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van Beers MA, Schreuder WH, Balm AJM, van Dijk BAC. Is locally advanced head and neck cancer 'increasing' in the Netherlands? The paradox of absolute numbers, standardized incidence rates and proportional share. Oral Oncol 2023; 138:106316. [PMID: 36709706 DOI: 10.1016/j.oraloncology.2023.106316] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Several reports have indicated that locally advanced head and neck cancer (LAHNC) has increased in the past decade. However, incidence trends cannot be easily compared because slightly different definitions of LAHNC were used. AIM To investigate if the incidence of locally advanced disease (LAD) in the oral cavity, oropharynx, hypopharynx and larynx is indeed increasing over time, considering the growing and ageing population in the Netherlands. PATIENTS AND METHODS Data were obtained from the Netherlands Cancer Registry (NCR). Primary head and neck squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx and larynx diagnosed between 1989 and 2017 were included. Yearly numbers and European standardized incidence rates (ESRs) were reported by extent of disease. The annual percentage change (APC) over time in ESRs was calculated to assess trends. RESULTS Absolute numbers and ESRs of LAD increased over time for oral cavity and most prominently for oropharynx carcinomas (before 1996, APC: 0.4, 95%CI: 0.1; 0.8 and APC: 5.7 (95%CI: 3.1; 8.4) after 1996: 1.5 (1.0; 2.0) respectively. For hypopharynx cancer the absolute number and ESR of LAD increased until 1997 and declined with 0.8% per year since 1997. Absolute numbers of patients with larynx cancer stayed stable over time, while ESR decreased (APC: -0.8 (95%CI: -1.1; -0.6)). CONCLUSION The perception of an increasing trend in LAD in the Netherlands can be attributed to the increasing incidence of oral cavity and oropharynx carcinomas. For LAD of the hypopharynx a decreasing trend was observed. In larynx cancer, the proportional share of LAD of the larynx increased, even though incidence rates declined.
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Affiliation(s)
- M A van Beers
- Department of Head and Neck Oncology & Surgery, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - W H Schreuder
- Department of Head and Neck Oncology & Surgery, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, AmsterdamUMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A J M Balm
- Department of Head and Neck Oncology & Surgery, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, AmsterdamUMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B A C van Dijk
- Netherlands Comprehensive Cancer Organization (IKNL), Department of Research and Development, Utrecht, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Epidemiology, Groningen, The Netherlands
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2
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Elshot YS, Tio DCKS, van Haersma-de With ASE, Ouwerkerk W, Zupan-Kajcovski B, Crijns MB, Limpens CEJM, Klop WMC, Bekkenk MW, Balm AJM, de Rie MA. Lentigo maligna (melanoma): A systematic review and meta-analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy. J Eur Acad Dermatol Venereol 2023; 37:871-883. [PMID: 36652277 DOI: 10.1111/jdv.18880] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
Because of an increased risk of local recurrence following surgical treatment of lentigo maligna (melanoma) (LM/LMM), the optimal surgical technique is still a matter of debate. We aimed to evaluate the effect of different surgical techniques and reflectance confocal microscopy (RCM) on local recurrence and survival outcomes. We searched MEDLINE, Embase and PubMed databases through 20 May 2022. Randomized and observational studies with ≥10 lesions were eligible for inclusion. Bias assessment was performed using the Methodological Index for Non-Randomized Studies instrument. Meta-analysis was performed for local recurrence, as there were insufficient events for the other clinical outcomes. We included 41 studies with 5059 LM and 1271 LMM. Surgical techniques included wide local excision (WLE) (n = 1355), staged excision (n = 2442) and Mohs' micrographic surgery (MMS) (n = 2909). Six studies included RCM. The guideline-recommended margin was insufficient in 21.6%-44.6% of LM/LMM. Local recurrence rate was lowest for patients treated by MMS combined with immunohistochemistry (<1%; 95% CI, 0.3%-1.9%), and highest for WLE (13%; 95% CI, 7.2%-21.6%). The mean follow-up varied from 27 to 63 months depending on surgical technique with moderate to high heterogeneity for MMS and WLE. Handheld-RCM decreased both the rate of positive histological margins (p < 0.0001) and necessary surgical stages (p < 0.0001). The majority of regional (17/25) and distant (34/43) recurrences occurred in patients treated by WLE. Melanoma-associated mortality was low (1.5%; 32/2107), and more patients died due to unrelated causes (6.7%; 107/1608). This systematic review shows a clear reduction in local recurrences using microscopically controlled surgical techniques over WLE. The use of HH-RCM showed a trend in the reduction in incomplete resections and local recurrences even when used with WLE. Due to selection bias, heterogeneity, low prevalence of stage III/IV disease and limited survival data, it was not possible to determine the effect of the different surgical techniques on survival outcomes.
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Affiliation(s)
- Y S Elshot
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - D C K S Tio
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - W Ouwerkerk
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Infection & Immunity Institute, Cancer Center, University of Amsterdam, Amsterdam, The Netherlands.,National Heart Centre Singapore, Singapore, Singapore
| | - B Zupan-Kajcovski
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - M B Crijns
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - C E J M Limpens
- Research Support, Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W M C Klop
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M W Bekkenk
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A J M Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M A de Rie
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Kappert KDR, Voskuilen L, Smeele LE, Balm AJM, Jasperse B, Nederveen AJ, van der Heijden F. Personalized biomechanical tongue models based on diffusion-weighted MRI and validated using optical tracking of range of motion. Biomech Model Mechanobiol 2021; 20:1101-1113. [PMID: 33682028 PMCID: PMC8154835 DOI: 10.1007/s10237-021-01435-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/11/2021] [Indexed: 12/13/2022]
Abstract
For advanced tongue cancer, the choice between surgery and organ-sparing treatment is often dependent on the expected loss of tongue functionality after treatment. Biomechanical models might assist in this choice by simulating the post-treatment function loss. However, this function loss varies between patients and should, therefore, be predicted for each patient individually. In the present study, the goal was to better predict the postoperative range of motion (ROM) of the tongue by personalizing biomechanical models using diffusion-weighted MRI and constrained spherical deconvolution reconstructions of tongue muscle architecture. Diffusion-weighted MRI scans of ten healthy volunteers were obtained to reconstruct their tongue musculature, which were subsequently registered to a previously described population average or atlas. Using the displacement fields obtained from the registration, the segmented muscle fiber tracks from the atlas were morphed back to create personalized muscle fiber tracks. Finite element models were created from the fiber tracks of the atlas and those of the individual tongues. Via inverse simulation of a protruding, downward, left and right movement, the ROM of the tongue was predicted. This prediction was compared to the ROM measured with a 3D camera. It was demonstrated that biomechanical models with personalized muscles bundles are better in approaching the measured ROM than a generic model. However, to achieve this result a correction factor was needed to compensate for the small magnitude of motion of the model. Future versions of these models may have the potential to improve the estimation of function loss after treatment for advanced tongue cancer.
