Pichit Sittitrai

Induction chemotherapy with paclitaxel, ifosfamide, and cisplatin followed by concurrent chemoradiotherapy for unresectable locally advanced head and neck cancer.

Objective: Induction chemotherapy (IC) and concurrent chemoradiotherapy (CCRT) for locally advanced head and neck cancer has been studied in many clinical trials. This study was conducted to determine the response rate of IC with paclitaxel, ifosfamide, and cisplatin followed by CCRT with cisplatin for this group of patients, and the effect of the entire treatment on survival and time to disease progression. Methods: Thirty patients with advanced and unresectable head and neck cancer were treated with 2 cycles of induction paclitaxel/ ifosfamide/ cisplatin. If the primary tumor had a complete or partial response, patients were treated with 2 more cycles of IC followed by radiotherapy 70 Gy plus 3 cycles of cisplatin. For those with less than partial response or disease progression were treated according to the discretion of the physicians. Results: Ninety percent of patients had stage IV disease and 40% of them had primary tumor at maxillary sinus and nasal cavity. One patient (3%) achieved complete response (CR) and 18 patients had partial responses (PR) to IC. CCRT enhanced the response rate, resulting in a total of 3 CR (10%) and 16 PR (53%) to treatment. The median time to progression was 11.5 months. The median overall survival was 27 months. The most severe hematologic toxicity occurred during IC was grade3-4 neutropenia (40%). Grade 3-4 mucositis occurred in 68% of patients during CCRT. Conclusion: This novel combined-modality treatment program, is toxic but feasible, and can be administered for selected patients with advanced and unresectable head and neck cancer.

A phase II study of docetaxel and carboplatin with concurrent radiation therapy for locally advanced head and neck cancer

OBJECTIVE In this study we evaluate the clinical response and safety profile of a regimen of docetaxel+carboplatin concurrent with radiotherapy (RT) in locally advanced squamous cell carcinoma of head and neck (HNSCC). METHODS Between January 2006 and December 2008, we enrolled 38 patients (stage IVA: 29 patients; stage III: 9 patients). Fourteen had oral cavity cancer (tongue 10, buccal mucosa 2, alveolar ridge 1, floor of mouth 1), 10 had oropharyngeal cancer (base of tongue 5, tonsil 5), 13 had laryngeal cancer, and 1 had maxillary sinus cancer. Patients received concurrent docetaxel 15 mg/m² 1-h infusion plus carboplatin AUC of 2, 30-min infusion on days 1, 8, 15, 22, 29, and 36. RT began on day 1 of concurrent chemotherapy with 2 cGy/fraction, 5 fractions/week (total dose: 66-70 cGy). Tumor was assessed by CT scan 3 months post-completion of concurrent chemoradiotherapy. RESULTS Thirty-five patients were evaluated (2 refused to receive all treatments, 1 had serious adverse event [rash, wheezing] from docetaxel first dose). The primary study endpoint of clinical response was achieved in 26 (74.3%) patients, 6 (17.1%) had stable disease, and 3 (8.6%) had disease progression. The 2-year disease-free survival was 62.9% (CI: 45.85-79.95%). The 2-year overall survival was 64.1% (CI: 43.52-84.68%). The most common Grade 3 toxicities were mucositis, xerostomia and dysphagia (13.9% each) and dermatitis (11%). No Grade 4 toxicities were observed. CONCLUSION In conclusion, this study with a limited number of patients, docetaxel+carboplatin concurrent with RT appears to show acceptable activity and is generally well tolerated in patients with locally advanced HNSCC.

