CA : A Cancer Journal for Clinicians

PURPOSEThe Southwest Oncology Group (SWOG) coordinated an Intergroup study with the participation of Radiation Therapy Oncology Group (RTOG), and Eastern Cooperative Oncology Group (ECOG). This randomized phase III trial compared chemoradiotherapy versus radiotherapy alone in patients with nasopharyngeal cancers.MATERIALS AND METHODSRadiotherapy was administered in both arms: 1.8- to 2.0-Gy/d fractions Monday to Friday for 35 to 39 fractions for a total dose of 70 Gy. The investigational arm received chemotherapy with cisplatin 100 mg/m2 on days 1, 22, and 43 during radiotherapy; postradiotherapy, chemotherapy with cisplatin 80 mg/m2 on day 1 and fluorouracil 1,000 mg/m2/d on days 1 to 4 was administered every 4 weeks for three courses. Patients were stratified by tumor stage, nodal stage, performance status, and histology.RESULTSOf 193 patients registered, 147 (69 radiotherapy and 78 chemoradiotherapy) were eligible for primary analysis for survival and toxicity. The median progression-free survival (PFS...

Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099.

The health-care facility environment is rarely implicated in disease transmission, except among patients who are immunocompromised. Nonetheless, inadvertent exposures to environmental pathogens (e.g., Aspergillus spp. and Legionella spp.) or airborne pathogens (e.g., Mycobacterium tuberculosis and varicella-zoster virus) can result in adverse patient outcomes and cause illness among health-care workers. Environmental infection-control strategies and engineering controls can effectively prevent these infections. The incidence of health-care--associated infections and pseudo-outbreaks can be minimized by 1) appropriate use of cleaners and disinfectants; 2) appropriate maintenance of medical equipment (e.g., automated endoscope reprocessors or hydrotherapy equipment); 3) adherence to water-quality standards for hemodialysis, and to ventilation standards for specialized care environments (e.g., airborne infection isolation rooms, protective environments, or operating rooms); and 4) prompt management of water intrusion into the facility. Routine environmental sampling is not usually advised, except for water quality determinations in hemodialysis settings and other situations where sampling is directed by epidemiologic principles, and results can be applied directly to infection-control decisions. This report reviews previous guidelines and strategies for preventing environment-associated infections in health-care facilities and offers recommendations. These include 1) evidence-based recommendations supported by studies; 2) requirements of federal agencies (e.g., Food and Drug Administration, U.S. Environmental Protection Agency, U.S. Department of Labor, Occupational Safety and Health Administration, and U.S. Department of Justice); 3) guidelines and standards from building and equipment professional organizations (e.g., American Institute of Architects, Association for the Advancement of Medical Instrumentation, and American Society of Heating, Refrigeration, and Air-Conditioning Engineers); 4) recommendations derived from scientific theory or rationale; and 5) experienced opinions based upon infection-control and engineering practices. The report also suggests a series of performance measurements as a means to evaluate infection-control efforts.

Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC)

Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).

This report consolidates previous recommendations and adds new ones for infection control in dental settings. Recommendations are provided regarding 1) educating and protecting dental health-care personnel; 2) preventing transmission of bloodborne pathogens; 3) hand hygiene; 4) personal protective equipment; 5) contact dermatitis and latex hypersensitivity; 6) sterilization and disinfection of patient-care items; 7) environmental infection control; 8) dental unit waterlines, biofilm, and water quality; and 9) special considerations (e.g., dental handpieces and other devices, radiology, parenteral medications, oral surgical procedures, and dental laboratories). These recommendations were developed in collaboration with and after review by authorities on infection control from CDC and other public agencies, academia, and private and professional organizations.

/pdf/guidelines-for-infection-control-in-dental-health-care-37zael4jrc.pdf

Guidelines for infection control in dental health-care settings - 2003

Combined CT (CDDP + 5FU) and RT were given to 28 patients with NPC during July 1982–May 1985. Two, 1, 4, and 21 were in Stages I–IV (AJC), respectively. None had distant metastasis. Four did not complete the planned treatment, and one each had more or fewer CT courses than planned. The median duration of follow-up of surviving patients was 29 months (19–52, x 31.1). Objective response (CR + PR) at the primary lesion was 2728 (96.4%), whereas CR was 2328 (82%). CR + PR and CR of the regional nodes were 2122 (95.5%) and 1822 (82%) respectively. Remaining node in the 2 patients, who did not prematurely die were pathologically negative. Response at N site should therefore be 100% CR. Only patients with T 3 (15) and T 4 (313) lesions had residual disease at the T site after initial treatment. Salvage therapy was able to induce CR in all asymptomatic PR patients. There were 4 relapses, 2 at T, and 1 each at T+N and T+M sites. All M disease occurred in patients with huge and/or low cervical lymphadenopathy. Five patients died, one of an unrelated disease, and one each of T, M, T+N, and T+M diseases. The remaining 23 patients were still alive, and all except 3 were free of disease. Side effects, mainly from RT, were clinically acceptable. One had transient cervical myelitis. Myelosuppression was mild and of short duration. Activity of CT was seen at both T, and N sites after the upfront CT. Compared to our previous experience using RT alone, the result of this study suggested a positive role of CT in this disease. However, future prospective randomized trials are required to better define its role.

Nasopharyngeal carcinoma: result of treatment with cis-diamminedichloroplatinum II, 5 fluorouracil, and radiation therapy.