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Affiliation(s)
- K D R Kappert
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Department of Robotics and Mechatronics, Faculty of EEMCS, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - L Voskuilen
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Centre for Dentistry Amsterdam and Amsterdam UMC, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - L E Smeele
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A J M Balm
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Robotics and Mechatronics, Faculty of EEMCS, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B Jasperse
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - A J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F van der Heijden
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Robotics and Mechatronics, Faculty of EEMCS, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Kappert KDR, Connesson N, Elahi SA, Boonstra S, Balm AJM, van der Heijden F, Payan Y. In-vivo tongue stiffness measured by aspiration: Resting vs general anesthesia. J Biomech 2020; 114:110147. [PMID: 33276256 DOI: 10.1016/j.jbiomech.2020.110147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 11/16/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022]
Abstract
Tongue cancer treatment often results in impaired speech, swallowing, or mastication. Simulating the effect of treatments can help the patient and the treating physician to understand the effects and impact of the intervention. To simulate deformations of the tongue, identifying accurate mechanical properties of tissue is essential. However, not many succeeded in characterizing in-vivo tongue stiffness. Those who did, measured the tongue At Rest (AR), in which muscle tone subsides even if muscles are not willingly activated. We expected to find an absolute rest state in participants 'under General Anesthesia' (GA). We elaborated on previous work by measuring the mechanical behavior of the in-vivo tongue under aspiration using an improved volume-based method. Using this technique, 5 to 7 measurements were performed on 10 participants both AR and under GA. The obtained Pressure-Shape curves were first analyzed using the initial slope and its variations. Hereafter, an inverse Finite Element Analysis (FEA) was applied to identify the mechanical parameters using the Yeoh, Gent, and Ogden hyperelastic models. The measurements AR provided a mean Young's Modulus of 1638 Pa (min 1035 - max 2019) using the Yeoh constitutive model, which is in line with previous ex-vivo measurements. However, while hoping to find a rest state under GA, the tongue unexpectedly appeared to be approximately 2 to 2.5 times stiffer under GA than AR. Explanations for this were sought by examining drugs administered during GA, blood flow, perfusion, and upper airway reflexes, but neither of these explanations could be confirmed.
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Affiliation(s)
- K D R Kappert
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands; Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - N Connesson
- TIMC-IMAG Laboratory, University Grenoble Alpes & CNRS, Grenoble, France
| | - S A Elahi
- Human Movement Science Department, Mechanical Engineering Department, KU Leuven, Leuven, Belgium
| | - S Boonstra
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands; Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - A J M Balm
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands; Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands; Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F van der Heijden
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands; Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Y Payan
- TIMC-IMAG Laboratory, University Grenoble Alpes & CNRS, Grenoble, France
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5
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Peeperkorn S, Meulemans J, Van Lierde C, Laenen A, Valstar MH, Balm AJM, Delaere P, Vander Poorten V. Validated Prognostic Nomograms for Patients With Parotid Carcinoma Predicting 2- and 5-Year Tumor Recurrence-Free Interval Probability. Front Oncol 2020; 10:1535. [PMID: 32984008 PMCID: PMC7477337 DOI: 10.3389/fonc.2020.01535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/17/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Salivary gland malignancies are rare tumors with a heterogenous histological and clinical appearance. Previously, we identified multiple prognostic factors in patients with parotid cancer and developed prognostic indices which have repeatedly been validated internationally, demonstrating their general applicability and lasting relevance. Recently, nomograms gained popularity as a prognostic tool. Thus, in this research we aimed to construct nomograms based on our previous validated prognostic models. Material and Methods: Nomograms were constructed using the previously reported dataset of 168 patients with parotid cancer which was used to develop pre- and postoperative prognostic scores, PS1 and PS2, respectively. Concordance indices for PS1 and PS2 were previously estimated at 0.74 and 0.71, respectively, and are in line with other, widely accepted oncological nomograms. Results: Pre- and postoperative nomograms predicting 2- and 5-year tumor recurrence-free survival probability are presented. All previously multivariately identified and validated prognostic factors, are incorporated (T size, N classification, pain, age at diagnosis, skin invasion, facial nerve dysfunction, perineural growth, and positive surgical margins). Examples of clinical application and interpretation are given. Conclusions: The presented prognostic nomograms for predicting 2- and 5-year tumor recurrence-free probability in patients with parotid cancer are powerful, user-friendly, visual tools and are based on internationally validated prognostic indices. They allow for a reliable prognostic assessment and result in a more individualized estimate of the risk for recurrence than the prognostic grouping based on PS1 and PS2. This facilitates assigning trial-patients to risk groups, and may assist in therapeutic decision making and determining appropriate follow-up intervals in clinical practice.
