Irradiation of tumors in the headandneckcancer patients is technically challenging especially in the patients with a short neck or high shoulders. Considering patient comfort, we had fixed the patient position by applying a mask. Higher stage headneck cases required comprehensive irradiation of the neck region extending inferiorly to the level of the lung apices. Owing to the body struc- ture, if we planned with coplanar beam arrangements, dose to the healthy tissue of the shoulder region would be higher than non-co- planar beam arrangements because of the photon path length to the PTV, i.e., photon beams had to pass through the shoulders and soft tissue of neck region . For this reason, we evaluated the dose for bilateral humeral heads. A significant dose reduction was noted for D max of bilateral humeral heads in non-coplanar beam ar- rangements.
Use of intensity-modulated radiation therapy (IMRT) for headandneckcancer is gradually increasing, because it could facilitate more sophsticated treatment of target volumes and reduction of acute and late sequelae. However, theoretically, there is a potential risk of increased skin surface dose resulting from multiple obliquity effects caused by multiple tangential beams.
Patients undergoing radiation therapy for headandneckcancer (HNC) experience significant early and long-term side effects. The likelihood and severity of complications depends on a number of fac- tors, including the total dose of radiation delivered, over what time it was delivered and what parts of the headandneck received radiation. Late side effects include: permanent loss of saliva; osteoradio- necrosis; radiation recall myositis, pharyngoesophageal stenosis; dental caries; oral cavity necrosis; fi- brosis; impaired wound healing; skin changes and skin cancer; lymphedema; hypothyroidism, hyper- parathyroidism, lightheadedness, dizziness and headaches; secondary cancer; and eye, ear, neurologi- cal andneck structures damage. Patients who undergo radiotherapy for nasopharyngeal carcinoma tend to suffer from chronic sinusitis. These side effects present difficult challenges to the patients and their caregivers and require life-long strategies to alleviate their deleterious effect on basic life func- tions and on the quality of life. This review presents these side effects and their management.
Purpose : When head&neckcancer radiation therapy, thermoplastic mask is applied for patients with fixed. The purpose of this study is to evaluate usefulness of thermoplastic mask for SRS in tomotherapy by conparison with the conventional mask.
Materials and Methods : Typical mask(conventional mask, C-mask) and mask for SRS are used to fix body phantom(rando phantom) on the same iso centerline, then simulation is performed. Tomotherapy plan for orbit and salivary glands is made by treatment planning system(TPS). A thick portion and a thin portion located near the treatment target relative to the mask S- mask are defined as region of interest for surface dose dosimetry. Surface dose variation depending on the type of mask was analyzed by measuring the TPS and EBT film.
survival observed in long-term follow-up can be attributed to the development of SPM; the median time to develop another tumor was 67 months.
Patients with SPM have a relatively long-term survival, and many patients do well considering it is their second tu- mor. Therefore, efforts should be made to implement regular follow-ups for early diagnosis 13 . In our study, many patients were diagnosed when they were not monitored because they had completed their 5 years of follow-up. We suggest that treated headandneckcancer patients be followed up throughout their lives to detect early SPMs, which should be treated aggressively to attain maximum benefit. Despite the better outcomes observed in this study, multi-institutional data are required to confirm the results.
showed long-term results of implants following radical headandneckcancer surgery with adjuvant radiation therapy, and the over- all 1-, 5-, and 10-year survival rates of all implants were 96.6%, 96.6%, and 86.9%, respectively. Based on the results of the re- search mentioned above, it was concluded that radiotherapy was the essential cause of implant failure. Irradiation can produce both early and late tissue changes. Early effects include those on the salivary glands, skin, and oral mucosa, whereas later effects involve bone changes leading to demineralization, fibrosis, increased sus- ceptibility to infection, and finally, avascular necrosis [16-18]. Thus, the treatments against the changes in the soft and hard tissues af- ter radiotherapy are meaningful for the success of dental implants in patients with headandneckcancer.
(Received November 23, 2018; Revised December 17, 2018; Accepted December 17, 2018)
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Streptococcus sp. strain NM belonging to Firmicutes was isolated from headandneckcancer patients. Here, we report the draft genome sequence of strain NM with a size of approximately 1.90 Mbp and a mean G+C content of 39.3%. The draft genome included 1,845 coding sequences, and 12 ribosomal RNA and 58 transfer RNA genes. In the draft genome, genes involved in the antimicrobial resistance, hemolysis and defense system have been identified.
Hemophilia A is a hemorrhagic disease caused by coagulation factor VIII deficiency. In headandneckcancer surgery, especially during a reconstructive one, complications can occur. These include hematomas due to bleeding which can then lead to flap ischemia, necrosis, and impaired wound healing. There are fewer cases of reconstructive surgery in patients with hemophilia A. Here in we report, a reconstructive surgery that involved mass resection, partial glossectomy (right), selective neck dissection (right, Levels I, II, III, IV), and reconstruction at the lateral arm free flap (left) in a 25-year-old man with hemophilia A. The surgery was successfully performed without any complications after pretreatment with Factor VIII concentrate, which has not been reported earlier.