Laser-induced fluorescence tumor imaging exploits the difference in tissue autofluorescence properties between normal and cancerous tissues. The effectiveness and reliability of fluorescence imaging with a lung imaging fluorescence endoscopy (LIFE) system for cancers in the head and neck were compared to those of white light endoscopy (WLE). Examinations by WLE and LIFE were conducted on 25 patients suspected for malignancy. Histologic diagnosis was confirmed by biopsy. Posttreatment evaluations were performed on 6 cancer patients identified by this study. By LIFE, all 16 cancerous lesions, including 2 occult cancers, were identified (100%), while WLE achieved only an 87.5% detection rate. LIFE (specificity 87.5%) was greatly helpful to WLE (specificity 50%) in differentiating inflammation from malignancy, though it failed to exclude granuloma. The results of this study suggest potential roles of LIFE in early detection, correct staging, and treatment evaluation of cancers in the head and neck.

Laser-Induced Fluorescence Imaging in Localization of Head and Neck Cancers

Laser-induced fluorescence endoscopy (LIFE) is a noninvasive method for detecting early cancers in hollow organs. A laser-induced fluorescence endoscope that was designed for lung imaging was investigated for its effectiveness in comparison to white light endoscopy (WLE) in localizing head and neck cancers. A total of 196 images from 98 sites in 56 patients were graded into 5 levels from normal to definitely abnormal. A cutoff level to differentiate normal from abnormal images was chosen from a receiver operating characteristic curve. On this basis, LIFE (sensitivity, 92.86%; specificity, 78.57%) was observed to be more effective and reliable than WLE (sensitivity, 67.86%; specificity, 70%) in locating neoplastic foci and precancerous lesions. Nevertheless, WLE was helpful in presenting anatomic details. The reliability of LIFE varied from site to site. It excelled in examination of the oropharynx (sensitivity, 100%; specificity, 96.20%), but was less effective for lesions of the nasopharynx (sensitivity, 66.70%; specificity, 75.00%). In standardizing the test, interobserver variation was assessed, and good agreement in image interpretation was confirmed by statistical analysis. In conclusion, LIFE was found to be an effective and reliable tool for detecting head and neck cancers.

Performance characteristics of fluorescence endoscope in detection of head and neck cancers.

The purpose of this study was to determine the potential risk of transmitting viable viral infected cells as well as viral infectivity of laryngeal papilloma in the plume derived from a continuous mode carbon dioxide laser. Each of 10 juvenile recurrent laryngeal papilloma specimens was divided into two equal parts. and one part was irradiated with a carbon dioxide laser employing a continuous mode at the power setting of 10 watts with 0.5 mm spot size and a power density of 1667 W/cm 2 . The resultant laser plume was trapped and was cultured simultaneously with the other part of the specimen which served as the control. All irradiated specimens tested yielded negative culture results while all the control counterparts revealed viable cell growth. To detect the viral infectivity, laser plume was cultured with two separate cell systems, one was the porcine PS clone D cell line and the other normal mucosal cells obtained from the same patient, and to control these systems both cell lines were also designed to be infected with polio virus. Both cell lines in the viral infectivity testing systems revealed no sign of viral infection. The results suggest that papilloma virus-infected cells cannot survive the continuous mode of carbon dioxide laser irradiation. We primarily conclude that, to avoid airborne transmission of plume containing laryngeal papilloma viral-infected cells and infectious viral particles, the carbon dioxide laser parameters should be in a continuous mode with the power density equal to, or more than, 1667 W/cm 2 .

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0022215100135686

Are laryngeal papilloma virus-infected cells viable in the plume derived from a continuous mode carbon dioxide laser, and are they infectious? A preliminary report on one laser mode.

Objective To explore the effect of Ki-67 and vascular endothelial growth factor A (VEGF-A) expression on the risks of advanced T category (T3,4) and positive lymph node involvement (N+) in oral and pharyngeal squamous cell carcinoma (SCC) compared with laryngeal SCC. Design Immunohistochemical analysis of prospectively recruited patients. Setting University-affiliated hospital. Patients A total of 147 previously untreated patients with different stages of SCC in the oral cavity, pharynx, and larynx. Main Outcome Measures Relative risks of T3,4 tumor and N+, a risk ratio comparing risks under high vs low marker expression. Results A significant association of Ki-67 and VEGF-A expression with tumor T category was observed for oral and pharyngeal SCC and for laryngeal SCC ( P  ≤ .006). Regarding nodal status, Ki-67 expression was a significant risk factor for N+ in all tumors ( P  ≤ .009), whereas VEGF-A expression was related to N+ in oral and pharyngeal SCC only ( P P  = .009), and additional expression of VEGF-A raised the value to 6.12 (2.09-17.93; P Conclusions Proliferative status was a common risk factor for N+ in all of the tumors in this series. Exploitation of VEGF-A in lymph node metastasis in addition to proliferation by oral and pharyngeal SCC but not by laryngeal SCC explains the clinical aggressiveness of oral and pharyngeal SCC, especially the early lymphatic invasion. In the management of cervical lymph nodes, combined expression of Ki-67 and VEGF-A may help identify patients at risk for occult metastases. This study suggests anti–VEGF-A therapy, an additional intervention to the classic antiproliferative regimen, for preventing lymphatic progression of oral and pharyngeal SCC.

https://jamanetwork.com/journals/jamaotolaryngology/articlepdf/409594/ooa80106_1305_1311.pdf

Boonchu Kulapaditharom

Papers

Nasopharyngeal carcinoma: result of treatment with cis-diamminedichloroplatinum II, 5 fluorouracil, and radiation therapy.

Laser-Induced Fluorescence Imaging in Localization of Head and Neck Cancers

Performance characteristics of fluorescence endoscope in detection of head and neck cancers.

Are laryngeal papilloma virus-infected cells viable in the plume derived from a continuous mode carbon dioxide laser, and are they infectious? A preliminary report on one laser mode.

Vascular Endothelial Growth Factor A and Proliferation Marker in Prediction of Lymph Node Metastasis in Oral and Pharyngeal Squamous Cell Carcinoma