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Affiliation(s)
- Sam Peeperkorn
- Otorhinolaryngology - Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.,Section Head and Neck Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Jeroen Meulemans
- Otorhinolaryngology - Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.,Section Head and Neck Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Charlotte Van Lierde
- Otorhinolaryngology - Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.,Section Head and Neck Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Annouschka Laenen
- KU Leuven Department of Public Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Matthijs H Valstar
- Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - A J M Balm
- Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Pierre Delaere
- Otorhinolaryngology - Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.,Section Head and Neck Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology - Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.,Section Head and Neck Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
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6
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Kappert KDR, van Alphen MJA, Smeele LE, Balm AJM, van der Heijden F. Quantification of tongue mobility impairment using optical tracking in patients after receiving primary surgery or chemoradiation. PLoS One 2019; 14:e0221593. [PMID: 31454385 PMCID: PMC6711543 DOI: 10.1371/journal.pone.0221593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/10/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Tongue mobility has shown to be a clinically interesting parameter on functional results after tongue cancer treatment which can be objectified by measuring the Range Of Motion (ROM). Reliable measurements of ROM would enable us to quantify the severity of functional impairments and use these for shared decision making in treatment choices, rehabilitation of speech and swallowing disturbances after treatment. METHOD Nineteen healthy participants, eighteen post-chemotherapy patients and seventeen post-surgery patients were asked to perform standardized tongue maneuvers in front of a 3D camera system, which were subsequently tracked and corrected for head and jaw motion. Indicators, such as the left-right tongue range and the deflection angle with the horizontal axis were extracted from the tongue trajectory to serve as a quantitative measure for the impaired tongue mobility. RESULTS The range and deflection angle showed an excellent intra- and interrater reliability (ICC 0.9) The repeatability experiment showed an average standard deviation of 2.5 mm to 3.5 mm for every movement, except the upward movement. The post-surgery patient group showed a smaller tongue range and higher deflection angle overall than the healthy participants. Post-chemoradiation patients showed less difference in tongue ROM compared with healthy participants. Only a few patients showed asymmetrical movement after treatment, which could not always be explained by T-stage or the side of treatment alone. CONCLUSION We introduced a reliable and reproducible method for measuring the ROM and to quantify for motion impairments, that was able to show differences in tongue ROM between healthy subjects and patients after chemoradiation or surgery. Future research should focus on measuring patients with oral cancer pre- and post-treatment in combination with the collection of detailed information about the individual tongue anatomy, so that the full ROM trajectory can be used to identify changes over time and to quantify functional impairment.
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Affiliation(s)
- K. D. R. Kappert
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
- * E-mail:
| | - M. J. A. van Alphen
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L. E. Smeele
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A. J. M. Balm
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
- Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F. van der Heijden
- Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
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7
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Kappert KDR, van Alphen MJA, van Dijk S, Smeele LE, Balm AJM, van der Heijden F. An interactive surgical simulation tool to assess the consequences of a partial glossectomy on a biomechanical model of the tongue. Comput Methods Biomech Biomed Engin 2019; 22:827-839. [PMID: 30963800 DOI: 10.1080/10255842.2019.1599362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Oral cancer surgery has a negative influence on the quality of life (QOL). As a result of the complex physiology involved in oral functions, estimation of surgical effects on functionality remains difficult. We present a user-friendly biomechanical simulation of tongue surgery, including closure with suturing and scar formation, followed by an automated adaptation of a finite element (FE) model to the shape of the tongue. Different configurations of our FE model were evaluated and compared to a well-established FE model. We showed that the post-operative impairment as predicted by our model was qualitatively comparable to a patient case for five different tongue maneuvers.
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Affiliation(s)
- K D R Kappert
- a Department of Head and Neck Oncology and Surgery , Netherlands Cancer Institute , Amsterdam , The Netherlands.,b Robotics and Mechatronics , University of Twente , Enschede , The Netherlands
| | - M J A van Alphen
- a Department of Head and Neck Oncology and Surgery , Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - S van Dijk
- a Department of Head and Neck Oncology and Surgery , Netherlands Cancer Institute , Amsterdam , The Netherlands.,c Department of Oral and Maxillofacial Surgery , Amsterdam UMC, University of Amsterdam , Amsterdam , The Netherlands
| | - L E Smeele
- a Department of Head and Neck Oncology and Surgery , Netherlands Cancer Institute , Amsterdam , The Netherlands.,c Department of Oral and Maxillofacial Surgery , Amsterdam UMC, University of Amsterdam , Amsterdam , The Netherlands
| | - A J M Balm
- a Department of Head and Neck Oncology and Surgery , Netherlands Cancer Institute , Amsterdam , The Netherlands.,c Department of Oral and Maxillofacial Surgery , Amsterdam UMC, University of Amsterdam , Amsterdam , The Netherlands
| | - F van der Heijden
- a Department of Head and Neck Oncology and Surgery , Netherlands Cancer Institute , Amsterdam , The Netherlands.,b Robotics and Mechatronics , University of Twente , Enschede , The Netherlands
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de Ridder M, Balm AJM, Baatenburg de Jong RJ, Terhaard CHJ, Takes RP, Slingerland M, Dik E, Sedee RJE, de Visscher JGAM, Bouman H, Willems SM, Wouters MW, Smeele LE, van Dijk BAC. Variation in head and neck cancer care in the Netherlands: A retrospective cohort evaluation of incidence, treatment and outcome. Eur J Surg Oncol 2017; 43:1494-1502. [PMID: 28336186 DOI: 10.1016/j.ejso.2017.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/15/2017] [Accepted: 02/23/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To explore variation in numbers and treatment between hospitals that treat head and neck cancer (HNC) in the Netherlands. MATERIAL AND METHODS Patient, tumor and treatment characteristics were collected from the Netherlands Cancer Registry, while histopathological features were obtained by linkage to the national pathology record register PALGA. Inter-hospital variation in volume, stage, treatment, pathologically confirmed loco-regional recurrence and overall survival rate was evaluated by tumor site. RESULTS In total, 2094 newly diagnosed patients were included, ranging from 65 to 417 patients in participating hospitals treating HNC in 2008. Oral cavity cancer was mainly treated by surgery only, ranging from 46 to 82% per hospital, while the proportion of surgery with (chemo)radiotherapy ranged from 18 to 40%. Increasing age, male sex, and high stage were associated with a higher hazard of dying. In oropharynx cancer, the use of (chemo)radiotherapy varied from 31 to 82% between hospitals. We found an indication that higher volume was associated with a lower overall hazard of dying for the total group, but not by subsite. Low numbers, e.g. for salivary gland, nasopharynx, nasal cavity and paranasal sinus, did not permit all desired analyses. CONCLUSION This study revealed significant interhospital variation in numbers and treatment of especially oropharyngeal and oral cavity cancer. This study is limited because we had to rely on data recorded in the past for a different purpose. To understand whether this variation is unwanted, future research should be based on prospectively collected data, including detailed information on recurrences, additional case-mix information and cause of death.