Submental island flap reconstruction in oral cavity cancer patients with level I lymph node metastasis

The submental island flap is useful as an alternative to microvascular free tissue transfer for the reconstruction of defects after resection of oral cancer because it is simple to harvest, reliable, and is associated with good oral function and low morbidity. However, because cancer of the oral cavity carries a risk of level I nodal metastases, the oncological safety of the flap remains controversial. Between April 2012 and September 2016, we studied patients with squamous cell carcinoma of the oral cavity who had surgical resection with submental island flap reconstruction for viability of the flap, signs of recurrence, and complications. Thirty-five patients (22 men and 13 women) were enrolled in the study and the mean (range) duration of follow-up was 23 (11-48) months. Six patients had local recurrences of their tumours, none of which was considered to be related to the flap. No flap was lost completely, but there were 10 cases of partial skin loss that healed with conservative management. There were no orocutaneous fistulas, haematomas, or marginal mandibular nerve palsies. We conclude that the submental island flap can be used safely in selected patients with level I lymph node metastases when the flap has been harvested meticulously.

Nasopharyngeal Tuberculosis: Epidemiology, Mechanism of Infection, Clinical Manifestations, and Management

Nasopharyngeal tuberculosis (NPTB) is a noteworthy disease especially in its worldwide spread of the Mycobacterium infection. Although NPTB has been identified in less than one percent of TB cases, recent multiple case reports indicate an either increased awareness or incidence of this disease. The most helpful diagnostic tool is an uncomplicated nasopharyngeal biopsy. However, NPTB is usually ignored because it has varied clinical manifestations and similar presentations with other more common head and neck diseases. Furthermore, the most common presenting symptom is cervical lymphadenopathy mimicking nasopharyngeal carcinoma, a more common and serious disease. Treatment outcomes of NPTB are good in both HIV-positive or HIV-negative patients. In addition, pulmonary tuberculosis association was reported in wide range between 8.3% and 82% which should be considered in a treatment program. In conclusion, early diagnosis and management in NPTB can be achieved by (1) increased awareness of this disease, (2) improvement in knowledge regarding clinical manifestations, and (3) improvement of diagnostic techniques.

Actinomycosis presenting as a parotid tumor

Actinomycosis of the parotid gland is a rare chronic infection and can present with a slow-growing mass mimicking a tumor. The authors report five cases of parotid actinomycosis. All patients presented as having enlarging masses at the parotid area for 2-6 months without a history of obvious dental infection, trauma, or immunocompromised condition. Retrograde bacterial spread from colonization in the oral cavity via Stensens duct is the possible pathophysiology. The diagnosis was made histopathologically by fine needle aspiration biopsy (FNAB). Treatment consisted of 1.5 months of intravenous penicillin, followed by 4.5 months of oral penicillin, with excellent results.

Epstein-Barr virus-associated smooth muscle tumor of the tonsil.

Smooth muscle tumors of the tonsil are rare. Recently, the occurrence of Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) has been increasingly recognized in immunocompromised patients, mainly post-transplantation and AIDS patients. The clinicopathologic features of EBV-SMT are different from conventional smooth muscle tumors. To the best of our knowledge, EBV-SMT involving the tonsil in an AIDS patient has not been reported. A 27-year-old man presented with a 2.2cm right tonsillar mass six months after AIDS diagnosis. The tumor was composed of a cellular proliferation of oval to spindle-shaped cells with mitotic count up to 10 in 10 high-power fields. The diagnosis of EBV-SMT was confirmed by in situ hybridization for EBV-encoded RNA (EBER) transcripts. Synchronous lesions were also detected in the liver and peritoneum by an abdominal computed tomographic scan. EBV-SMT should be included in the differential diagnoses of a mesenchymal tumor in immunocompromised patients, and in the differential diagnoses of a smooth muscle tumor occurring in uncommon sites including the tonsil.

