Background Patients with head-and-neck cancers who are free of disease after local therapy remain at high risk for both recurrent and second primary tumors Retinoids have proved efficacious in the treatment of premalignant oral lesions and are promising agents for the prevention of epithelial carcinogenesis Methods We prospectively studied 103 patients who were disease-free after primary treatment for squamous-cell cancers of the larynx, pharynx, or oral cavity After completion of surgery or radiotherapy (or both), these patients were randomly assigned to receive either isotretinoin (13-cis-retinoic acid) (50 to 100 mg per square meter of body-surface area per day) or placebo, to be taken daily for 12 months Results There were no significant differences between the two groups in the number of local, regional, or distant recurrences of the primary cancers However, the isotretinoin group had significantly fewer second primary tumors After a median follow-up of 32 months, only 2 patients (4

https://www.nejm.org/doi/pdf/10.1056/NEJM199009203231205

Prevention of second primary tumors with isotretinoin in squamous-cell carcinoma of the head and neck.

The authors reviewed treatment results in patients with nasal and paranasal sinus carcinoma from a large retrospective cohort and conducted a systematic literature review.

/pdf/nasal-and-paranasal-sinus-carcinoma-are-we-making-progress-a-zvo3vjpueg.pdf

Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review.

Basaloid-squamous carcinoma of the tongue, hypopharynx, and larynx:: Report of 10 cases

Retrospective analysis of 1502 patients with facial fractures.

Squamous cell carcinoma of the head and neck (HNSCC) is a heterogeneous but largely preventable disease with complex molecular abnormalities. It arises from a premalignant progenitor followed by outgrowth of clonal populations associated with cumulative genetic alterations and phenotypic progression to invasive malignancy. These genetic alterations result in inactivation of multiple tumour suppressor genes and activation of proto-oncogenes, including p16(ink4A), p53, cyclin D1, p14(ARF), FHIT, RASSF1A, epidermal growth factor receptor (EGFR), and Rb. Intramucosal migration and clonal expansion of transformed cells with formation of abnormal genetic fields appear to be responsible for local recurrences and development of second primary tumours.

https://jcp.bmj.com/content/jclinpath/59/5/445.full.pdf

Molecular biology of squamous cell carcinoma of the head and neck.

Comparison of reported series of laryngeal lesions is complicated by the inconsistency in the terminology. The classification of these lesions should logically be based on the degrees of dysplasia, as this has a bearing on the prognosis. The material for this study consisted of 193 patients with hyperplasia and/or keratosis, with or without mild dysplasia (Group I), moderate dysplasia (Group II), and severe dysplasia and carcinoma in situ (Group III). They were treated over a 14-year period (1966-1979) at Linkoping University Hospital. Of the 98 patients in Group I available for follow-up, 23 had repeat excisions. Moderate dysplasia developed in 3 patients, severe dysplasia in 2, and invasive carcinoma in another 2 within 3 and 3.5 years; they both underwent laryngectomy. Among the 24 patients in Group II available for follow-up, severe dysplasia developed in 3 and invasive carcinoma in 3 up to 13 years after the initial diagnosis, all but one (with severe dysplasia) received a full course of radiotherapy, on one case total laryngectomy was subsequently performed for recurrent carcinoma. Of the 39 patients with severe dysplasia and carcinoma in situ 16 were given primary radiotherapy; 4 of these developed invasive carcinoma; 3 of them underwent total laryngectomy and one partial laryngectomy. Excision or stripping of the vocal cords was the primary treatment in 23 cases; 5 of these developed invasive carcinoma; 2 of them underwent total laryngectomy. Diffuse lesions and well differentiated forms of severe dysplasia caused most problems and had the highest incidence of invasive carcinoma irrespective of the form of treatment. Patients with hyperplasia, keratosis, dysplasia and carcinoma in situ should be carefully followed up, as invasive carcinoma may develop many years after the initial diagnosis.