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Affiliation(s)
- M de Ridder
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Head and Neck Surgery, Amsterdam, The Netherlands.
| | - A J M Balm
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Head and Neck Surgery, Amsterdam, The Netherlands; Academic Medical Center, Department of Maxillo-facial Surgery, Amsterdam, The Netherlands
| | | | - C H J Terhaard
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands
| | - R P Takes
- Radboud University Medical Center, Department of Otorhinolaryngology, Nijmegen, The Netherlands
| | - M Slingerland
- Leiden University Medical Center, Department of Medical Oncology, Leiden, The Netherlands
| | - E Dik
- Maastricht University Medical Center, Department of Cranio-maxillofacial Surgery Maastricht, The Netherlands
| | - R J E Sedee
- Medical Center Haaglanden, Department of Otorhinolaryngology, Den Haag, The Netherlands
| | - J G A M de Visscher
- Medical Center Leeuwarden, Department of Maxillo-facial Surgery, Leeuwarden, The Netherlands
| | - H Bouman
- Rijnstate Hospital, Department of Otorhinolaryngology, Arnhem, The Netherlands
| | - S M Willems
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Pathology, Amsterdam, The Netherlands; The Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands (PALGA), The Netherlands; University Medical Center Utrecht, Department of Pathology, Utrecht, The Netherlands
| | - M W Wouters
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Surgical Oncology, Amsterdam, The Netherlands
| | - L E Smeele
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Head and Neck Surgery, Amsterdam, The Netherlands; Academic Medical Center, Department of Maxillo-facial Surgery, Amsterdam, The Netherlands
| | - B A C van Dijk
- Comprehensive Cancer Organization The Netherlands (IKNL), Department of Research, Utrecht, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
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9
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Valstar MH, de Ridder M, van den Broek EC, Stuiver MM, van Dijk BAC, van Velthuysen MLF, Balm AJM, Smeele LE. Salivary gland pleomorphic adenoma in the Netherlands: A nationwide observational study of primary tumor incidence, malignant transformation, recurrence, and risk factors for recurrence. Oral Oncol 2017; 66:93-99. [PMID: 28249655 DOI: 10.1016/j.oraloncology.2017.01.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/20/2016] [Accepted: 01/06/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Whereas salivary gland pleomorphic adenoma (SGPA) is the most common type of salivary gland tumor, little is known about its epidemiology because national cancer registries do not register this disease. OBJECTIVES To establish SGPA incidence trends, rates of secondary malignant transformation and recurrence and associated factors in the Netherlands. MATERIALS AND METHODS Data on incidence, epidemiology, secondary malignant transformation and recurrence were retrieved from the Dutch pathology registry (PALGA) for the years 1992, 1997, 2002, 2007, and 2012. Multivariate analysis was performed to discover the risk factors for recurrence. RESULTS 3506 cases of SGPA were recorded implying an overall European standardized rate of 4.2-4.9 per 100,000 person-years. Our figures showed a female preponderance (1:1.43) with an annual 1% rise in female incidence (95% confidence interval [CI]: 0.2-1.8) and a bimodal age distribution in women (p<0.0001). The overall 20-year recurrence rate was 6.7%, and median time to first recurrence was 7years. Positive and uncertain resection margins and younger age at diagnosis were risk factors for recurrence, with odds ratios (ORs) of 4.62 (95%CI 2.84-7.51), 4.08 (95%CI 2.24-7.43), and 0.42 (95%CI 0.29-0.63) respectively. Tumor locations in the minor salivary glands had lower odds of recurrence than tumors in the parotid (OR 0.24; 95% CI: 0.07-0.77; p<0.016). Malignant transformation occurred in 0.15% of SGPAs (3.2% of recurrences). CONCLUSION This first nationwide study clearly showed sex differences in SGPA epidemiology, possibly suggesting some underlying hormonal mechanism. Long-term recurrence risks were low, and secondary malignant transformation risks were very low.
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Affiliation(s)
- M H Valstar
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands.
| | - M de Ridder
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Radiotherapy, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - E C van den Broek
- The Nationwide Network and Registry of Histo - and Cytopathology in the Netherlands (PALGA), Houten, The Netherlands
| | - M M Stuiver
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - B A C van Dijk
- Department of Research, Comprehensive Cancer Organisation (IKNL) The Netherlands, Utrecht, The Netherlands; Department of Epidemiology, University of Groningen, University Medical Centre, Groningen, The Netherlands
| | | | - A J M Balm
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - L E Smeele
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands
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Schoot RA, Theunissen EAR, Slater O, Lopez-Yurda M, Zuur CL, Gaze MN, Chang YC, Mandeville HC, Gains JE, Rajput K, Pieters BR, Davila Fajardo R, Talwar R, Caron HN, Balm AJM, Dreschler WA, Merks JHM. Hearing loss in survivors of childhood head and neck rhabdomyosarcoma: a long-term follow-up study. Clin Otolaryngol 2016; 41:276-83. [PMID: 26293165 DOI: 10.1111/coa.12527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the hearing status of survivors treated for head and neck rhabdomyosarcoma (HNRMS) at long-term follow-up. DESIGN Cross-sectional long-term follow-up study. SETTING Tertiary comprehensive cancer centre. PARTICIPANTS Survivors treated for HNRMS during childhood in two concurrent cohorts; survivors in London had been treated with external beam radiotherapy (EBRT-based local therapy); survivors in Amsterdam were treated with AMORE (Ablative surgery, MOuld technique afterloading brachytherapy and surgical REconstruction) if feasible, otherwise EBRT (AMORE-based local therapy). MAIN OUTCOME MEASURES We assessed hearing status of HNRMS survivors at long-term follow-up. Hearing thresholds were obtained by pure-tone audiometry. METHODS We assessed the hearing thresholds, the number of patients with clinically relevant hearing loss and hearing impairment graded according to the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv4) and Boston criteria. Furthermore, we compared hearing loss between survivors treated with EBRT-based local therapy (London) and AMORE-based local therapy (Amsterdam). RESULTS Seventy-three survivors were included (median follow-up 11 years). We found clinically relevant hearing loss at speech frequencies in 19% of survivors. Multivariable analysis showed that survivors treated with EBRT-based treatment and those with parameningeal tumours had significantly more hearing impairment, compared to survivors treated with AMORE-based treatment and non-parameningeal tumours. CONCLUSIONS One in five survivors of HNRMS developed clinically relevant hearing loss. AMORE-based treatment resulted in less hearing loss compared to EBRT-based treatment. As hearing loss was highly prevalent and also occurred in survivors with orbital primaries, we recommend systematic audiological follow-up in all HNRMS survivors.
