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Cisplatin as a radiation sensitizer in the treatment of advanced head and neck cancers
858
CURRENT LITERATURE
vascular supply to the scalp is provided principally by four paired vessels of the supraorbital, superficial temporal, posterior auricular, and occipital arteries. Small scalp lesions ( < 3.0 cm) can be closed primarily, usually after some undermining. If pericranium remains, a skin graft can be placed to be excised in the future after tissue expansion. Local scalp flaps are effective in covering full thickness scalp defects. The pectorals major, latissimus dorsi and trapezius flaps are the three distant flaps most frequently described for scalp repair. Free tissue transfer of fasciocutaneous flaps from the radial forearm have also been described. Calvarial reconstruction is usually accomplished with alloplastic materials (including acrylic [methylmethacrylate], and various metal sheets) or autogenous grafts of rib, calvarium, or ilium. Postextirpative, postradiation wounds can result from minor trauma and become infected or necrotic. In these cases only large rotation flaps or free tissue transfers are effective.-R.H. HAUG
staged advanced (stage III of IV) squamous cell carcinoma of the head and neck region were entered in a prospective study (protocol-RIH/841). The study was a regimen consisting of an induction phase of 4,500 cGy and two cycles of cisplatin followed by an eradicative phase of either radical surgery (group A, 27 patients) or radical radiotherapy (group B, 41 patients). Cisplatin and radiation therapy have been found to be synergistic and additive. Concomitant use of high-dose cisplatin (100/mg/m 2 every 3 weeks) showed superior complete responses. This study showed 83% response (complete response, 26%; partial response, 57%) to induction chemoradiotherapy using cisplatin. Although the overall survival was 32% (no improvement compared with historic controls), the subgroup with pathologic complete tumor clearance had improved survival of 5 8 % . - - W . G . BAST
Reprint requests to Dr Luce: Division of Plastic Surgery, Kentucky Clinic, Suite K454, 740 South Limestone, Lexington, Kentucky 40536-0284.
The Medical Management of Masseteric Hypertrophy With Botulinum Toxin Type A. Moore AP, Wood GD. Br J Oral Maxillofac Surg 32, 1994
Normal Transcutaneous Oxygen Pressure in Skin After Radiation Therapy for Cancer. Rudolph, Tripuranemi P, Koziol JA, et al. Cancer 74:3063, 1994
Hypertrophy of the masseter muscle may be due to congenital malformations or a host of nonorganic causes such as clenching. Prior treatment modalities for esthetic correction of this deformity included intraoral or extraoral debulking of the muscle. Botulinum toxin type A (BtA) is a protein produced by the bacterium Clostridium botulinum. Its exact mechanism of action is unknown. However, it is known to block release of acetylcholine to cause presynaptic neuromuscular blockade. Muscles become weak typically within 2 to 20 days and recover within 2 to 4 months. The technique used in this study was to inject 100 mouse units into the most bulky aspect of the muscle. A 200-unit dose was injected 2 weeks later. Results showed significant clinical reduction in muscle bulk which satisfied the study patient. Results have lasted greater than 6 months. Possible risks include dysphagia or build-up of antitoxin antibodies so that repeated injections are rendered less effective.--G.T. LYNAM
Changes in skin after radiation treatment for cancer have been reported for years. These changes, including atrophy, scarring, ulcers, and a decreased ability to heal have been linked to progressive worsening ischemia including both a decreased blood supply and a decreased amount of oxygen delivered to the local tissues. This study evaluated the transcutaneous oxygen pressure (TCPO2), which accurately effects skin oxygenation, in 100 patients with a history of previous radiation therapy for cancer. Measurements were made at control sites and compared with the site of previous radiation, in addition, measurements were made with the patients breathing ambient air and with oxygen via face mask at 6 L/min for 10 minutes. Measurements by sex, grade, age, and time since irradiation were compared. Study results showed that control TCPO2 measurements were significantly higher than irradiated sites with and without supplemental oxygen in men, and only with supplemental oxygen in women. Medium and severe grades of radiation damaged skin did not differ greatly from normal skin regarding tissue oxygenation with ambient air or with supplemental inspired oxygen. Another interesting finding was that TCPOz values in the cheek, temple, and especially mandible regions in normal nonirradiated patients were lower than corresponding values for extremities. These normal levels could be lower than 30 mm Hg. Although some groups had significantly lower values in the irradiated groups, overall in 88% of irradiated patients, TCPO2 was within the accepted normal range and responded appropriately to supplemental oxygenation, even with increasing time since irradiation.--E.D. CHAFrrz
Reprint requests to Dr Chougule: Department of Radiation Therapy, Rhode Island Hospital, Providence, RI 02903.
