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Foscan-mediated photodynamic therapy (PDT) in the treatment of primary squamous cell carcinoma of the head and neck
Int. J. Oral Maxillofac. Surg. 2005; 34 (Supplement 1): $ 1 - $ 1 8 1
38 [-~--~
FOSCAN-MEDIATED PHOTODYNAMIC THERAPY (PDT) IN THE TREATMENT OF PRIMARY SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK
L. Smeele, B. Tan, M. Copper. Department of Head and Neck Surgery,
The Netherlands Cancer Institute, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands To estimate the complete tumour response rate following treatment with PDT and Foscan® in patients with primary, histologically confirmed, squamous cell carcinoma of the oral cavity and oropharynx. 25 Patients with 29 T1-2 NO tumors (stage I) of the oral cavity and/or oropharynx were included in a prospective study. Patients were injected intravenously with 0.15mg/kg Foscan® (Scotia Pharmaceuticals, Stirling, Scotland), dissolved in 30% polyethylene glycol 400, 20% ethanol, and 50% water. After four days, patients were brought under general anesthesia with nasotracheal intubation. The primary tumors were illuminated including a 10 mm margin of healthy surrounding tissue with 652-nm light at a power setting of 100 mW/cm2, emitted from a 6-watt diode laser (AOC, South Plainfield, NJ) and delivered via a hand held lens fibre (Patrick Thielen, Microtechnique, Lausanne, Switzerland). The mean follow-up was 37 months after treatment. The primary outcome measure was complete local tumor remission. In 25 of 29 tumors (86%) a complete remission of the primary tumor was obtained. Four recurrent tumors could all be salvaged by conventional therapy. In none of the patients any longterm functional deficit was detected. This study confirms that PDT is a powerful treatment modality, which may be considered as an alternative to surgery or radiotherapy in selected T1-2 cases of head and neck cancer. The major advantage of PDT in comparison with conventional surgery and radiotherapy is the reduction in long-term morbidity, i.e. the minor tissue loss, the insignificant scarring, the absence of xerostomia, and the possibility to repeat the treatment, e.g. for a second primary in the same site. Radiotherapy or surgery could be reserved for salvage therapy in the event of a recurrence or more advanced second primary tumors. [-~--~
TRENDS IN SURGICAL MANAGEMENT OF ORAL CANCER; A 10 YEAR PAKISTAN EXPERIENCE
S.M. Haider, H.M. Zaidi. Joint Departments of Oral and Maxillofacial
Surgery, Karachi Medical and Dental College & Abbasi Shaheed Hospital Karachi, Pakistan The objective of this study is to review our experience of management of oral squamous cell carcinoma with primary surgery in order to determine the impact of our treatment protocols on patients' outcome. We reviewed the charts of 250 histologically proven oral squamous cell carcinoma (OSCC) patients, who were seen at the oral and maxillofacial surgery consultant OPD between January, 1992 and December, 2002. 179 cases were selected who were untreated and were subsequently treated exclusively. Patients who were previously treated elsewhere or whose lesions arose in other sites and only secondarily involved the oral cavity were excluded. Surgical excision of the primary lesion, jaw resection and neck dissection were performed in combination; based on the tumor size and clinical nodal involvement. Reconstruction was accomplished using masseter muscle flap, temporalis muscle flap, nasolabial flaps, radial forearm and fibula free flaps. Postoperatively, most patients received radiation therapy (51-58 Gy) to the primary side and neck. There were 65.5% men and 34.5% women, ranging in age from 23 to 76 years (mean 52.2 years). 31 patients were initially seen at stage I, 72 patients at stage II and 76 patients at stage III or IV of the disease. Patients with T1- or T2-sized tumors had only a 78% and 66% 5-year survival, respectively. Bone invasion, and extra-capsular spread of involved lymph nodes were all associated with decreased survival (p<0.05). Most patients have been diagnosed at advanced stage of oral squamous cell carcinoma, suggesting that a more intensive program of prevention and early detection should be carried out. Particularly close surveillance in younger age group should be implemented. ~
MANAGEMENT OF JEHOVAH'S WITNESS PATIENTS
UNDERGOING MAJOR SURGERY FOR HEAD AND NECK MALIGNANCY K. Balaraman, A.A. Baskaran, W. Halfpenny, P. McGowan. Barnet and
Chase Farm Hospitals NHS Trust, United Kingdom The aim of this presentation is to discuss alternative strategies that we use to offset blood transfusion during surgical management of Head and
Neck malignancy in Jehovah's witness who refuse to have transfusion of blood or blood products. We discuss our experience in managing 2 cases of Jehovah's witness with Head and Neck malignancy without recourse to blood transfusion. Surgical management included ablative tumor resection, neck dissection and reconstruction with free tissue transfer. Use of Erythropoietin, Acute Normovolemic Hemodilution, Hypotensive anaesthesia, meticulous hemostasis and judicious postoperative blood testing helped us to overcome the impediment of lack of blood transfusion. Comprehensive surgery of orofacial malignancy including tumor resection, neck dissection and state of art reconstruction was carried out in a single stage successfully without any blood transfusion. Surgical management of malignancy is possible in this special group of patients without any compromise. Pharmacological support of erythropoiesis and hemostasis are quite helpful in achieving the objective successfully.