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Affiliation(s)
- R A Schoot
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - E A R Theunissen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - O Slater
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M Lopez-Yurda
- Department of Epidemiology and Biostatistics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C L Zuur
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M N Gaze
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Y-C Chang
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - H C Mandeville
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - J E Gains
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - K Rajput
- Department of Audiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - B R Pieters
- Department of Radiation Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - R Davila Fajardo
- Department of Radiation Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - R Talwar
- Department of Otorhinolaryngology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - H N Caron
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - A J M Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - W A Dreschler
- Department of Audiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - J H M Merks
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
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Timmer FCA, Klop WMC, Relyveld GN, Crijns MB, Balm AJM, van den Brekel MWM, Lohuis PJFM. Merkel cell carcinoma of the head and neck: emphasizing the risk of undertreatment. Eur Arch Otorhinolaryngol 2015; 273:1243-51. [DOI: 10.1007/s00405-015-3558-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
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12
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Borbón-Arce M, Brouwer OR, van den Berg NS, Mathéron H, Klop WMC, Balm AJM, van Leeuwen FWB, Valdés-Olmos RA. An innovative multimodality approach for sentinel node mapping and biopsy in head and neck malignancies. Rev Esp Med Nucl Imagen Mol 2014; 33:274-9. [PMID: 24842707 DOI: 10.1016/j.remn.2013.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 11/26/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Recent innovations such as preoperative SPECT/CT, intraoperative imaging using portable devices and a hybrid tracer were evaluated in a multimodality approach for sentinel node (SN) mapping and biopsy in head and neck malignancies. MATERIAL AND METHODS The evaluation included 25 consecutive patients with head and neck malignancies (16 melanomas and 9 oral cavity squamous cell carcinomas). Patients were peritumorally injected with the hybrid tracer ICG-(99m)Tc-nanocolloid. SNs were initially identified with lymphoscintigraphy followed by single photon emission computed tomography (SPECT/CT) 2 hours after tracer administration. During surgery a portable gamma camera in combination with a near-infrared fluorescence camera was used in addition to a handheld gamma ray detection probe to locate the SNs. RESULTS In all patients the use of conventional lymphoscintigraphy, SPECT/CT and the additional help of the portable gamma camera in one case were able to depict a total of 67 SNs (55 of them visualized on planar images, 11 additional on SPECT/CT and 1 additional with the portable gamma camera). A total of 67 of the preoperatively defined SNs together with 22 additional SNs were removed intraoperatively; 12 out of the 22 additional SNs found during operation were located in the vicinity of the injection site in anatomical areas such as the periauricular or submental regions. The other 10 additional SNs were found by radioguided post-resection control of the excision SN site. CONCLUSION In the present series 26% additional SNs were found using the multimodal approach, that incorporates SPECT/CT and intraoperative imaging to the conventional procedure. This approach appears to be useful in malignancies located close to the area of lymphatic drainage such as the periauricular area and the oral cavity.
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Affiliation(s)
- M Borbón-Arce
- Servicio de Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España; Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - O R Brouwer
- Servicio de Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España
| | - N S van den Berg
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Radiology, Leiden University Medical Centre, Leiden, Netherlands
| | - H Mathéron
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - W M C Klop
- Department of Head & Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A J M Balm
- Department of Head & Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F W B van Leeuwen
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Head & Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R A Valdés-Olmos
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Radiology, Leiden University Medical Centre, Leiden, Netherlands
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13
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Marres CCM, de Ridder M, Hegger I, van Velthuysen MLF, Hauptmann M, Navran A, Balm AJM. The influence of nodal yield in neck dissections on lymph node ratio in head and neck cancer. Oral Oncol 2013; 50:59-64. [PMID: 24161464 DOI: 10.1016/j.oraloncology.2013.09.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/18/2013] [Accepted: 09/23/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Recent studies suggest that lymph node ratio (LNR) is a strong prognostic factor in head and neck cancer. This study aims to determine if the yield of harvested lymph nodes (LNs) influences the LNR. METHODS The study included 522 head and neck cancer patients, undergoing 638 primary and salvage (selective) neck dissections between 2002 and 2012. Before 2007 the neck dissection specimens were macroscopically and microscopically examined by pathologists and after 2007 the macroscopic examination was performed by pathology technicians. For comparison of mean LN yields, univariate and multivariate analyses were performed. RESULTS The mean number of LNs among 374 specimens examined by pathologists was 24 (range 0-89) vs. 32 (range 2-89) among 264 specimens examined by pathology technicians (P<.001). This caused the mean LNR in the non pre-treated patient group to drop from 11.4% to 8.7%. The counts of LNs per type of neck dissection were significantly different and increased with the number of levels involved. However, there was no linear relationship and the higher yields could be mostly ascribed to LNs in level V. The LNR varied from 8.1% to 18.4% among the different types of neck dissections. CONCLUSIONS A significant increase in the number of harvested LNs, but a decrease in LNR was observed after introducing pathology technicians for macroscopic examination. A clear association between the extent of the dissection and the number of harvested LNs was observed. LNR appears to be strongly dependent on the harvesting protocol and the extent of the dissection.