Reprint requests to Dr Moore: The Walton Centre for Neurology and Neurosurgery, Walton Hospital, Rice Lane, Liverpool; Wirral Hospitals Trust, Arrowe Park Hospital, Wirral.
Lingual Abscess. Redleaf MI. Ann Otol Rhinol Laryngol 103:986, 1994 Tongue abscesses are rare, but lingual cellulitis without pus formation is seen in immunocomprimised patients. A case of lingual abscess in a 48-year-old diabetic edentulous man was CT scanned to distinguish it from lingual cellulitis. A clinical distinction of the two conditions in edematous tongues is not easily made. CT scans of cellulitis is seen as attenuation of the affected areas' signal, while abscess is seen as a rim-enhancing lesion with a low density cavity. The treatment regimens differ.--G.H. SPERBER
Reprint requests to Dr Rudolph: Scripps Clinic and Research Foundation, MS115, 10666 North Torrey Pines Rd, La Jolla, CA 92037.
Reprint requests to Dr Redleaf: Department Otolaryngology--Head and Neck Surgery, University of Chicago Medical Center, 5841 S Maryland Ave MC 1035, Chicago, IL 60637.
Cisplatin as a Radiation Sensitizer in the Treatment of Advanced Head and Neck Cancers. Chougule PB, Suk S, et al, Cancer 74:1927, 1994
Microvascular Decompression for Hemifacial Spasm. Barker FG, Jannetta PJ, Bissonette DJ, et al. J Neurosurg 82:201, 1995
Between 1984 and 1990, a total of 68 patients with previously untreated, histologically confirmed, and clinically
Hemifacial spasm, although painless, is distressing to patients because the involuntary spasms are exacerbated by
CURRENT LITERATURE
vascular supply to the scalp is provided principally by four paired vessels of the supraorbital, superficial temporal, posterior auricular, and occipital arteries. Small scalp lesions ( < 3.0 cm) can be closed primarily, usually after some undermining. If pericranium remains, a skin graft can be placed to be excised in the future after tissue expansion. Local scalp flaps are effective in covering full thickness scalp defects. The pectorals major, latissimus dorsi and trapezius flaps are the three distant flaps most frequently described for scalp repair. Free tissue transfer of fasciocutaneous flaps from the radial forearm have also been described. Calvarial reconstruction is usually accomplished with alloplastic materials (including acrylic [methylmethacrylate], and various metal sheets) or autogenous grafts of rib, calvarium, or ilium. Postextirpative, postradiation wounds can result from minor trauma and become infected or necrotic. In these cases only large rotation flaps or free tissue transfers are effective.-R.H. HAUG
staged advanced (stage III of IV) squamous cell carcinoma of the head and neck region were entered in a prospective study (protocol-RIH/841). The study was a regimen consisting of an induction phase of 4,500 cGy and two cycles of cisplatin followed by an eradicative phase of either radical surgery (group A, 27 patients) or radical radiotherapy (group B, 41 patients). Cisplatin and radiation therapy have been found to be synergistic and additive. Concomitant use of high-dose cisplatin (100/mg/m 2 every 3 weeks) showed superior complete responses. This study showed 83% response (complete response, 26%; partial response, 57%) to induction chemoradiotherapy using cisplatin. Although the overall survival was 32% (no improvement compared with historic controls), the subgroup with pathologic complete tumor clearance had improved survival of 5 8 % . - - W . G . BAST
Reprint requests to Dr Luce: Division of Plastic Surgery, Kentucky Clinic, Suite K454, 740 South Limestone, Lexington, Kentucky 40536-0284.