020. Reconstructive Surgery II
[ - 0 - - ~ - ~ APPLICATION OF RAPID MANUFACTURING TECHNIQUES IN SUPPORT OF MAXlLLOFACIAL TREATMENT EVIDENCE OF THE REQUIREMENTS OF CLINICAL APPLICATIONS A. Chandra, J. Watson, J. Rowson, L. Cheng, R. Darlison, A. Sibtain, J. Holland, R. Harris, D.J. Williams. 1Wolfson School of Mech &
Manu Eng., Loughborough University, Loughborough, UK; 2Oral and Maxillofacial Surgery, Queens Medical Centre, Nottingham, UK; 3Oral and Maxillofacial Surgery, Nottingham City Hospital, Nottingham, UK The concept of applying rapid manufacturing technology to maxillofacial treatment has been described previously however these reports did not take into account the practicality of its actual incorporation into clinical practice. Patents in the field are based on imaging techniques combined with rapid manufacturing which theoretically lead to reconstruction of faces. Some cases studies reported have dealt with the manufacture of prostheses and masks on the laboratory scale. Here we report three case studies which used imaging and rapid manufacturing techniques for making an ear prosthesis, a patient immobilisation mask for radiotherapy, and a burns splint for three patients. Laser scanning was chosen for imaging and thermojet printing, stereolithography, and fused deposition modelling for rapid manufacturing. Outcomes of the study were three fold: improvement of process, improvement of patient care, and clinical application of existing technology to healthcare. With further research this technology may aid those in busy facial clinics by reducing working times and patient clinic time and improving the final product designed by the maxillofacial prosthetist and radiotherapy technologist.
References [1] Chua, C. K., Jacob, and G. G. K., Mei, T., Interface between CAD and rapid prototyping systems. Part 1: A study of existing interfaces, International Journal of Advanced Manufacturing Technology, 1997, 13, 566-570. [2] Moss J. E, Linney A. D., Grindrod S. R., and Mosse C. A. A laser scanning system for the measurement of facial surface morphology. Optics and Lasers in Engineering, 1989, 10, 179-190. [3] King, G. E. Maxillofacial prosthetic rehabilitation. J. Oral Surg., 1971, 29, 805-811. [ - 0 - - ~ - ~ ESTABLISHMENT OF DIGITAL MODEL OF BIOMECHANICS-MAN DIBLE (BMM) L. Shu, X. Zhang, J. Sun, C. Zhang. 9th people's hospital affiliated to
Shanghai second medical university, Mainland, China To establish the digital model of biomechanics-mandible upon biomechanical principle of mandible for reasonable design of titanium mandibular prosthesis in mandibular reconstruction. Craniomaxillofacial spinal CT scan of a adult with normal occlusion from east China was performed, from which the image data was released as DICOM file. Then three dimensional finite element model of mandible was established using ANSYS 6.0. According to biomechanical laws of mandible, digital model of hemi-mandibular prosthesis, including dental implant hole and fixation device, was designed applying CAD software (Powershape). To analyse the stress distribution in prosthesis, four loading conditions, such as
38 [-~--~
FOSCAN-MEDIATED PHOTODYNAMIC THERAPY (PDT) IN THE TREATMENT OF PRIMARY SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK
L. Smeele, B. Tan, M. Copper. Department of Head and Neck Surgery,
The Netherlands Cancer Institute, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands To estimate the complete tumour response rate following treatment with PDT and Foscan® in patients with primary, histologically confirmed, squamous cell carcinoma of the oral cavity and oropharynx. 25 Patients with 29 T1-2 NO tumors (stage I) of the oral cavity and/or oropharynx were included in a prospective study. Patients were injected intravenously with 0.15mg/kg Foscan® (Scotia Pharmaceuticals, Stirling, Scotland), dissolved in 30% polyethylene glycol 400, 20% ethanol, and 50% water. After four days, patients were brought under general anesthesia with nasotracheal intubation. The primary tumors were illuminated including a 10 mm margin of healthy surrounding tissue with 652-nm light at a power setting of 100 mW/cm2, emitted from a 6-watt diode laser (AOC, South Plainfield, NJ) and delivered via a hand held lens fibre (Patrick