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Affiliation(s)
- C C M Marres
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M de Ridder
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - I Hegger
- Department of Pathology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M L F van Velthuysen
- Department of Pathology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M Hauptmann
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - A Navran
- Department of Radiotherapy, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - A J M Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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14
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Remmelts AJ, Hoebers FJP, Klop WMC, Balm AJM, Hamming-Vrieze O, van den Brekel MWM. Evaluation of lasersurgery and radiotherapy as treatment modalities in early stage laryngeal carcinoma: tumour outcome and quality of voice. Eur Arch Otorhinolaryngol 2013; 270:2079-87. [PMID: 23568036 DOI: 10.1007/s00405-013-2460-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 03/20/2013] [Indexed: 11/24/2022]
Abstract
For treatment of early stage (Tis-T2) laryngeal cancer the main choice is between microlaryngoscopy with carbon dioxide laser resection (laser surgery) and radiotherapy. Because both treatments provide excellent tumour control, secondary outcome variables such, as quality of voice may be of importance in treatment preference. In this study tumour outcomes and quality of voice were analysed for a cohort of patients with early stage (Tis-T2) laryngeal (glottic) carcinoma. The "physical subscale" of the voice handicap index questionnaire (VHI) and a validated five-item screening questionnaire were used. Analysis of 89 patients treated with laser surgery and 159 patients treated with radiotherapy revealed a 5-year local control of 75 and 86 % (p = 0.07). Larynx preservation (5-year) was, however, superior in patients treated with laser surgery, 93 vs 83 % (p < 0.05). Tumour outcomes were also analysed per tumour stage and none were of significant difference. Quality of voice was analysed in 142 patients. VHI scores were 12.4 ± 8.9 for laser surgery and 8.3 ± 7.7 for radiotherapy (p < 0.05), with a higher score reflecting a worse outcome. VHI scores per tumour stage for laser surgery and radiotherapy were, respectively, 12.0 ± 9.9 and 7.9 ± 7.5 in T1a (p = 0.06), 16.7 ± 9.0 and 4.9 ± 6.6 in T1b (p < 0.05). Outcomes of the five-item questionnaire showed voice deficiency in 33 % for laser surgery and 23 % for radiotherapy in T1a (p = 0.330) and 75 and 5 % for T1b (p = 0.001). Oncologic outcomes of laser surgery and radiotherapy were comparable. Larynx preservation is, however, preferable in patients initially treated with laser surgery. According to subjective voice analysis, outcomes were comparable in T1a lesions. Depth of laser resection is of influence on voice deficiency displayed by a significantly higher percentage of voice deficiency in patients treated with laser surgery for T1b lesions.
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Affiliation(s)
- A J Remmelts
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, PO Box 1066 CX, Amsterdam, The Netherlands.
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15
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Affiliation(s)
- A M Kreeft
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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16
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Lodder WL, Pameijer FA, Rasch CRN, van den Brekel MWM, Balm AJM. Prognostic significance of radiologically determined neck node volume in head and neck cancer: a systematic review. Oral Oncol 2011; 48:298-302. [PMID: 22112442 DOI: 10.1016/j.oraloncology.2011.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 11/01/2011] [Indexed: 11/19/2022]
Abstract
This systematic review addresses the prognostic significance of neck node volume in head and neck cancer. Primary tumor volume evolved as an independent significant factor for survival in head and neck cancer patients. Besides primary tumor volume, multiple prognostic features related to the regional lymph nodes were studied in literature. In literature, some authors showed the significance of total tumor volume/nodal volume for survival and loco-regional control. Articles reporting prognosis and survival in nodal tumor volumes were collected by systematically reviewing publications listed in the Pubmed and Embase databases. Publications were included when they at least reported on total tumor volume (TTV) or nodal volume and survival. In this systematic review we studied 21 articles. For measurement of nodal volume different formulas were used. Until now, there's no clear statistical evidence for the use of either TTV or nodal volume versus primary tumor volume to predict the individual loco-regional control or survival after treatment. There is wide variety of tumor measuring systems in the literature. The cut-off value for local tumor response also shows large variation. Firstly consensus should be accomplished on standardization of volume measurements, preferably automatic, and secondly large study groups are needed with identical treatment modalities to further unravel the role of neck node volume as separate staging tool.
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Affiliation(s)
- W L Lodder
- Department of Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Rasch CRN, Hauptmann M, Schornagel J, Wijers O, Buter J, Gregor T, Wiggenraad R, de Boer JP, Ackerstaff AH, Kroger R, Hoebers FJP, Balm AJM. Erratum: Intra-arterial versus intravenous chemoradiation for advanced head and neck cancer: Results of a randomized phase 3 trial. Cancer 2010. [DOI: 10.1002/cncr.25234] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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18
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Lodder WL, Hauptmann M, Teertstra HJ, van den Brekel MWM, Balm AJM. Letter to the editor: "Is preoperative ultrasonography accurate in measuring tumor thickness and predicting the incidence of cervical metastasis in oral cancer?". Oral Oncol 2010; 46:627; author reply 628. [PMID: 20371207 DOI: 10.1016/j.oraloncology.2010.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
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Kreeft A, Tan IB, van den Brekel MWM, Hilgers FJ, Balm AJM. The surgical dilemma of ‘functional inoperability’ in oral and oropharyngeal cancer: current consensus on operability with regard to functional results. Clin Otolaryngol 2009; 34:140-6. [PMID: 19413612 DOI: 10.1111/j.1749-4486.2009.01884.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Kreeft
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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van Rij CM, Oughlane-Heemsbergen WD, Ackerstaff AH, Lamers EA, Balm AJM, Rasch CRN. Parotid gland sparing IMRT for head and neck cancer improves xerostomia related quality of life. Radiat Oncol 2008; 3:41. [PMID: 19068126 PMCID: PMC2631487 DOI: 10.1186/1748-717x-3-41] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Accepted: 12/09/2008] [Indexed: 11/26/2022] Open
Abstract
Background and purpose To assess the impact of intensity modulated radiotherapy (IMRT) versus conventional radiation on late xerostomia and Quality of Life aspects in head and neck cancer patients. Patients and nethods Questionnaires on xerostomia in rest and during meals were sent to all patients treated between January 1999 and December 2003 with a T1-4, N0-2 M0 head and neck cancer, with parotid gland sparing IMRT or conventional bilateral neck irradiation to a dose of at least 60 Gy, who were progression free and had no disseminated disease (n = 192). Overall response was 85% (n = 163); 97% in the IMRT group (n = 75) and 77% in the control group (n = 88) the median follow-up was 2.6 years. The prevalence of complaints was compared between the two groups, correcting for all relevant factors at multivariate ordinal regression analysis. Results Patients treated with IMRT reported significantly less difficulty transporting and swallowing their food and needed less water for a dry mouth during day, night and meals. They also experienced fewer problems with speech and eating in public. Laryngeal cancer patients in general had fewer complaints than oropharynx cancer patients but both groups benefited from IMRT. Within the IMRT group the xerostomia scores were better for those patients with a mean parotid dose to the "spared" parotid below 26 Gy. Conclusion Parotid gland sparing IMRT for head and neck cancer patients improves xerostomia related quality of life compared to conventional radiation both in rest and during meals. Laryngeal cancer patients had fewer complaints but benefited equally compared to oropharyngeal cancer patients from IMRT.
