Faculty Bibliography

OBJECTIVES/OBJECTIVE:We evaluated the efficacy of the application of selective neck dissection to cases of clinically node-positive disease. METHODS:We performed a retrospective review at the University of Pittsburgh Head and Neck Cancer Database. A database of 65 patients was followed for an average of 36 months (range, 2 to 128 months) after they underwent selective neck dissection for clinically node-positive regional disease. RESULTS:Regional failure occurred in 8 patients (12.3%). In-field failure was experienced in 4 patients (6.1%), and failures outside the field of dissection occurred in 4 patients (6.1%). The overall incidence of extracapsular spread was 33.8% (22 of 65). Only 2 of 8 regional recurrences were associated with extracapsular spread at the initial neck dissection; however, both recurrences were in the contralateral, undissected side of the neck. Four regional failures were salvaged with surgery, with eventual overall regional control in the neck of 93.9%. Only 1 of 4 ipsilateral recurrences (25%) was successfully salvaged. In contrast, 3 of 4 contralateral failures (75%) were successfully salvaged. In our study population, 21 of 65 cases (32%) that were initially staged as clinically node-positive had no evidence of nodal metastases on pathologic examination. CONCLUSIONS:The application of selective neck dissection and postoperative irradiation in patients with clinically Nl and limited N2 clinical disease appears to be oncologically efficacious. Clinical overstaging occurred frequently in this sample, and may put patients at risk for more morbid surgical procedures.

Since the landmark publication by Ketcham et al in the early 1960s, the resection of sinonasal tumors involving the anterior skull base combines transcranial and transfacial incisions and osteotomies. Recent technical and technologic advances have allowed the use of endoscopic approaches for the resection of these tumors. We report our technique for the endoscopic resection of tumors involving the anterior skull base. Our technique includes the extirpation of select tumors following critical premises, such as obtaining a complete resection and reestablishment of the separation of the sinonasal tract from the cranial cavity. There were 20 patients with various malignant tumors of the sinonasal tract operated on using an endoscopic technique. There are 19 patients alive and without evidence of disease at short-term follow-up (range 11-46 months) The only patient who presented with a recurrent tumor had a sinonasal undifferentiated carcinoma treated with primary chemoradiation. She died of an aggressive recurrence at 8 months postoperatively. In 20 patients, we did not encounter any intraoperative complication. However, postoperative complications included 1 episode of tension pneumocephalus, cerebrospinal fluid leak in 3 patients, and 1 episode of bacterial meningitis associated with a prior cerebrospinal fluid leak. Short-term results suggest that an endoscopic transnasal anterior skull base resection can be performed safely and effectively. Further experience and follow-up are required to ascertain the outcomes of patients treated with endoscopic techniques. © 2006 Elsevier Inc. All rights reserved.

BACKGROUND:Metastatic adenocarcinoma of the colon is a frequently encountered medical situation. Metastasis to the mandible from adenocarcinoma of the colon is very unusual and rarely reported. We report the case of a 73-year-old man with metastatic adenocarcinoma to the mandible. METHODS:The patient was referred for evaluation of a mass of 2 months' duration in the right parotid gland. He gave a history of watery bowel movements of unknown duration. Physical examination revealed a 7- x 6-cm hard mass, which seemed to be fixed to the right mandible. A CT scan revealed a destructive process involving the ramus and condyle of the right mandible that invaded the pterygopalatine fossa, pterygoid muscles, and middle cranial fossa. CT scans of the abdomen and pelvis revealed a 5-cm mass in the sigmoid colon with metastases to the liver. RESULTS:A biopsy of the mass in the mandible was performed, and metastatic adenocarcinoma of colonic origin was diagnosed. Colonoscopy and biopsy of the colonic mass substantiated that the sigmoid colon was the primary site of the cancer. Because the patient had disseminated disease, he declined treatment, and he died shortly thereafter. CONCLUSIONS:Although rare, metastatic adenocarcinoma from the colon to the mandible and parotid area should be included in the differential diagnosis of masses in this area. After analysis of our case and a review of the literature, we conclude that metastasis from adenocarcinoma of the colon is quite rare and represents incurable disseminated disease.

OBJECTIVE/HYPOTHESIS/OBJECTIVE:The utility of elective neck dissection in the management of patients with oral cavity and oropharyngeal cancer who present without neck metastases remains controversial. The study addressed the question of whether elective neck dissection improves regional control and survival in patients with squamous cell carcinoma of the oral cavity and oropharynx presenting with T1/T2 node-negative disease. STUDY DESIGN/METHODS:A nonrandomized, uncontrolled retrospective chart review. METHODS:A nonrandomized, uncontrolled retrospective chart review was performed. Resection of the primary tumor was performed in all patients. The neck was observed in one group, and elective neck dissection was performed for patients in another group. RESULTS:The study data indicated that elective neck dissection significantly improves regional control and regional recurrence-free survival. Elective neck dissection when compared with observation of the neck did not improve overall survival. CONCLUSION/CONCLUSIONS:Elective neck dissection reduces regional recurrence and may extend disease-free survival.

Objective To assess the correlation between changes in spin-lattice relaxation in the rotating frame (T(1rho)) and proteoglycan (PG) loss from bovine articular cartilage and to demonstrate the feasibility of performing T(1rho) MR imaging on a 1.5T clinical scanner. Design MR relaxation times (T(1rho), T(2) and T(1)) were measured from excised cartilage plugs (N=3) before and after two sequential digestions with trypsin on a 2T whole-body magnet. Proteoglycan and collagen loss induced by the trypsin digestion was measured using standard biochemical techniques. The correlation between changes in relaxation times and PG loss were tested with regression analysis. T(1rho) MRI was also performed on a clinical 1.5T MRI system to determine whether the spatial distribution of PG loss could be detected. The MRI results were compared with histology sections of native and PG-depleted tissue. Results Increase in T(1rho) relaxation times correlated with PG loss (R(2)=0.81). T(1rho) measurements alone were indicative of PG loss (R(2)=0.8), the addition of T1 and T2 data into the statistical model did not improve the correlation substantially (R(2)=0.83). T(1rho)-weighted imaging demonstrated a hyperintense lamina at the articular surface of the digested tissue, which was subjected to trypsin digestion that correlated with a superficial zone of PG loss observed on histological sections. Conclusion The results of this study demonstrate that T(1rho) relaxation changes are correlated with PG loss in vitro. Furthermore, T(1rho) measurements alone can be used to indicate PG loss data. T(1rho) MRI may thus be developed into a useful adjunct to existing techniques for the evaluation of cartilage disease.

This study compares two potential magnetic resonance imaging (MRI) indices for noninvasive early detection of tumor response to chemotherapy: the spin-lattice relaxation in the rotating frame (T1rho) and the transverse relaxation time (T2). Measurements of these relaxation parameters were performed on a s.c. murine radiation-induced fibrosarcoma (RIF-1) model before and after cyclophosphamide treatment. The number of pixels exhibiting T1rho values longer than controls in viable regions of the tumor increased significantly as early as 18 h after drug administration and remained elevated up to 36 h after treatment (P < 0.005). Although a trend of increasing T2s relative to controls was noted in viable regions of the tumor 36 h after treatment, the changes were not statistically significant. Histological examination indicated a decrease in mitotic index that paralleled the changes in T1rho. We conclude that T1rho measurements may be useful for noninvasive monitoring of early response of tumors to chemotherapy.