Thielen, Microtechnique, Lausanne, Switzerland). The mean follow-up was 37 months after treatment. The primary outcome measure was complete local tumor remission. In 25 of 29 tumors (86%) a complete remission of the primary tumor was obtained. Four recurrent tumors could all be salvaged by conventional therapy. In none of the patients any longterm functional deficit was detected. This study confirms that PDT is a powerful treatment modality, which may be considered as an alternative to surgery or radiotherapy in selected T1-2 cases of head and neck cancer. The major advantage of PDT in comparison with conventional surgery and radiotherapy is the reduction in long-term morbidity, i.e. the minor tissue loss, the insignificant scarring, the absence of xerostomia, and the possibility to repeat the treatment, e.g. for a second primary in the same site. Radiotherapy or surgery could be reserved for salvage therapy in the event of a recurrence or more advanced second primary tumors. [-~--~
TRENDS IN SURGICAL MANAGEMENT OF ORAL CANCER; A 10 YEAR PAKISTAN EXPERIENCE
S.M. Haider, H.M. Zaidi. Joint Departments of Oral and Maxillofacial
Surgery, Karachi Medical and Dental College & Abbasi Shaheed Hospital Karachi, Pakistan The objective of this study is to review our experience of management of oral squamous cell carcinoma with primary surgery in order to determine the impact of our treatment protocols on patients' outcome. We reviewed the charts of 250 histologically proven oral squamous cell carcinoma (OSCC) patients, who were seen at the oral and maxillofacial surgery consultant OPD between January, 1992 and December, 2002. 179 cases were selected who were untreated and were subsequently treated exclusively. Patients who were previously treated elsewhere or whose lesions arose in other sites and only secondarily involved the oral cavity were excluded. Surgical excision of the primary lesion, jaw resection and neck dissection were performed in combination; based on the tumor size and clinical nodal involvement. Reconstruction was accomplished using masseter muscle flap, temporalis muscle flap, nasolabial flaps, radial forearm and fibula free flaps. Postoperatively, most patients received radiation therapy (51-58 Gy) to the primary side and neck. There were 65.5% men and 34.5% women, ranging in age from 23 to 76 years (mean 52.2 years). 31 patients were initially seen at stage I, 72 patients at stage II and 76 patients at stage III or IV of the disease. Patients with T1- or T2-sized tumors had only a 78% and 66% 5-year survival, respectively. Bone invasion, and extra-capsular spread of involved lymph nodes were all associated with decreased survival (p<0.05). Most patients have been diagnosed at advanced stage of oral squamous cell carcinoma, suggesting that a more intensive program of prevention and early detection should be carried out. Particularly close surveillance in younger age group should be implemented. ~
MANAGEMENT OF JEHOVAH'S WITNESS PATIENTS
UNDERGOING MAJOR SURGERY FOR HEAD AND NECK MALIGNANCY K. Balaraman, A.A. Baskaran, W. Halfpenny, P. McGowan. Barnet and
Chase Farm Hospitals NHS Trust, United Kingdom The aim of this presentation is to discuss alternative strategies that we use to offset blood transfusion during surgical management of Head and
Neck malignancy in Jehovah's witness who refuse to have transfusion of blood or blood products. We discuss our experience in managing 2 cases of Jehovah's witness with Head and Neck malignancy without recourse to blood transfusion. Surgical management included ablative tumor resection, neck dissection and reconstruction with free tissue transfer. Use of Erythropoietin, Acute Normovolemic Hemodilution, Hypotensive anaesthesia, meticulous hemostasis and judicious postoperative blood testing helped us to overcome the impediment of lack of blood transfusion. Comprehensive surgery of orofacial malignancy including tumor resection, neck dissection and state of art reconstruction was carried out in a single stage successfully without any blood transfusion. Surgical management of malignancy is possible in this special group of patients without any compromise. Pharmacological support of erythropoiesis and hemostasis are quite helpful in achieving the objective successfully.