Perioperative antibiotic prophylaxis in open tracheostomy: A preliminary randomized controlled trial

BACKGROUND The efficacy of perioperative antibiotic prophylaxis for prevention of wound infection in open tracheostomy has been minimally studied and remains controversial. METHODS A preliminary double-blind, randomized, placebo-controlled trial was conducted. A total of 159 patients who underwent open tracheostomy were enrolled, and 88 patients were excluded because of lack of desire to participate in research, emergency condition, administration of other antibiotics, immunocompromise, or cervical skin infection. The remainings were randomly assigned to an antibiotic group or a control group. Another 11 patients were excluded after the randomization due to intraoperative contamination, death from the underlying disease, receiving other antibiotics, or lost to the follow-up. A total of 30 patients in each group were qualified for analysis. In the antibiotic group, clindamycin was intravenously administered 30 min before the incision and every 8 h after the operation for 24 h. In the control group, an equal volume of sterile saline was administered. RESULTS Wound infection developed in 2 patients (6.7%) in the antibiotic group and 7 patients (23.3%) in the control group (p = 0.08). In multivariate analysis, smoking and previous neck irradiation were the significant risk factors for wound infection (p = 0.042 and 0.019, respectively). The mean length of hospital stay after tracheostomy in patients with and without wound infection were 17 ± 2 days and 4 ± 2 days, respectively (p = 0.013). CONCLUSION The result of this preliminary study reveals that antibiotic prophylaxis reduced tracheostomy wound infection rate from 23.3% to 6.7% although it was not statistically significant. However, wound infection may lead to serious complications and prolonged postoperative length of hospital stay, and therefore proper perioperative antibiotics should be considered in patients who are not receiving other antibiotics, and particularly in patients with risk factors for wound infection.

Ultrasonographic findings of thyroglossal duct papillary carcinoma: A case report

Highlights • Thyroglossal duct cyst carcinoma can be classified as primary, secondary and multicentric.• Preoperative ultrasound with possible fine needle aspiration biopsy are useful for determining the extent of the operation.• The treatment is Sistrunk’s operation with the addition of total thyroidectomy and neck dissection when indicated.

Ten-Year Outcome of Different Treatment Modalities for Squamous Cell Carcinoma of Oral Cavity

Objective: This study reports outcomes of squamous cell carcinoma of oral cavity (SCCOC) patients with different treatment modalities. Materials and Methods: We evaluated the treatment outcomes of 775 newly diagnosed SCCOC patients treated in our hospital between 2001 and 2010. Outcome data were obtained from the medical records. Survival rates were estimated by the Kaplan-Meyer method. Cox-proportional-hazard regression models were used to compare the risk of death among all risk factors. Results: The patients were divided into group 1) surgery ± adjuvant radiotherapy (RT) (n = 323) or group 2) RT ± chemotherapy (CT) for curative intent (n = 315) or group 3) RT/CT for palliative intent (n = 137). The overall 10-year survival rate was 17%. Statistically significant difference was noted in 10-year overall survival when SCCOC was managed surgically as compared to curative RT and palliative RT/CT with 25.3 %, 12.9%, 4.7%, respectively. The hazard ratio of cancer death in group 1 was 2.0 (95% CI 1.7-2.4) as compared to group 2. Conclusion: This study suggested that surgery must be the mainstay of treatment in locally advanced stage SCCOC. Palliative RT/CT still offered long term survival in some SCCOC patients.

Central Papillary Cystadenocarcinoma of the Mandible: A Case Report

Papillary cystadenocarcinoma; Intraosseous tumor; Salivary gland neoplasm Background: Central papillary cystadenocarcinoma of the jaw is an extremely rare tumor with only three previously reported cases in the English literature. This tumor is a histologically low-grade cancer, affecting only the mandible. Methods: A 65-year-old woman presented with a two months history of a rapidly growing, painless mass of the right ascending ramus of the mandible. The patholologic report from incisional biopsy was a papillary cystic tumor with a differential diagnosis of cystadenoma versus cystadenocarcinoma. Results: Segmental mandibulectomy, parotidectomy and submandibular gland resection were performed. The final pathology was intraosseous papillary cystadenocarcinoma. Conclusions: Clinical features of central papillary cystadenocarcinoma of the mandible mimic an odontogenic lesion and metastatic bone disease, careful review of radiograph and pathology should be done. En bloc resection with adjuvant postoperative radiotherapy in high stage disease, and long-term follow-up allow the patient to have a favourable prognosis.