[A case of acinic cell carcinoma of the parotid gland treated with radiotherapy combined with hyperthermia and Doridamine].
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Biomedical subjects
Publications and source records attributed to F Ozzello.
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The authors report their results on the treatment of 211 T1-2/N0-1 carcinoma of the oral cavity treated with radiotherapy alone or associated with surgery and/or chemotherapy. Five- and ten-year survival rates are respectively 48 and 37%. Two groups were recognized: one with a better prognosis (T1 gum and cheek) and another with a poor prognosis (T2-N1 mobile tongue and floor of the mouth).
The appearance, site of occurrence, and selected physical and clinical characteristics are reported for 102 symptomatic carcinomas diagnosed during a 30-month period in Torino, Italy. Erythroplasia was a more significant visual component than leukoplakia, confirming the results of a previous study on asymptomatic cancer in a US population. Floor of the mouth, oral tongue, and soft palate complex accounted for 75% of all sites and 84% of sites if posterior pillar is excluded. Seventeen percent of the lesions were T1, 60% T2, and 23% larger than T2. Size of the lesion was associated with anterior or posterior position and the mobility of the structure, as well as with ulceration, bleeding, and lymphadenopathy (55% of cancers had no nodal involvement). Tumefaction, burning, and pain were the most frequently reported symptoms. About 50% of patients experienced a time lapse between onset of symptoms and final diagnosis of less than 3 months, and this proportion was higher among patients with T1 cancers.
The paper reports on a case of recurrent hemangiopericytoma of the cheek, discusses the results of hyperthermia combined with intra-arterial chemotherapy after the postoperative recurrence and draws significant conclusions about the therapeutic approach to this type of tumour.
Personal experience with the sugar cube test for evaluating the degree of xerostomy induced by radiation therapy carried out by means of 60Co photons on volumes including the parotid glands is reported. The execution technique is described and the processing of data deriving from a series of 480 tests carried out in 60 patients suffering from head-neck cancers reported. On the basis of experience it is maintained that the test presents the following advantages: simple execution, maximum tolerance, easy evaluation, possibility of numerically quantifying and graphically evidencing the course of xerostomy; in conclusion, it is considered that this can be advantageously adopted for both research and practical clinico-therapeutic purposes.
Authors present results obtained by hyperthermic treatment (alone or associated with radiation therapy) on 50 patients (with a total of 66 sites) treated between September 1983 and August 1986. All patients had recurrent or metastatic lesions of pretreated malignant tumors. Among these there were 19 breast adenocarcinomas, 33 squamous cell carcinomas of head and neck, 9 melanomas and 5 subcutaneous metastases of adenocarcinoma of the cervix, rectum and colon. The clinical protocol was: hyperthermia alone (43 degrees -45 degrees C for 30 minutes, bi-weekly, for 4-5 weeks) or hyperthermia plus radiation therapy (4 Gy/fraction) for a total of 8-10 seances, in accordance with previous given doses of irradiation. In summary, complete response rates were 21.2% for head and neck tumors, and 51.5% for cutaneous or subcutaneous lesions. Results have also been analysed according to different prognostic variables related to tumor and treatment characteristics. These data are discussed.
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Eighty-four previously untreated patients (69 males, 15 females) with squamous carcinoma of the tongue (30 patients), floor of the mouth (30), cheek (16), and retromolar region (8) were treated using a protocol comprising cryosurgery + chemotherapy, followed by external 60Co radiotherapy. The follow-up period was at least 6 months (median, 50 months). Cryosurgery (1-2 sessions in 49 T1-2 cases; 2-4 in 35 T3-4 cases) was accompanied by a CMF (cyclophosphamide, methotrexate, 5-fluorouracil) schedule (T1-2, two courses; T3-4, three courses). Radiotherapy was given 15 to 20 days after combined cryochemotherapy (T1, 50 Gy on tumor and lymph nodes; T2-3-4, same with an extra dose of 10 to 15 Gy on the primary lesion). Complete remission was reached 4 months after treatment in 76 of 84 patients (90.5%). Survival with no evidence of disease (NED) in the 57 patients (27 T1-2, 30 T3-4) with a follow-up of more than 3 years was 59.6% for the series as a whole, 70.3% for T1-2, and 50.0% for T3-4; 78.2% for the tongue, 52.6% for the floor, 66.6% for the cheek, and 0% for the retromolar region. The picture was much the same after 5 years. Actuarial survival at 6 years was 66% in the series as a whole, 75.5% in T1-2, and 57.5% in T3-4 (tongue 86.9%, floor 56.1%, cheek 68.4%, and retromolar region 0%). It is believed that the results obtained in tumors of the tongue, floor and cheek, coupled with the conservative aspects of the protocol, make it a suitable subject for a controlled trial.