The Medical Management of Masseteric Hypertrophy With Botulinum Toxin Type A. Moore AP, Wood GD. Br J Oral Maxillofac Surg 32, 1994
Normal Transcutaneous Oxygen Pressure in Skin After Radiation Therapy for Cancer. Rudolph, Tripuranemi P, Koziol JA, et al. Cancer 74:3063, 1994
Hypertrophy of the masseter muscle may be due to congenital malformations or a host of nonorganic causes such as clenching. Prior treatment modalities for esthetic correction of this deformity included intraoral or extraoral debulking of the muscle. Botulinum toxin type A (BtA) is a protein produced by the bacterium Clostridium botulinum. Its exact mechanism of action is unknown. However, it is known to block release of acetylcholine to cause presynaptic neuromuscular blockade. Muscles become weak typically within 2 to 20 days and recover within 2 to 4 months. The technique used in this study was to inject 100 mouse units into the most bulky aspect of the muscle. A 200-unit dose was injected 2 weeks later. Results showed significant clinical reduction in muscle bulk which satisfied the study patient. Results have lasted greater than 6 months. Possible risks include dysphagia or build-up of antitoxin antibodies so that repeated injections are rendered less effective.--G.T. LYNAM
Changes in skin after radiation treatment for cancer have been reported for years. These changes, including atrophy, scarring, ulcers, and a decreased ability to heal have been linked to progressive worsening ischemia including both a decreased blood supply and a decreased amount of oxygen delivered to the local tissues. This study evaluated the transcutaneous oxygen pressure (TCPO2), which accurately effects skin oxygenation, in 100 patients with a history of previous radiation therapy for cancer. Measurements were made at control sites and compared with the site of previous radiation, in addition, measurements were made with the patients breathing ambient air and with oxygen via face mask at 6 L/min for 10 minutes. Measurements by sex, grade, age, and time since irradiation were compared. Study results showed that control TCPO2 measurements were significantly higher than irradiated sites with and without supplemental oxygen in men, and only with supplemental oxygen in women. Medium and severe grades of radiation damaged skin did not differ greatly from normal skin regarding tissue oxygenation with ambient air or with supplemental inspired oxygen. Another interesting finding was that TCPOz values in the cheek, temple, and especially mandible regions in normal nonirradiated patients were lower than corresponding values for extremities. These normal levels could be lower than 30 mm Hg. Although some groups had significantly lower values in the irradiated groups, overall in 88% of irradiated patients, TCPO2 was within the accepted normal range and responded appropriately to supplemental oxygenation, even with increasing time since irradiation.--E.D. CHAFrrz
Reprint requests to Dr Chougule: Department of Radiation Therapy, Rhode Island Hospital, Providence, RI 02903.
Reprint requests to Dr Moore: The Walton Centre for Neurology and Neurosurgery, Walton Hospital, Rice Lane, Liverpool; Wirral Hospitals Trust, Arrowe Park Hospital, Wirral.
Lingual Abscess. Redleaf MI. Ann Otol Rhinol Laryngol 103:986, 1994 Tongue abscesses are rare, but lingual cellulitis without pus formation is seen in immunocomprimised patients. A case of lingual abscess in a 48-year-old diabetic edentulous man was CT scanned to distinguish it from lingual cellulitis. A clinical distinction of the two conditions in edematous tongues is not easily made. CT scans of cellulitis is seen as attenuation of the affected areas' signal, while abscess is seen as a rim-enhancing lesion with a low density cavity. The treatment regimens differ.--G.H. SPERBER
Reprint requests to Dr Rudolph: Scripps Clinic and Research Foundation, MS115, 10666 North Torrey Pines Rd, La Jolla, CA 92037.
Reprint requests to Dr Redleaf: Department Otolaryngology--Head and Neck Surgery, University of Chicago Medical Center, 5841 S Maryland Ave MC 1035, Chicago, IL 60637.
Cisplatin as a Radiation Sensitizer in the Treatment of Advanced Head and Neck Cancers. Chougule PB, Suk S, et al, Cancer 74:1927, 1994
Microvascular Decompression for Hemifacial Spasm. Barker FG, Jannetta PJ, Bissonette DJ, et al. J Neurosurg 82:201, 1995
Between 1984 and 1990, a total of 68 patients with previously untreated, histologically confirmed, and clinically
Hemifacial spasm, although painless, is distressing to patients because the involuntary spasms are exacerbated by