J. J. Quak

Larynx preservation surgery for advanced posterior pharyngeal wall carcinoma with free flap reconstruction: a critical appraisal

To report the functional and oncologic results of larynx preservation surgery with free flap reconstruction for posterior pharyngeal wall carcinoma. Retrospective medical chart review. Tertiary care referral center. We present a series of seven patients, who were treated for an advanced stage posterior pharyngeal wall carcinoma between 1995 and 1998. All patients underwent posterior pharyngectomy with larynx preservation via a suprahyoidal approach for carcinoma of the posterior pharyngeal wall, with radial forearm free flap reconstruction. Complications occurred in three patients with grade 3 comorbidity, one of whom suffered flap loss. After a mean follow-up of 48 months, three patients are alive without disease. One patient is alive with a second primary tongue carcinoma. Two patients died of disease, whereas one patient died of another cause. All patients could be decannulated and maintain their voice. Six out of seven patients were able to take oral nutrition, although four patients needed additional PEG-tube feeding. Posterior pharyngectomy with larynx preservation and radial forearm free flap reconstruction is feasible in selected patients, with acceptable functional results and survival. However, the patient must be aware of the risk of chronic aspiration and the possibility of long-term PEG feedings.

Current perspectives in the use of monoclonal antibodies for detection and treatment of head and neck tumors

Squamous cell carcinomas (SCC) represent the vast majority of all malignant tumors of the head and neck. The development of distant metastases is now more often observed among these tumors than in the past. The department of Otolaryngology-Head and Neck Surgery, Free University Hospital has focussed upon the use of monoclonal antibodies (mAb) for treating SCC metastases. MAb E 48 was selected after it was shown to react strongly to SCC and minimally to normal tissues. In animal models clear tumor visualization and impressive tumor regression occurred when the antibody was linked to a suitable isotope. A diagnostic phase I/II study for the detection of lymph node metastases has entered 51 patients with head and neck cancer. Biodistribution data, acquired from surgical specimens, has shown an average tumor uptake of 30m%/g tumor tissue of the injected dose of mAb E 48. Extrapolation of data from therapeutic animal studies to these findings suggests that radioimmunotherapy can be effective in head and neck cancer patients, notably as adjuvant therapy in patients with a high chance of developing distant metastases.

The Value of Radioimmunoscintigraphy for Detection of Lymph Node Metastases in Head and Neck Cancer Patients

Monoclonal antibodies (MAbs) directed against tumor-specific or tumor-associated antigens can be used for selective tumor targeting. If such an MAb is labeled with a radionuclide that emits gamma rays, the localization of a targeted tumor can be visualized with a gamma camera. This imaging technique is called radioimmunoscintigraphy (RIS). Because RIS identifies biological antigenic targets on the tumor cell it differs fundamentally from anatomic imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US). The potential of RIS depends on the tumor antigen, the monoclonal antibody, the radionuclide, the tumor and the imaging procedures used. This paper deals with the progress made in the technical development of RIS during recent decades. Furhtermore, the diagnostic potential of RIS for tumor detection in general, and for the detection of lymph node metastases in patients with squamous cell carcinoma of the head and neck (HNSCC) in particular, will be outlined. Advantages and disadvantages of RIS relative to other diagnostic modalities will be discussed. Finally, possibilities for further improvement of antibody imaging, for example the use of positron emission tomography (PET), will be indicated.