UNLABELLED: Eighty-five patients (74 males, 11 females) with untreated squamous-cell carcinoma of the tongue (40 patients) and the floor of the mouth (45 patients) underwent a multidisciplinary treatment. FOLLOW-UP: 6-72 months (median 52 months). T1-4N0M0 lesions (tongue; 32 patients; floor of mouth, 32 patients) were treated with cryosurgery (T1-2: 1-2 sessions, T3-4: 2-4 sessions) and contemporaneously with CMF (cyclophosphamide, methotrexate, fluorouracil) (T1-2: 2 courses; T3-4: 3 courses). 15-20 days after the end of cryo-chemotherapy the patients underwent TCT (T1: 50 Gy to the tumour and lymph nodes; T2-3-4: same with an extra dose of 10-15 Gy to the primary lesion). T1-4N1-3M0 patients (tongue: 8, floor of mouth: 13) received the same cryotherapy and chemotherapy, followed by surgery (13 extended suprahyoid dissections, 8 conservative laterocervical dissections, 1 RND). The actuarial survival rate of patients with tongue tumours after 6 years was 81.4% (N0 87.1%; N+ 60.0%). Four months after treatment, 35 patients had reached complete remission (CR). The probability of remaining in CR for 6 years was 53.6% (N0 56.1%; N+ 50.0%). For tumours of the floor of the mouth the actuarial survival rate was 55.2% (N0 56.5%; N+ 48.6%). Four months after treatment, 38 patients had reached CR. The probability of remaining in CR for 6 years was 59.9% (N0 61.5%; N+ 59.3%). A controlled study is recommended in the light of these results and the conservative nature of the protocol.
UNLABELLED: One hundred and twelve patients (95 males, 17 females) with untreated squamous-cell carcinoma of the oral cavity underwent a multidisciplinary treatment. FOLLOW-UP: 6-72 months (median 51 months). T1-4N0M0 lesions (tongue, 31 patients; floor, 31 patients; cheek, 17 patients; retromolar, 9 patients) were treated with cryosurgery (T1-2: 1-2 sessions, T3-4: 2-4 sessions) and contemporaneously with (cyclophosphamide, methotrexate, fluorouracil)(CMF) (T1-2:2 courses; T3-4: 3 courses). The patients, 15-20 days after the end of cryo-chemotherapy, underwent TCT (T1: 50 Gy on tumour and lymph nodes; T2-3-4: same with an extra dose of 10-15 Gy on the primary lesion). T1-4N1-3M0 patients (tongue: 8, floor: 13, cheek: 2, retromolar: 1) received the same cryotherapy and chemotherapy, followed by surgery (16 widened suprahyoid dissections, 8 conservative laterocervical dissections, 1 radical neck dissection). Overall actuarial survival at six years was 61.9%: T1-4N0M0 (88 patients) 66.6% (T1-2 76.0%; T3-4 56.9%); T1-4N1-3M0 (24 patients) 44.4% (T1-2 66.6%; T3-4 33.3%). Six-year actuarial survival by site was: tongue (39 patients) 79.2% (N0 85.9%); floor (44 patients) 55.2% (N0 57.1%); cheek (19 patients) 74.2% (N0 68.9%); retromolar (10 patients) 0% (N0 0%). Complete remission was reached four months after treatment by 97 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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The authors report their experience on the treatment of carcinoma of the oral tongue and floor of the mouth with interstitial brachytherapy, alone or in combination with external irradiation. One hundred and fifty patients were treated; among these, 116 with brachytherapy alone, 34 with combined treatment. The five years local control in those patients treated with brachytherapy alone was 72.5% in T1, 61.2% in T2 and 35% in T3; in those patients treated with external irradiation and brachytherapy the global five years control was 42.5%. The global five years survival was 64% in the patients treated with brachytherapy alone and 48% in the patients treated with combined therapy.