020. Reconstructive Surgery II
[ - 0 - - ~ - ~ APPLICATION OF RAPID MANUFACTURING TECHNIQUES IN SUPPORT OF MAXlLLOFACIAL TREATMENT EVIDENCE OF THE REQUIREMENTS OF CLINICAL APPLICATIONS A. Chandra, J. Watson, J. Rowson, L. Cheng, R. Darlison, A. Sibtain, J. Holland, R. Harris, D.J. Williams. 1Wolfson School of Mech &
Manu Eng., Loughborough University, Loughborough, UK; 2Oral and Maxillofacial Surgery, Queens Medical Centre, Nottingham, UK; 3Oral and Maxillofacial Surgery, Nottingham City Hospital, Nottingham, UK The concept of applying rapid manufacturing technology to maxillofacial treatment has been described previously however these reports did not take into account the practicality of its actual incorporation into clinical practice. Patents in the field are based on imaging techniques combined with rapid manufacturing which theoretically lead to reconstruction of faces. Some cases studies reported have dealt with the manufacture of prostheses and masks on the laboratory scale. Here we report three case studies which used imaging and rapid manufacturing techniques for making an ear prosthesis, a patient immobilisation mask for radiotherapy, and a burns splint for three patients. Laser scanning was chosen for imaging and thermojet printing, stereolithography, and fused deposition modelling for rapid manufacturing. Outcomes of the study were three fold: improvement of process, improvement of patient care, and clinical application of existing technology to healthcare. With further research this technology may aid those in busy facial clinics by reducing working times and patient clinic time and improving the final product designed by the maxillofacial prosthetist and radiotherapy technologist.
References [1] Chua, C. K., Jacob, and G. G. K., Mei, T., Interface between CAD and rapid prototyping systems. Part 1: A study of existing interfaces, International Journal of Advanced Manufacturing Technology, 1997, 13, 566-570. [2] Moss J. E, Linney A. D., Grindrod S. R., and Mosse C. A. A laser scanning system for the measurement of facial surface morphology. Optics and Lasers in Engineering, 1989, 10, 179-190. [3] King, G. E. Maxillofacial prosthetic rehabilitation. J. Oral Surg., 1971, 29, 805-811. [ - 0 - - ~ - ~ ESTABLISHMENT OF DIGITAL MODEL OF BIOMECHANICS-MAN DIBLE (BMM) L. Shu, X. Zhang, J. Sun, C. Zhang. 9th people's hospital affiliated to
Shanghai second medical university, Mainland, China To establish the digital model of biomechanics-mandible upon biomechanical principle of mandible for reasonable design of titanium mandibular prosthesis in mandibular reconstruction. Craniomaxillofacial spinal CT scan of a adult with normal occlusion from east China was performed, from which the image data was released as DICOM file. Then three dimensional finite element model of mandible was established using ANSYS 6.0. According to biomechanical laws of mandible, digital model of hemi-mandibular prosthesis, including dental implant hole and fixation device, was designed applying CAD software (Powershape). To analyse the stress distribution in prosthesis, four loading conditions, such as