Jui-Lin Huang

Risks and clinical implications of perineural invasion in T1‐2 oral tongue squamous cell carcinoma

Risks of perineural invasion (PNI) in T1‐2 oral tongue squamous cell carcinoma (SCC) have not been specifically elucidated.

Positron emission tomography in surveillance of head and neck squamous cell carcinoma after definitive chemoradiotherapy.

We assessed the role of 18F‐fluoro‐deoxy‐glucose positron emission tomography (PET) in detecting head and neck squamous cell carcinoma (HNSCC) after definitive chemoradiotherapy (CRT).

Second Primary Malignancies in Squamous Cell Carcinomas of the Tongue and Larynx: An Analysis of Incidence, Pattern, and Outcome

Background: Head and neck cancer patients have a higher risk of developing a second primary malignancy (SPM) than the general population. This study was conducted to identify the characteristics of SPM and its impact on survival in patients with squamous cell carcinoma of the tongue (TSCC) and larynx (LSCC). Methods: A retrospective study was conducted of 538 patients who were treated by surgery primarily for TSCC (n = 146) and LSCC (n = 392) from 1990 to 2000. The incidence, site, and overall survival of SPMs were evaluated. Results: Seventy‐seven patients developed SPM during the follow‐up period (median, 73 months), including 18 (12%) with TSCC and 59 (15%) with LSCC. Fifty‐six percent of SPMs of the TSCC group appeared in the oral cavity. Among the SPMs of LSCC patients, 54% developed in the lung (31%) and larynx (24%). The 5‐year overall survival after the diagnosis of SPM in the head and neck was 39%, compared to 29% for SPM in other areas (p = 0.010). Conclusion: SPMs after treatment of TSCC and LSCC are similar in incidence but distinct in pattern. SPMs within the head and neck are associated with a better prognosis than those outside this area.

Different patterns of second primary malignancy in patients with squamous cell carcinoma of larynx and hypopharynx.

PURPOSE The aim of the present study was to compare the incidence, patterns, and survival of second primary malignancy (SPM) in patients with squamous cell carcinoma of the larynx (LSCC) and hypopharynx (HPSCC). METHODS We retrospectively review the medical record of 581 previously untreated patients with LSCC (392 cases) and HPSCC (189 cases) who received primary surgery with or without postoperative radiotherapy from 1990 to 2000. Data including age, sex, risk factors, subsites and TNM stage of primary tumor, treatment, site and incidence of SPM, and prognosis were collected from medical charts. RESULTS Groups with HPSCC had a higher incidence (4.2% vs 2.9% annual rate) and shorter median time (30 vs 59 months) developing SPM rather than LSCC. Fifty-five percent of the SPM occurred in the respiratory axis in LSCC, and 66% developed in the digestive axis in HPSCC. The factors influencing the appearance of SPM included early T stage, tobacco use, and less tumor recurrence. Long-term survival was poorer in those with than without SPM (38% vs 49% at 10 years). CONCLUSIONS There is a tendency for SPM to occur in the respiratory axis (lung and larynx) in LSCC and in the digestive axis (oral cavity, pharynx, and esophagus) in HPSCC. This information is important for posttreatment follow-up.

Chemoradiotherapy Laryngeal Preservation for Advanced Hypopharyngeal Cancer

OBJECTIVE Laryngeal preservation is a challenge for the treatment of advanced hypopharyngeal cancer. The objective of this study is to evaluate the results of chemoradiotherapy laryngeal preservation for advanced hypopharyngeal cancer at a single institute and the impact of treatment factors on prognosis. METHODS The study population consisted of 42 consecutive patients with resectable stage III-IV hypopharyngeal cancer. Patients with T4b tumor, synchronous primary cancer or those treated palliatively were excluded. Induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) was performed in 32 (76.2%) patients, whereas primary CCRT was done in the other 10 (23.8%). Patients were grouped according to the dose intensity of chemotherapy and total dose of radiotherapy (RT). RESULTS Grade 3-4 toxicities occurred mostly during CCRT. Thirty-five (83.3%) patients received an optimum dose of cisplatin (CT-optimum), 27 (64.3%) received an optimum dose of RT-optimum and 26 (61.9%) received optimum doses of both (CRT-optimum). CT- and RT-optimum both correlated significantly with better disease-free survival (DFS) (P < 0.001 and = 0.003), overall survival (OS) (P < 0.001 and = 0.004) and laryngeal preservation survival (LPS) (P = 0.01 and 0.04). The 3-year DFS, OS and LPS for CRT-optimum patients were 48.1, 50.0 and 45.6%, respectively. CONCLUSIONS Achievement of optimum treatment dose remains challenging in chemoradiotherapy laryngeal preservation for advanced hypopharyngeal cancer. Intensive patient care and monitoring by experienced multi-disciplinary teamwork are mandatory. The criteria for selecting patients who will respond to and complete the treatment remain key issues for future investigation.

Methotrexate and Leucovorin Double-modulated 5-Fluorouracil Combined with Cisplatin (MPFL) in Metastatic/Recurrent Head and Neck Cancer

Background: To determine the efficacy and safety profile of the combination of cisplatin and 5‐fluorouracil modulatedboth by methotrexate and leucovorin in metastatic/recurrent squamous cell carcinoma of the head and neck. Methods: Twenty‐eight patients were treated with cisplatin 40 mg/m2/day continuous infusion for 24 hours on day 1;high‐dose 5‐fluorouracil 2,000 mg/m2/day and leucovorin 100 mg/m2/day continuous infusion for 48 hours on days 1and 2; methotrexate 40 mg/m2/day as a bolus infusion 4 hours before 5‐fluorouracil and leucovorin on day 1. The treat‐ment was repeated every 2 weeks in a cycle. Results: The overall response rate was 25%, and 14% of the patients achieved stable disease status. Subgroup analy‐sis demonstrated significantly improved overall survival in the disease‐control group (12.0 months vs. 5.3 months, p < 0.001). Only 3 (10.7%) patients developed grade 3–4 neutropenia, and none developed grade 3–4 non‐hematologictoxicity. Conclusion: This multiagent‐containing regimen has an excellent safety profile and improved survival in disease‐controlgroup of patients with metastatic/recurrent squamous cell carcinoma of the head and neck.

Removal of Unapproachable Laryngopharyngeal Foreign Bodies Under Flexible Videolaryngoscopy

INTRODUCTION The ingestion of foreign bodies in the upper aerodigestive tract is a common emergency. Removal of foreign bodies under guidance of a laryngeal mirror or flexible endoscopy is the primary approach in Taiwan and other countries and usually is performed without difficulty. However, in some patients the procedure cannot be completed smoothly because of poor cooperation of the patients or poor visualization of foreign bodies, especially when these are lodged in the larynx or hypopharynx. Rigid endoscopy with the patient under general anesthesia is eventually needed. Transoral laryngeal surgery under flexible laryngeal videostroboscopy was developed at our institute in 1993. Under topical anesthesia, almost all patients with laryngeal lesions could tolerate the surgical procedure at our outpatient clinic. Compared with other methods, this procedure has the advantages of less invasiveness and better cost-effectiveness, and it does not require general anesthesia and hospitalization. After accumulating the manipulative experience, flexible videolaryngoscopy (FVL) was applied to the removal of laryngopharyngeal foreign bodies that could not be retrieved under guidance of a laryngeal mirror or fiberscope.