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The incidence of occult cervical metastasis in oral cavity cancer, even in early stages, is significant, necessitating elective treatment of the neck in a majority of cases. There is no method of imaging or other examination that will detect microscopic foci of metastatic disease in cervical lymph nodes. Immunohistochemical and molecular analysis of neck specimens reveals the incidence of occult metastases to be higher than revealed by light microscopy with ordinary hematoxylin and eosindoi:10.1016/j.bjoms.2008.06.001 pmid:19121878 fatcat:n3lxci7awjegjlpkgyll24c6wm
more »... in and eosin staining. The neck may be treated electively by surgery or irradiation. Surgery has the advantage of permitting pathological staging of the neck, avoiding unnecessary radiation treatment and indicating cases where adjuvant therapy should be employed. As oral cavity cancer rarely metastasizes to level V, a radical or modified radical neck dissection of all five node levels is not necessary. Selective dissection of levels I-III ("supraomohyoid neck dissection") is the usual procedure of choice for elective dissection of the neck. Most of the relatively small number of isolated metastasis to level IV are from primary tumours of the tongue, which are known to produce "skip" metastases. Thus an "extended supraomohyoid neck dissection" of levels I-IV is recommended by some authors for elective treatment of the neck in tongue cancer. A number of recent prospective multi-institutional studies have demonstrated that sublevel IIB is rarely involved with isolated metastasis from oral cavity primary tumours, except from some tongue cancers. Thus it is justifiable to omit dissection of sublevel IIB in elective treatment of most cases of oral cavity cancer. Bilateral neck dissection should be performed in elective treatment of tumours involving midline structures, and in patients with ipsilateral neck metastasis.
In a comprehensive review of the recent literature in laryngeal cancers, Silver et al. ...doi:10.1007/s00405-009-1105-6 pmid:19771440 fatcat:bljzj2xzxzho5ienzu7nd5aeke
Advances in Therapy
Andrés Coca-Pelaz and Carl E. Silver have nothing to disclose. ...doi:10.1007/s12325-019-01160-9 pmid:31802393 pmcid:PMC6979447 fatcat:avp6kx4qxbh3zmwi47x7f5jil4
The prevailing view is that recreational methamphetamine use causes a broad range of severe cognitive deficits, despite the fact that concerns have been raised about interpretations drawn from the published literature. This article addresses an important gap in our knowledge by providing a critical review of findings from recent research investigating the impact of recreational methamphetamine use on human cognition. Included in the discussion are findings from studies that have assessed thedoi:10.1038/npp.2011.276 pmid:22089317 pmcid:PMC3260986 fatcat:icsbsdesvjbcnevipoqcjw7qm4
more »... ave assessed the acute and long-term effects of methamphetamine on several domains of cognition, including visuospatial perception, attention, inhibition, working memory, long-term memory, and learning. In addition, relevant neuroimaging data are reviewed in an effort to better understand neural mechanisms underlying methamphetamine-related effects on cognitive functioning. In general, the data on acute effects show that methamphetamine improves cognitive performance in selected domains, that is, visuospatial perception, attention, and inhibition. Regarding long-term effects on cognitive performance and brain-imaging measures, statistically significant differences between methamphetamine users and control participants have been observed on a minority of measures. More importantly, however, the clinical significance of these findings may be limited because cognitive functioning overwhelmingly falls within the normal range when compared against normative data. In spite of these observations, there seems to be a propensity to interpret any cognitive and/or brain difference(s) as a clinically significant abnormality. The implications of this situation are multiple, with consequences for scientific research, substance-abuse treatment, and public policy.
doi:10.1080/003655402_000028041 pmid:12484656 fatcat:unlcg6cge5aynnvz6gkua3p77a
doi:10.1080/003655402/000028041 pmid:12484656 fatcat:6lbiqajizbd4pi67axs7yowqf4
Head and Neck
The tumor is composed of uniform small cells with hyperchromatic nuclei and scanty cytoplasm (H&E stain, original magnification, Â100). ... FIGURE 1 . 1 Typical carcinoid of the larynx of trabecular pattern composed of cuboidal cells with round to ovoid nuclei (hematoxylin-eosin [H&E] stain; original magnification, Â100). ...doi:10.1002/hed.21162 pmid:19536850 fatcat:jew3adsdorfj5msjctuoqixh7a
E-mail: firstname.lastname@example.org ... During T-E speech, the esophagus becomes distended with air. ... To assess reliable acoustic data of T-E voices, a robust acoustical T-E voice analysis program should be used and proved to be valid and feasible in the determination of fundamental frequencies, stability ...doi:10.1002/lary.22459 pmid:22258890 fatcat:qngbwfhxffcpponxcshdjd2cp4
modalities for resectable stage III and IV cancers as an alternative to surgical management. this development has led to an increasing role for salvage surgery in cases of recurrent disease. In HNSCC, salvage surgery is, besides aggressive re-irradiation if applicable, often the only curative option in patients with locoregional recurrence  . Among patients with advanced HNSCC treated with definitive pr(C)t or adjuvant r(C)t, locoregional recurrence develops in 18-20 % of cases and in 17-33doi:10.1007/s00405-014-3043-1 pmid:24756615 fatcat:jqk55in36ffdhhb33wqzaw36tq
