scholarly journals Analysis of the critical dose of radiation therapy in the incidence of Osteoradionecrosis in head and neck cancer patients: a case series

BDJ Open ◽  
2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Zain Iqbal ◽  
Panayiotis Kyzas
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Pathological Fracture ◽  
Case Series ◽  
Electronic Patient Records ◽  
Head And Neck Tumours ◽  
Necrotic Bone ◽  
The Mean ◽  
Associated Risk Factors ◽  
Mandibular Surgery

Abstract Introduction Osteoradionecrosis (ORN) is a dramatic complication following radiation therapy (RT) for head and neck tumours. Symptoms include pain, trismus, and malodour. ORN can present with exposed necrotic bone, an orocutaneous fistula, and/ or a pathological fracture. Aims To analyse the RT dose responsible for the pathogenesis of ORN and its associated risk factors. Methods The data of 17 patients from 2005 to 2017 were retrospectively reviewed from the Pinnacle(3), WebPublication, and Electronic patient records (EPR) provided by Christie Hospital and Pennine Acute NHS Trust. Results The mean RT dose that ORN sites received was 57.3 Gy. The mean onset duration for ORN after RT was 640.6 days. six patients (35.2%) developed ORN following post-RT dental extractions. Conclusion RT dosages of >57.3 Gy significantly increase the likelihood of developing ORN. Mandibular surgery, post-RT dental extraction, concurrent smoking, and alcohol abuse all amplify the risk of developing ORN.

Waiting times during the management of head and neck tumours

2002 ◽  
Vol 116 (4) ◽  
pp. 275-279 ◽  
Author(s):  
T. M. Jones ◽  
O. Hargrove ◽  
J. Lancaster ◽  
J. Fenton ◽  
A. Shenoy ◽  
...  
Keyword(s):  
Head And Neck ◽  
Waiting Times ◽  
Symptom Duration ◽  
Head And Neck Tumours ◽  
Magnetic Resonance Scan ◽  
Primary Radiotherapy ◽  
The Mean ◽  
Mean Time ◽  
Referral Letters

The waiting times incurred during the management of 75 consecutive head and neck oncology patients attending for post-treatment follow-up were reviewed. Data were gleaned from general practitioner (GP) referral letters, patient case-notes as well as radiology and histology reports. The mean time for GP referral to ENT was 5.1 weeks. From ENT to endoscopy was 3.1 weeks, to histology 3.5 weeks, to computed tomography (CT) scan 5.6 weeks, to magnetic resonance scan (MR) 4.1 weeks, to primary radiotherapy 10.3 weeks and to surgery 5.5 weeks. The mean symptom duration prior to referral was 4.9 months.Our results compare unfavourably with the standards recommended by the BAO-HNS. Local modifiations may improve matters, but significant increases in funding, manpower and equipment are required to achieve the stipulated standards. Moreover, criteria for referral have to be re-emphasized and patient education has to be addressed as these appear to contribute the longest delay in the diagnosis of head and neck tumours.

Application of Proximal Lateral Leg Perforator Flaps for Head and Neck Reconstructions

2014 ◽  
Vol 151 (5) ◽  
pp. 791-796 ◽  
Author(s):  
Honda Hsu ◽  
Peir-Rong Chen ◽  
Sou-Hsin Chien ◽  
Jiunn-Tat Lee
Keyword(s):  
Head And Neck ◽  
Donor Site ◽  
Tertiary Care ◽  
Case Series ◽  
Functional Results ◽  
Donor Site Morbidity ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Recipient Site ◽  
The Mean

Objective Analyze the reliability, complications, and donor site morbidity of the proximal lateral leg flap when applied to head and neck reconstruction. Study Design Case series and chart review. Setting Tertiary care teaching hospital. Subjects and Methods Nineteen patients who underwent reconstruction of various head and neck defects with this flap were analyzed. The patient demographics, flap characteristics, method of donor site closure, scars of the donor area, complication rates, as well as functional results at the recipient site were assessed. Results The flap size ranged from 4 × 4 cm to 11 × 8 cm. Vascular pedicle length ranged from 5 to 9 cm. The mean distance of the perforator from the fibula head was 9.2 cm. The mean thickness of this flap was 5.5 mm. All the donor wounds were closed primarily. The flap survival rate was 100%. Conclusion This flap has the advantages of thinness, short harvesting time, minimal donor site morbidity, and primary closure at the donor site when the flap width is less than 6 cm. This flap may be useful for reconstruction in selected patients with small and thin heads and neck defects.

