinel nodes. In an attempt to keep up with possible scientific progress, this article reviews new and innovative tools for sentinel node localization in this specific area. The overview comprises a short introduction of the sentinel node procedure as well as indications in the head and neck region. Then the results of SPECT/CT for sentinel node detection are described. Finally, a portable gamma camera to enable intraoperative real-time imaging with improved sentinel node detection is described.

Human papillomavirus status in young patients with head and neck squamous cell carcinoma

The role of human papillomavirus (HPV) in head and neck squamous cell carcinoma (HNSCC) development has been recognized only in the last decade. Although younger patients develop HNSCC associated with HPV, the incidence in young patients has not been studied. Forty‐five young HNSCC patients (<40 years) were tested for HPV and the expression of p16ink4a and p53 in tumor biopsies. The presence of HPV was correlated with the absence and presence of alcohol and tobacco exposure. Paraffin‐embedded, archival biopsy materials from HNSCC of 45 patients younger than 40 years were analyzed. HPV subtypes were identified by PCR followed by genotyping. Expression of p16ink4a and p53 were determined by immunohistochemistry. Fourteen (31%) of the HNSCC specimens from 45 patients unequivocally exhibited HPV16 positivity. Sixty percentage of the oropharyngeal tumors and 5% of the oral cavity tumors were HPV16 positive. P16ink4a overexpression was detected in 93% of the HPV16‐positive tumors. None of the HPV16 tumors showed p53 overexpression. There was no association of HPV positivity with (lack of) exposure to alcohol and smoking. HPV association was not exclusively detected in nonsmoking, nondrinking young HNSCC patients. The presence of p16ink4a accumulation and the absence of p53 overexpression are good surrogate markers for HPV‐associated HNSCC.

Preservation of function by radiotherapy of small primary carcinomas preceded by neck dissection for extensive nodal metastases of the head and neck

When patients are initially seen with a small primary tumor and regional metastases, the question arises whether the primary can be managed by definitive radiotherapy while treating the neck with surgery and postoperative radiation. The advantage of this is least disturbance of the primary site, while still achieving maximal control of the neck disease.

Soft tissue sarcomas of the head and neck associated with surgical trauma

Soft tissue sarcomas in the head and neck are rare. Aetiological factors relating to these tumours have not yet been identified. The association with von Recklinghausens disease and with irradiation is however well recognized. In the literature it has been speculated that trauma may also play a role in the development of soft tissue sarcomas. In this article we present five patients with a history of surgical trauma at the site where a sarcoma later developed. Although we cannot prove a causal relationship, the relatively high incidence of possibly trauma-related soft tissue sarcomas in a series of 60 patients we have seen over a 30-year period, suggests that such a relationship could exist.

Multiple malignancies in a patient with bilateral retinoblastoma

A case is presented of a patient with bilateral retinoblastoma, treated at infancy with surgery, chemotherapy and radiotherapy, who subsequently developed at least four additional histologically distinct malignancies: a Ewing sarcoma of the left fibula, two extraskeletal osteosarcomas of the left lower extremity, a mucoepidermoid carcinoma of the right parotid gland and a squamous cell carcinoma of the left paranasal cavity. In addition to retinoblastoma, patients with a germline RB-1 mutation are at high risk of second primary malignancies. An additive carcinogenic effect of cytotoxic therapy in these patients has been assumed. Patients with hereditary retinoblastoma should be under life-long follow-up programmes including a regular head and neck examination for detection of new primaries, especially in the radiation field of the presenting retinoblastoma.