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Affiliation(s)
- C M van Rij
- Department of Radiotherapy, Academic Medical Center, Amsterdam, the Netherlands.
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Oskam IM, Hoebers F, Balm AJM, van Coevorden F, Bais EM, Hart AM, van den Brekel MWM. Neck management in medullary thyroid carcinoma. European Journal of Surgical Oncology (EJSO) 2008; 34:71-6. [PMID: 17555910 DOI: 10.1016/j.ejso.2007.03.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2006] [Accepted: 03/07/2007] [Indexed: 11/17/2022]
Abstract
AIMS The aims of this study were to retrospectively evaluate incidence and patterns of lymph node metastases, surgical treatment and prognostic factors of medullary thyroid carcinoma. METHODS Out of a group of 70 MTC patients data of 67 patients were collected. Sixty-two of these patients underwent surgery. Apart from thyroidectomy, 16 patients underwent a bilateral neck dissection, 21 a unilateral neck dissection and 29 a paratracheal dissection or node-picking operation. Thirty-six patients were irradiated, of which 31 postoperatively and five with palliative intent. RESULTS Lymph node metastases were found in 91% of the ipsilateral neck dissection specimens, 91% of the paratracheal dissections and 63% of the contralateral dissections. Of the 12 elective neck dissections, 5 were tumor positive. Level VI was positive in 91% of the cases where a dissection was done, whereas preoperatively only 16% were scored tumor positive. During follow-up 22 of the 67 patients developed one or more locoregional recurrences (in total 28 recurrences). The most important factors that were correlated with a worse prognosis of survival were late stage of disease (stage III and IV) (p=0.0014), high number of positive lymph nodes (p=0.0023) and incomplete surgical resection (p=0.0002). CONCLUSIONS The high rate of locoregional recurrences in this study are a strong argument for a more aggressive approach to the primary and neck. A routine central and ipsilateral selective neck dissection of levels II-V should be considered in all MTC patients based on the high incidence of metastases and the relative low morbidity of a unilateral neck dissection. Patients referred after thyroidectomy alone with elevated (stimulated) calcitonin levels should be re-operated, performing an elective or therapeutic central and unilateral neck dissection.
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Affiliation(s)
- I M Oskam
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
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Balm AJM, Smeele LE, Lohuis PJFM. Optimizing exposure of the posterolateral maxillary and pterygoid region: the lower cheek flap. Eur J Surg Oncol 2007; 34:699-703. [PMID: 18029135 DOI: 10.1016/j.ejso.2007.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 08/24/2007] [Accepted: 08/28/2007] [Indexed: 10/22/2022] Open
Abstract
AIM Description of an alternative surgical approach to the posterolateral maxillary and pterygoid region. PATIENTS AND METHOD Three patients with posterior maxillary/pterygoid lesions are described in whom a lower cheek flap was used to achieve optimal surgical exposure. After midline division of the soft tissues of the lower lip and chin, the incision is extended posteriorly in the inferior gingivobuccal sulcus and continued lateral from the retromolar trigone in the upward direction lateral from the maxillary tuberosity. The flap is elevated under the periosteum towards the angle of the mandible with detachment of the masseter muscle. By marginal resection of the anterior part of the ascending mandible, visualisation of the posterolateral maxillary and pterygoid region can be optimized. CONCLUSION As compared to the transoral approach, the lower cheek flap creates an optimal surgical exposure of the posterolateral maxillary sinus wall and pterygoid plates and should be considered for maxillary lesions extending into the pterygoid plate and pterygoid muscles.
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Affiliation(s)
- A J M Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Hoebers FJP, Pluim D, Hart AAM, Verheij M, Balm AJM, Fons G, Rasch CRN, Schellens JHM, Stalpers LJA, Bartelink H, Begg AC. Cisplatin-DNA adduct formation in patients treated with cisplatin-based chemoradiation: lack of correlation between normal tissues and primary tumor. Cancer Chemother Pharmacol 2007; 61:1075-81. [PMID: 17639394 PMCID: PMC2270367 DOI: 10.1007/s00280-007-0545-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 06/08/2007] [Indexed: 11/24/2022]
Abstract
Purpose In this study, the formation of cisplatin-DNA adducts after concurrent cisplatin-radiation and the relationship between adduct-formation in primary tumor tissue and normal tissue were investigated. Methods Three intravenous cisplatin-regimens, given concurrently with radiation, were studied: daily low-dose (6 mg/m2) cisplatin, weekly 40 mg/m2, three-weekly 100 mg/m2. A 32P-postlabeling technique was used to quantify adducts in normal tissue [white blood cells (WBC) and buccal cells] and tumor. Results Normal tissue samples for adduct determination were obtained from 63 patients and tumor biopsies from 23 of these patients. Linear relationships and high correlations were observed between the levels of two guanosine- and adenosine–guanosine-adducts in normal and tumor tissue. Adduct levels in tumors were two to five times higher than those in WBC (P < 0.001). No significant correlations were found between adduct levels in normal tissues and primary tumor biopsies, nor between WBC and buccal cells. Conclusions In concurrent chemoradiotherapy schedules, cisplatin adduct levels in tumors were significantly higher than in normal tissues (WBC). No evidence of a correlation was found between adduct levels in normal tissues and primary tumor biopsies. This lack of correlation may, to some extent, explain the inconsistencies in the literature regarding whether or not cisplatin-DNA adducts can be used as a predictive test in anticancer platinum therapy.