Principles of the ERAS protocol in Ajou University Hospital
Before implementation of the ERAS approach, perioperative care was directed by the individual surgeon and did not follow a specific protocol. Beginning in August 2015, a protocol was established according to the basic ERAS principles and applied to perioperative care. The main contents of the Ajou Hospital- developed ERAS protocol for headandneckcancer surgery with free-flap reconstruction patients were as follows. Patients were informed regarding the surgical procedure and precautions before surgery, and the operation proceeded with voluntary consent. Prophylactic intravenous antibiotics were administered 1 to 2 hours before surgery and preanesthetic medication was administered before anesthesia. Patients were routinely admitted to the intensive care unit (ICU) on the operation day, and ventilator weaning took place immediately if there were no cardiopulmonary difficulties. If there were no specific problems or complications on postoperative day (POD) 1, the patient was transferred to the general ward. Routine anticoagulation was
SCC-9, KB cells were cultured and growth inhibition activity of gefitinib was measured with MTT assay. To study influence of gefitinib in cell cycle, we performed cell cycle analysis with flow cytometry. Western blot was done to elucidate the expression of EGFR in cell lines and phosphory- lation of EGFR and downstream kinase protein, Erk and Akt.
Significant growth inhibition was observed in SCC-9 cells in contrast with KB cells. Also, flow cytometric analysis showed G1 phase arrest only in SCC-9 cells. In Western blot analysis for investigation of EGFR expression and downstream molecule phosphorylation, gefitinib suppressed phospho- rylation of EGFR and downstream protein kinase Erk, Akt in SCC-9. However, in EGFR positive KB cells, weak expression of active form of Erk and Akt and no inhibitory activity of phosphorylation in Erk and Akt was observed. The antiproliferative activity of gefitinib was not correlated with EGFR expression and some possibility of phosphorylation of Erk and Akt as a predictive factor of gefitinib response was emerged. Further investiga- tions on more reliable predictive factor indicating gefitinib response are awaited to be useful gefitinib treatment inheadandneckcancer patients.
s u m m a r y
Toxicities resulting from platinum based chemotherapy inheadandneckcancer is a cause for much concern. There is a lack of clinical criteria for defining these patient populations, which has posed serious problems associated with increased morbidity and consequently an adverse effect on patients’ quality of life. In addition, there is a lack of consensus on clinical criteria for defining such patient populations, who may be unsuitable for concurrent chemoradiotherapy. A group of experts in the field of headandneckcancer from the Asia Pacific Region convened in August 2014 in Korea to discuss the development of a set of clinical criteria in order to fill the knowledge gap and provide a reference tool for headandneck oncologists. This paper reports the final output from this meeting and the accompanying literature review, with the aim of aiding clinical decision making with the help of some clinical criteria to identify platinum unsuitable patient populations inheadandneckcancer management. Some alternative treat- ment options are also discussed in this paper.
However, FSRT with large fractional dose needs more experiences and longer follow up to define potential long-term complications. We report on the clinical outcome of Cyberknife radiosurgery (CKS) boost after external RT for locally advanced headandneckcancer with emphasis on unexpected high, late complications.
Multiple mechanisms are involved in the anticancer activity of thioridazine. First, thioridazine inhibits PI3K/Akt signaling, which is important for cancer cell survival. Thioridazine inhibits cell viability and induces cell death through inhibition of the PI3K/Akt signaling pathway in ovarian cancerandin cervical and endometrial cancer cells. 11,12 In addition, thioridazine inhibits angiogenesis and tumor growth in ovarian cancer xenografts by inhibiting PI3K/Akt signaling. 17 In our study, thioridazine also inhibited Akt phosphorylation (Supple- mentary Figure S1a). However, PI3K/Akt inhibitors (LY294002 and wortmanin) plus carboplatin did not induce apoptosis inheadandneckcancer cells (Supplementary Figure S1b). Furthermore, both PI3K/Akt inhibitors had no Figure 2 Downregulation of c-FLIP and Mcl-1 expression by carboplatin plus thioridazine contributes to apoptosis. (a and b) AMC-HN4 cells were transiently transfected with pcDNA 3.1-c-FLIP (a) or pFLAG-CMV-4/Mcl-1 (b). Twenty-four hours after transfection, cells were treated with 200 nM carboplatin in the presence or absence of 10 μM thioridazine for 24 h. The sub-G1 fraction was measured by flow cytometry. The protein expression levels of PARP, c-FLIP, Mcl-1, and actin were determined by western blotting.
Aspiration showed a signifi cantly higher incidence from
onset to examination. But significant differences were not observed when other variables were controlled in the multivariate logistic regression analysis. According to the report of Logemann et al. 25 who performed VFSS on patients 3 and 12 months after they underwent radio- therapy or chemoradiotherapy, dysphagia and aspiration showed significantly higher incidences before and 3 months after treatments. But, significant changes were not observed 12 months after treatments. In a study by Petterson et al., 20 the functional endoscopic swallowing study and the 100 cc water swallowing test were per- for med on patients who underwent radiotherapy or chemoradiotherapy. The incidence of aspiration in- creased at 3, 6, and 12 months after the operations, respectively, rather than before the operations. However, no inter-period diff erences were reported. In this study, the incidence of aspiration increased in proportion to the duration from onset to examination. Th e incidence may not have been aff ected by duration itself but by increasing the proportion of patients who underwent operations, chemotherapy, or radiotherapy with time. These results were similar to those of previous studies.
ORN treatment is difficult, involves a combination of ther- apies, depends on available therapeutic resources, and relies on patient compliance with instructions and their individual biological response. For many researchers, conservative treat- ment is performed only in small ORN areas since for more advanced conditions, surgical resection is considered more efficient 1 . The conservative and surgical approach associated with HOT is well documented 1,19,36 . A less invasive option for ORN control and healing involves 0.12% chlorhexidine which, when administered topically, acts as a bactericide against gram-positive and gram-negative microorganisms and some yeasts. Despite exhibiting good results when associated with superficial necrotic bone curettage, there is still no pro- tocol for the use of chlorhexidine for ORN treatment 1,17 .