scholarly journals The Treatment Outcome and Radiation-Induced Toxicity for Patients with Head and Neck Carcinoma in the IMRT Era: A Systematic Review with Dosimetric and Clinical Parameters

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Vassilis Kouloulias ◽  
Stella Thalassinou ◽  
Kalliopi Platoni ◽  
Anna Zygogianni ◽  
John Kouvaris ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Head And Neck ◽  
Head And Neck Carcinoma ◽  
Locoregional Control ◽  
Tumor Control ◽  
Neck Carcinoma ◽  
Radiation Induced ◽  
The Mean ◽  
Spearman Test

A descriptive analysis was made in terms of the related radiation induced acute and late mucositis and xerostomia along with survival and tumor control rates (significance level at 0.016, bonferroni correction), for irradiation in head and neck carcinomas with either 2D Radiation Therapy (2DRT) and 3D conformal (3DCRT) or Intensity Modulated Radiation Therapy (IMRT). The mean score of grade>II xerostomia for IMRT versus 2-3D RT was 0.31 ± 0.23 and 0.56 ± 0.23, respectively (Mann Whitney,P<0.001). The parotid-dose for IMRT versus 2-3D RT was 29.56 ± 5.45 and 50.73 ± 6.79, respectively (Mann Whitney,P=0.016). The reported mean parotid-gland doses were significantly correlated with late xerostomia (spearman test, rho = 0.5013,P<0.001). A trend was noted for the superiority of IMRT concerning the acute oral mucositis. The 3-year overall survival for either IMRT or 2-3DRT was 89.5% and 82.7%, respectively (P=0.026, Kruskal-Wallis test). The mean 3-year locoregional control rate was 83.6% (range: 70–97%) and 74.4 (range: 61–82%), respectively (P=0.025, Kruskal-Wallis). In conclusion, no significant differences in terms of locoregional control, overall survival and acute mucositis could be noted, while late xerostomia is definitely higher in 2-3D RT versus IMRT. Patients with head and neck carcinoma should be referred preferably to IMRT techniques.

Results of Radiation Therapy for Primary Extranodal Lymphoma of the Head and Neck: A Report of Case Series

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4761-4761
Author(s):  
Aruna Turaka ◽  
Li Tianyu ◽  
Adam D Cohen ◽  
Barbara Pro ◽  
Michael Millenson ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Case Series ◽  
Post Treatment ◽  
Cancer Center ◽  
Combined Modality Treatment ◽  
Actuarial Survival ◽  
Neck Node ◽  
Involved Field

Abstract Abstract 4761 Purpose: Radiation therapy is an important treatment modality for the extra-nodal lymphoma (ENL) of the head and neck. Intensity Modulated radiation therapy (IMRT) has been shown for head and neck cancers to be associated with decreased late side effects like Xerostomia compared with conventional RT techniques (Conv.RT). The purpose of the study is to determine the clinico-pathological features, treatment outcomes and late toxicities in patients (pts) with ENL of head and neck treated with different RT techniques. Methods: Retrospective review of records from 2007–2010 identified 14 pts with ENL of the head and neck treated with RT at Fox Chase Cancer Center. Eight were treated with IMRT and 6 with conventional RT technique. Thirteen had CD20+ non-Hodgkin lymphoma [NHL; 7 diffuse large B cell (DLBCL), 3 MALT, 3 others], and one Hodgkin's lymphoma (HL; classic). All pts underwent routine staging work-up with negative bone marrow biopsy for all. Pre and post-treatment PET scans were done in 7 pts. Initial chemotherapy (R-CHOP × 4–6 courses for DLBCL, ABVD × 4 for HL), or no chemotherapy (MALT) was followed by involved field radiation therapy (median RT dose: 36 Gy for NHL, 30 Gy HL, 150– 180 cGy per fraction in 20 fractions over 4 weeks). Results: The median follow up was 28 months (range: 1– 52). The median age was 60 years (range: 42–95; 7 males and 7 female). Nine had stage IEA disease, 3 had stage II and 2 stage IV. Five had oropharynx involvement, two had paranasal sinus (DLBCL) 2 nasopharynx (1 DLBCL, 1 MALT) and 1 vallecula (HL). The overall response rate after combined modality treatment was 100%. There were no FDG avid lesion noted on post-treatment PET. There were no local or neck node relapses at last follow up. The 2-year actuarial survival rate was 80%. One DLBCL patient had systemic relapse involving stomach and bilateral testes, was treated with second-line chemotherapy and radiation therapy. At the last follow up, 12/14 were alive. RTOG grade 2 acute skin changes were noted in 6 pts (3 by each RT technique), grade 2 mucositis in 5 pts (3 with Conv.RT) and grade 2 xerostomia in 6 pts. None of the pts developed grade 3 xerostomia (both acute and late). Late grade 2 Xerostomia was seen in 5 pts treated with Conv.RT but not with IMRT. Conclusions: RT following chemotherapy or used alone in ENL of head and neck was associated with local and distant disease control in the majority of patients, with a toxicity profile that appears favorable for IMRT compared with conventional radiotherapy techniques. Larger studies are required to confirm that IMRT is as effective as conventional involved-field RT. Disclosures: Pro: Celgene: Consultancy, Honoraria.