Hyperplasia, keratosis, dysplasia and carcinoma in situ of the vocal cords—a follow-up study

Adenocarcinoma makes up only a small percent of all nasal and paranasal sinus carcinomas, and is most often found in the ethmoid sinuses. Adenocarcinoma of the ethmoid sinuses is known to be associated with exposure to wood dust. Twenty-eight patients with ethmoid adenocarcinomas were collected, mainly during the last decade from a region with approximately 900,000 inhabitants and with a large amount of furniture industries. There were 4 women and 24 men in the study. Twenty of the men were exposed to dust from hardwood for 20 to 55 years (mean, 40 years) which is in accord with other reports and supports data on the increased risk for workers of developing adenocarcinoma of the ethmoid sinuses when exposed to dust from hardwood. Radiologic diagnosis is necessary to delineate the extent of these tumours, and computerized tomography (CT) especially furnishes important information. Most patients received preoperative radiotherapy followed by surgery, 50% of them survived 5 years, which is in accord with other reports.

Adenocarcinoma of the ethmoid sinuses. A review of 28 cases with special reference to wood dust exposure.

Adenoid cystic carcinoma (cylindroma) is a well-recognized tumor that is frequently encountered in the major salivary glands, the lacrimal glands and in the minor salivary glands of the oral cavity and upper respiratory tract. Only 60 cases of adenoid cystic carcinoma have been described arising in the larynx. Four new cases are reported and the literature is reviewed. In the larynx, these tumors arise almost exclusively in the subglottic and supraglottic regions--areas having large numbers of seromucinous glands of the minor salivary gland type. These malignant tumors, whether occurring in the larynx or elsewhere, tend to grow quite slowly with prolonged non-specific symptomatology and protracted clinical course. Despite their slow growth, in a majority of cases, they eventually lead to the death of the patient.

Adenoid cystic carcinoma of the larynx: a report of four cases and a review of the literature.

Microscopic malignancy grading using the 8-factor system proposed by Jakobsson et al. (1973), the 4-factor system set up by Glanz and Eichhorn (1985), and DNA cytofluorometry were applied to thirteen T1 and thirty-seven T2 squamous cell carcinomas of the oral cavity, 9 with and 41 without metastases. There was a significant correlation between the presence of lymph node metastases (N1) and the malignancy scores (P less than 0.05) and tumour DNA ploidy (P less than 0.01, chi-square). The total number of patients with initial and late lymph node metastases correlated significantly with polyploid nuclei (P less than 0.05) and with malignancy scores (P less than 0.001), which also correlated with regional recurrences (P less than 0.01, chi-square). No remaining tumour after preoperative radiotherapy indicated less risk for local recurrence than if tumour persisted (P less than 0.01, chi-square). The cumulative survival (Kaplan-Meier) was worse for patients with nodal involvement (N1) than for those without (N0) (P less than 0.01), and for patients with poorly differentiated tumours compared with moderately well differentiated (P less than 0.05) and to well differentiated (P less than 0.001). The prognosis was worse for patients with high malignancy scores than those with low (P less than 0.001). DNA diploid tumours had a better prognosis than DNA non-diploid, but the difference was not significant.

DNA content, malignancy grading and prognosis in T1 and T2 oral cavity carcinomas.

Postoperative pharyngocutaneous fistula formation is a troublesome complication in head and neck surgery and occurred in 8 out of 53 patients following a total laryngectomy (15%). The incidence falls within the lower range of that reported in the literature (6-66%). Different factors which may influence the formation of fistulae were analysed. Factors which seem to increase fistula formation are previous full dose radiotherapy (Co60), residual carcinoma and surgical technique.

J. Olofsson

Papers

Hyperplasia, keratosis, dysplasia and carcinoma in situ of the vocal cords—a follow-up study

Adenocarcinoma of the ethmoid sinuses. A review of 28 cases with special reference to wood dust exposure.

Adenoid cystic carcinoma of the larynx: a report of four cases and a review of the literature.

DNA content, malignancy grading and prognosis in T1 and T2 oral cavity carcinomas.

Pharyngocutaneous fistulae following total laryngectomy