Sheng-Po Hao

Nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 53 patients and prognostic factors

Conclusions. Salvage surgery is a justified treatment for primary recurrence of nasopharyngeal carcinoma (NPC). Skull base surgery can play a role in rescuing patients with more advanced local recurrence of NPC. Objectives. The purpose of this study was to report the local control and overall survival outcome of patients with (NPC) with local failure who received salvage nasopharyngectomy and to identify prognostic factors. Patients and methods. Fifty-three consecutive patients who had primary recurrence of NPC and underwent salvage surgery with curative intention from July 1993 to December 2006 were retrospectively reviewed. The follow-up time ranged from 5.1 to 142.2 months. The numbers of cases of recurrent NPC stage were as follows: stage I, 26; stage II, 9; stage III, 10 and stage IV, 8. Fifty patients had one course of radiation therapy while 3 had two courses of radiation therapy before the salvage surgery. For the nasopharyngectomy, 2 patients underwent endoscopic approach and 33 underwent facial translocation, while 18 had craniofacial resection. Postoperative adjuvant treatment included radiation therapy, 4 cases; radiosurgery, 8 cases; concurrent chemoradiation therapy, 7 cases; and chemotherapy, 2 cases. Results. The 5-year local control rates were T1, 58.3%; T2, 27.8%; T3, 53.3%; T4, 75.0%; and all stages, 53.6%. The 5-year overall survival rates were stage I, 64.8%; stage II, 38.1%; stage III, 25.9%; stage IV, 46.9%; and all stages, 48.7%. Multivariate analysis revealed that gender, margin status, adjuvant treatment type and parapharyngeal space involvement were significant impact factors of local control, whereas dura or brain involvement, local recurrence and adjuvant treatment type were significant impact factors of survival.

Screening nasopharyngeal carcinoma by detection of the latent membrane protein 1 (LMP-1) gene with nasopharyngeal swabs

Nasopharyngeal carcinoma (NPC) is a common head and neck cancer in Taiwan. The goals of the current study were to investigate whether a nasopharyngeal swab technique could provide enough DNA for polymerase chain reaction (PCR) analysis of the Epstein–Barr virus (EBV)–derived latent membrane protein 1 (LMP‐1) gene and to determine the feasibility and reliability of diagnosing NPC by detection of LMP‐1 in the nasopharynx.

Osteomyocutaneous peroneal artery-based combined flap for reconstruction of composite and en bloc mandibular defects.

The osteomyocutaneous peroneal artery‐based combined (OPAC) flap is a refinement of fibula osteoseptocutaneous flap, with the inclusion of partial soleus muscle based on an independent myocutaneous perforator.

Osteomyocutaneous peroneal artery perforator flap for reconstruction of composite maxillary defects

Composite maxillary defects often involve the maxilla, nasal mucosa, palate, and maxillary sinus. We presented the surgical techniques and outcome of the osteomyocutaneous peroneal artery perforator (PAP) flap for reconstruction of composite maxillary defects.

Osteoradionecrosis with Combined Mandibulotomy and Marginal Mandibulectomy

Introduction: To evaluate the outcome of simultaneous anterior mandibulotomy and marginal mandibulectomy for patients with oral cavity cancer.

The role of supraomohyoid neck dissection in patients of oral cavity carcinoma

The aim of this study was to evaluate the role of supraomohyoid neck dissection (SOHND) in oral carcinoma patients with clinically negative neck nodes. From July 1993 to June 1998, 140 patients with oral carcinomas and clinically negative lymph nodes in the neck underwent elective SOHND in Chang Gung Memorial Hospital, Taiwan. Thirty-seven patients had postoperative radiotherapy.Thirty-four (24.3%) patients had occult cervical metastases. The overall regional control rates were 93.4% vs. 85.3% for pathologically negative vs positive nodes, respectively, with or without adjuvant radiotherapy. Adjuvant radiotherapy significantly improved ipsilateral regional control (P=0.012) in patients with occult cervical metastases but not in patients with negative neck disease. (P=1.0) SOHND is both a diagnostic and therapeutic procedure in patients with negative neck disease. Its therapeutic role in patients with positive neck disease remains controversial. Postoperative radiotherapy significantly improve ipsilateral neck control in patients with occult cervical metastasis.

Primary thyroid-like papillary adenocarcinoma of the nasopharynx.

Thyroid-like papillary adenocarcinoma is an extremely rare neoplasm in the nasopharynx. We present a case with a pedunculated tumor in the nasopharyngeal vault and the preoperative biopsy revealed a thyroid-like papillary adenocarcinoma. Complete tumor resection via modified facial translocation was undergone subsequently. Postoperative histopathological examinations and immunohistochemical studies confirmed the diagnosis. Regarding the association with Epstein-Barr virus (EBV), the tumor was negative for both small EBV-encoded RNA (EBER) and EBV latent membrane protein-1 (LMP-1) oncogene. This rare neoplasm demonstrated a distinct etiology and nature from typical nasopharyngeal carcinomas and should be managed mainly by surgical resection.

The Anatomical Basis for Mandibulotomy: Midline Versus Paramidline

Objective To provide an anatomical basis for mandibulotomy.

Differentiation of Recurrent Nasopharyngeal Carcinoma and Skull Base Osteoradionecrosis by Epstein‐Barr Virus‐Derived Latent Membrane Protein‐1 Gene

Objectives In patients with nasopharyngeal carcinoma (NPC), the differentiation between recurrent primary cancer and osteoradionecrosis (ORN) is clinically difficult. Epstein‐Barr virus (EBV)‐derived latent membrane protein‐1 (LMP‐1) has been demonstrated to be highly associated with NPC. The objective of this study is to define the role of the LMP‐1 gene in the differential diagnosis of recurrent NPC and ORN.

Monitoring tumor recurrence with nasopharyngeal swab and latent membrane protein-1 and epstein-barr nuclear antigen-1 gene detection in treated patients with nasopharyngeal carcinoma.

Objectives: Epstein‐Barr virus (EBV) is closely related to nasopharyngeal carcinoma (NPC). Detection of EBV genomic DNA in a nasopharyngeal swab specimen may indicate the presence of NPC, and the EBV genomic DNA is only detected in patients with NPC and not in other head and neck cancers. This study aims to prove that detection of EBV genomic DNA by means of the latent membrane protein (LMP)‐1 gene and the Epstein‐Barr nuclear antigen (EBNA)‐1 gene in the nasopharynx in NPC patients after radiation therapy indicates local recurrence of NPC.