more »... cases and in 17-33 % of patients treated with definitive rCt for locally advanced, unresectable tumors  . locally, recurrent tumors may arise from residual neoplastic cells that survive initial treatment-most likely due to biological factors that provide radio-and/or chemoresistance, the existence of cancer stem cells, or insufficiencies in initial treatment parameters such as radiation dose, volume, fractionation and/or treatment duration. Also, secondary tumors following pr(C)t may develop from underlying field cancerization, as a radiationinduced malignancy, or as a de novo process. For patients with resectable disease recurrence, salvage surgery is considered the standard of care and may provide long-term disease control in up to 45 % of patients with advanced and up to 80 % of patients with early recurrent disease [3, 6] . However, recurrence rates after salvage surgery, even when negative margins have been obtained, are high  . the rate of recurrence following salvage surgery has been described as 54.9 % in a retrospective analysis of patients with oropharyngeal cancer and cancer of the oral cavity, with an overall five-year survival rate of 32.3 %. In this study, significant prognostic factors in multivariate analysis were recurrent tumor stage (p = 0.049) and disease-free interval (p = 0.045)  . röösli et al.  showed in a retrospective study of 156 patients with recurrent oropharyngeal tumors that five-year overall survival and disease-specific survival after salvage treatment was 29 and
doi:10.1007/s00405-013-2803-7 pmid:24213276 fatcat:rqpr3vaswvhl7cbb63bnafmaz4
doi:10.1007/s00405-013-2366-7 pmid:23371541 fatcat:cfdttiralrcafkr4hnkjqoizfa
ORIGINAL ARTICLE From the Department of Surgery, Head and Neck Division (Drs Owen, Silver, and Ravikumar) and the Departments of Neuroradiology (Drs Brook and Bello) and Pathology (Dr Breining), ...doi:10.1001/archotol.130.1.52 pmid:14732768 fatcat:dhcpm4cvsnc3thflq4p7cmpxae
Head and Neck
Background. Almost all concurrent chemoradiation regimens for head and neck are platinum based; however, cisplatin is associated with severe renal, oto-, and neurotoxicity. Hydroxyurea (HU) has been associated with fewer irreversible toxicities. We obtained HU in parenteral form to be administered continually during the radiation treatment. Intravenous HU promised better pharmacokinetics and cell cycle blockade. Methods. Participants had biopsy-proven, untreated squamous cell carcinoma of thedoi:10.1002/hed.20477 pmid:16983691 fatcat:2eegquclerdzbfattexd6ntmh4
more »... carcinoma of the oral cavity, oropharynx (stage IV) and hypopharynx (stages II-IV). Radiation therapy consisted initially of 74.4 Gy administered in twice daily 1.2-Gy fractions. After 20 patients, the radiation dose was reduced to 60.0 Gy, and another 16 patients were enrolled. Results. Patients received HU by Continuous Ambulatory Drug Delivery (CADD) pump on a daily Â5 schedule during radiation therapy. Because of persistent long-term dysphagia, after 20 patients, the dose of external beam radiation therapy was reduced from 74 to 60 Gy, and the duration of concurrent HU was correspondingly reduced. The new regimen was much better tolerated. The median survival for the group as a whole was 30 months. Within this small study, there were no significant differences in survival, regional control, or local control between the 2 groups. Reprints are not available.
doi:10.1007/s00405-014-3331-9 pmid:25327689 fatcat:6jpldyb43bfmjolfsyp2v4plk4
Although a generally accepted definition of "elderly" still does not exist, in a medical context, persons over the age of 65 are often considered to be elderly. As life expectancy rates have increased within the last decades and continuously increase every year by approximately 3 months , this segment of the population has increased, particularly in Western countries. Because cancer is a disease of aging, the risk of developing malignant disease including head and neck cancer is highest indoi:10.1007/s00405-014-3203-3 pmid:25060978 fatcat:33zgjdjdrndaxdcwboprbl4t7a
more »... cer is highest in this patient population. It also follows that malignancy-related mortality is highest among the elderly. Younger patients with head and neck cancers have a much better overall prognosis. A comparative survival analysis revealed that patients with head and neck cancer who are aged 40 years or younger at the time of diagnosis show significantly improved 5-year survival when compared to older patients  . For all age groups the 5-year survival rate of patients with a newly diagnosed head and neck cancer is approximately 60 % at diagnosis. However, prognosis is a dynamic process that improves after the initial critical years of recurrence-free survival. Conditional relative survival shows clinically relevant variations according to time since diagnosis, type of cancer, and age  . Conditional survival rates can better analyze and reflect actual life expectancy. After 3 years of survival, the conditional survival rate improves from 60 % up to 80 %. However, long-term survival rates stagnate at 80 %. Patients cured of and neck cancer face an excess mortality of about 20 % in long-term follow-up  . The critical reason for this is attributed to the comorbid burden of head and neck cancer patients, connected with unhealthy habits and general lifestyle choices. Comorbidities in cancer patients are defined as one or more unrelated diseases present at the time of cancer diagnosis. Particularly in elderly patients, these predominantly consist of reduced organ and cognitive functions, malnutrition, polypharmacy, and socio-economic factors. Most studies show that approximately 60 % of head and neck cancer patients have concurrent illnesses  . For better evaluation of comorbidities, weighted assessment systems like Adult Comorbidity Evaluation-27 (ACE-27), and Charlson Comorbidity Index (CCI) include the occurrence of comorbidities as well as their degrees. Comorbidities exist in 46 % of head and neck cancer
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