Treatment of ruptured lenticulostriate artery aneurysms

2008 ◽  
Vol 109 (1) ◽  
pp. 28-37 ◽  
Author(s):  
Chirag D. Gandhi ◽  
Ronit Gilad ◽  
Aman B. Patel ◽  
Abilash Haridas ◽  
Joshua B. Bederson
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Single Institution ◽  
Neurological Outcomes ◽  
Ruptured Aneurysms ◽  
Mean Size ◽  
Lenticulostriate Artery ◽  
The Mean ◽  
Associated Risk Factors ◽  
Surgical Treatments

Object Lenticulostriate artery (LSA) aneurysms are rarely reported in the literature, making management decisions challenging. Conservative, endovascular, and surgical treatments have been described primarily through case reports and reports of individual authors' experiences. The purpose of this study is to report neurological outcomes in a single-institution experience of ruptured lenticulostriate aneurysms treated surgically. Methods The authors have conducted a retrospective review of all cases involving patients with ruptured LSA aneurysms who presented to the Mt. Sinai Hospital neurosurgical service between September 2001 and January 2007. Results Over 5.4 years, the authors treated 6 patients with 7 LSA aneurysms—6 ruptured and 1 unruptured. The Hunt and Hess grade on admission ranged from I to IV, with subarachnoid hemorrhage in 5 of the 6 patients. Catheter angiography confirmed the presence of the aneurysms, and all patients underwent a pterional craniotomy and clipping or resection of the aneurysm, performed by a single surgeon. Associated risk factors in our series of patients included hypertension, cocaine abuse, and intracranial occlusive disease suggestive of moyamoya disease. Two types of LSA aneurysms were identified. The mean size of the 6 ruptured aneurysms was 3.2 mm. The LSA was preserved in 3 of 6 patients, but LSA preservation did not correlate with development of a postoperative infarct, clinically or radiologically. In patients with ruptured aneurysms, the mean modified Rankin Scale score at discharge was 1.7. The 3 patients in whom the LSA was sacrificed had good outcomes, suggesting that loss of the artery is clinically well tolerated. Conclusions This case series demonstrates that surgical treatment of ruptured LSA aneurysms can be an appropriate, effective, and safe therapy.

scholarly journals Analysis of the Indigenous and Pathogenic Microbiota in Bone Sequestration due to Osteonecrosis of the jaws by Bisphosphonates (MRONJ)

2020 ◽  
Vol 5 (1) ◽  
pp. 1-5
Author(s):  
Picardo Silvana N ◽  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Bone Mineral ◽  
Chronic Treatment ◽  
Bone Area ◽  
Necrotic Bone ◽  
Mineral Research ◽  
Osteonecrosis Of The Jaws ◽  
Oral Environment

The American Surgery of Bone Mineral Research (ASBMR) defined MRONJ as “necrotic bone area exposed to the oral environment with more than eight weeks of permanence, in the presence of chronic treatment with BPs, in the absence of radiation therapy to the head and neck in 2007.

scholarly journals NSQIP as a Predictor of Length of Stay in Patients Undergoing Free Flap Reconstruction

OTO Open ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. 2473974X1668569 ◽  
Author(s):  
Charles A. Riley ◽  
Blair M. Barton ◽  
Claire M. Lawlor ◽  
David Z. Cai ◽  
Phoebe E. Riley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Head And Neck ◽  
Free Flap ◽  
Reconstructive Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Flap Surgery ◽  
Improvement Program ◽  
Free Flap Surgery ◽  
The Mean

Objective The National Surgical Quality Improvement Program (NSQIP) calculator was created to improve outcomes and guide cost-effective care in surgery. Patients with head and neck cancer (HNC) undergo ablative and free flap reconstructive surgery with prolonged postoperative courses. Methods A case series with chart review was performed on 50 consecutive patients with HNC undergoing ablative and reconstructive free flap surgery from October 2014 to March 2016 at a tertiary care center. Comorbidities and intraoperative and postoperative variables were collected. Predicted length of stay was tabulated with the NSQIP calculator. Results Thirty-five patients (70%) were male. The mean (SD) age was 67.2 (13.4) years. The mean (SD) length of stay (LOS) was 13.5 (10.3) days. The mean (SD) NSQIP-predicted LOS was 10.3 (2.2) days ( P = .027). Discussion The NSQIP calculator may be an inadequate predictor for LOS in patients with HNC undergoing free flap surgery. Additional study is necessary to determine the accuracy of this tool in this patient population. Implications for Practice: Head and neck surgeons performing free flap reconstructive surgery following tumor ablation may find that the NSQIP risk calculator underestimates the LOS in this population.

Clinical evidence on PET–CT for radiation therapy planning in head and neck tumours

2010 ◽  
Vol 96 (3) ◽  
pp. 328-334 ◽  
Author(s):  
Esther G.C. Troost ◽  
Dominic A.X. Schinagl ◽  
Johan Bussink ◽  
Wim J.G. Oyen ◽  
Johannes H.A.M. Kaanders
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Clinical Evidence ◽  
Therapy Planning ◽  
Head And Neck Tumours ◽  
Radiation Therapy Planning ◽  
Pet Ct

scholarly journals Post- operative Radiotherapy of Conjunctival Malignancies: A Series of 24 Cases

2017 ◽  
Vol 2 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Asma Belaïd ◽  
Chiraz Nasr ◽  
Omar Jmour ◽  
Aziz Cherif ◽  
Hajer Kamoun ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Recurrence ◽  
Case Series ◽  
Treatment Modalities ◽  
Basal Diameter ◽  
Strontium 90 ◽  
The Mean ◽  
Clinical Records ◽  
Plaque Brachytherapy

Objective: To assess the results of post-operative radiation therapy in the management of incompletely resected conjunctival malignancies.Methods: In this retrospective case series, we reviewed the clinical records of all cases of conjunctival tumors treated with post-operative radiotherapy in the radiation oncology department of Salah Azaïz Institute of Tunis, from January 1990 to December 2015. We focused on clinico-pathological characteristics, treatment modalities and patients’ outcome.Results: Twenty four patients were enrolled in our study: 19 men and 5 women. The mean age of our patients was 54 years (range: 20 to 84). The mean basal diameter of the tumor was 11 mm (range 6 to 20 mm). The mean tumor thickness was 4 mm (range 1 to 15 mm). The most frequent histological type was squamous cell carcinoma in 23 cases. One patient had a malignant conjunctival fibrohistiocytoma. Radiation therapy was post-operative for positive or narrow surgical margins in all cases. Eighteen patients were treated with kilovoltage radiation therapy (KVRT). The mean delivered dose to the tumor bed was 64 Gy (range: 60 to 70 Gy). Four patients were treated with an association of KVRT and Strontium 90 plaque brachytherapy. Two patients were treated only with Strontium 90 plaque brachytherapy (2 fractions of 17 Gy). After a median follow-up of 110 months, 19 patients were alive with no evidence of local recurrence in 17 patients. Two patients had a local recurrence and were referred to surgery. Two patients were ost to follow up. The 5-year relapse free survival rate was 90.9%. Radiation-induced side effects were conjunctivitis, cataract, eye watering and glaucoma.Conclusion: Post-operative radiation therapy allows good local control with acceptable toxicities in conjunctival malignancies. Management of these tumors needs a broad collaboration between ophthalmologists and radiation oncologists, to allow a conservative treatment with the lowest rates of local recurrence.

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