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Affiliation(s)
- F J P Hoebers
- Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
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Huitink JM, Balm AJM, Keijzer C, Buitelaar DR. A reply. Anaesthesia 2007. [DOI: 10.1111/j.1365-2044.2007.05154_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Huitink JM, Balm AJM, Keijzer C, Buitelaar DR. Awake fibrecapnic intubation in head and neck cancer patients with difficult airways: new findings and refinements to the technique. Anaesthesia 2007; 62:214-9. [PMID: 17300296 DOI: 10.1111/j.1365-2044.2006.04947.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recently, we described an adaptation of awake fibreoptic intubation that we call awake fibrecapnic intubation. The aim of this study was to evaluate the efficacy and risk of complications with this novel technique in a consecutive case series of head and neck cancer patients known to have difficult airways. We prospectively studied 40 consecutive intubations in head and neck cancer patients prior to a diagnostic or surgical procedure. Following topical anaesthesia, a flexible bronchoscope was introduced into the pharynx; spontaneous respiration was maintained in all patients. A special suction catheter was advanced into the airway through the suction channel of the bronchoscope for carbon dioxide measurements. When four capnograms were obtained, the bronchoscope was railroaded over the catheter and a tracheal tube was placed. All adverse events and complications were recorded. There were no complications associated with the technique. The median (range) time to intubation was 3 min (1.5-15 min). All patients were intubated successfully, 39 (98%) of them using awake fibrecapnic intubation. There was one patient with severe tumour bleeding and acute airway obstruction caused by advancement of the tube over the bronchoscope. This was not considered to be a complication of the fibrecapnic technique. Awake fibrecapnic intubation is a safe and valuable technique in head and neck cancer patients with a difficult airway.
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Affiliation(s)
- J M Huitink
- Department of Head and Neck Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Geurts TW, Ackerstaff AH, Van Zandwijk N, Hart AAM, Hilgers FJM, Balm AJM. The psychological impact of annual chest X-ray follow-up in head and neck cancer. Acta Otolaryngol 2006; 126:1315-20. [PMID: 17101594 DOI: 10.1080/00016480600868414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONCLUSION Annual post-treatment screening of head and neck squamous cell carcinoma (HNSCC) patients for second primary lung cancer and metastatic recurrence appeared to form no major burden for head and neck cancer patients. A majority of patients regard the annual chest X-ray as a reassurance. Given these results a more intensive screening program seems psychologically justifiable for this group. OBJECTIVE To assess the psychological impact of annual post-treatment screening for second primary lung cancer and metastases in HNSCC patients. PATIENTS AND METHODS In a cohort of 106 patients, 68 men and 38 women, with a mean age of 56, the impact of the yearly chest radiograph was evaluated by means of a nine-item questionnaire. RESULTS In all, 90% of the patients were in favor of annual post-treatment screening, 2% would not like to receive this screening, and 8% had no preference. A majority (98%) considered the screening as an extra medical check and 76% felt reassured. Although 21% of the patients were very nervous about the outcome of the screening, only 3% wanted to avoid the yearly chest X-ray for this reason.
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Affiliation(s)
- T W Geurts
- Department of Head and Neck Oncology and Surgery, The Nethelands Cance Institute / Antoine van Leuwenhoek Hospital, Amsterdam, The Netherlands
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Zuur CL, Simis YJW, Lansdaal PEM, Rasch CRN, Tange RA, Balm AJM, Dreschler WA. Audiometric Patterns in Ototoxicity of Intra-Arterial Cisplatin Chemoradiation in Patients with Locally Advanced Head and Neck Cancer. Audiol Neurootol 2006; 11:318-30. [PMID: 16983183 DOI: 10.1159/000095818] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Accepted: 06/02/2006] [Indexed: 11/19/2022] Open
Abstract
This study describes audiometric patterns of ototoxicity in a consecutive series of patients uniformly treated with intra-arterial high-dose cisplatin chemoirradiation for advanced cancer of the head and neck. Air conduction thresholds were measured from 0.125 to 16 kHz and bone conduction thresholds were measured from 0.5 to 4 kHz. The overall audiometric pattern was characterized by maximum threshold shifts after the 2nd cisplatin infusion and a maximum total threshold shift at 8 kHz, irrespective of gender, age, pretreatment sensorineural hearing loss (SNHL) or subjective complaints during therapy. A hearing deterioration gradient was observed from (ultra-) high to low frequencies, worse with increasing pre-existent SNHL and with increasing cumulative dose of cisplatin chemoradiation. Cisplatin chemoradiation-induced hearing loss seemed to reach a plateau at higher levels (75-80 dB HL) for frequencies above 8 kHz compared to frequencies up to 8 kHz (45-60 dB HL). Recovery of SNHL was found after therapy in 27 ears characterized by extensive hearing loss at frequencies 1, 2 and 4 kHz.
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Affiliation(s)
- C L Zuur
- Department of Otorhinolaryngology, Academical Medical Centre Amsterdam, Amsterdam, The Netherlands.
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van den Berg JH, Beijnen JH, Balm AJM, Schellens JHM. Future opportunities in preventing cisplatin induced ototoxicity. Cancer Treat Rev 2006; 32:390-7. [PMID: 16781082 DOI: 10.1016/j.ctrv.2006.04.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 04/21/2006] [Accepted: 04/25/2006] [Indexed: 12/15/2022]
Abstract
Cisplatin is one of the most commonly used cytotoxic agents. Ototoxicity is an important and dose-limiting side-effect of cisplatin therapy. It is believed that cisplatin suppresses the formation of endogenous anti-oxidants that normally prevent the inner ear against reactive oxygen species (ROS). These ROS affect the outer hair cells (OHCs) in the organ of Corti. Results from clinical trials with amifostine, an anti-oxidant with possible otoprotective action during cisplatin therapy, were disappointing. A variety of agents with chemoprotective action against cisplatin-induced ototoxicity were successfully tested in animal models. It is important to translate these promising results from animal models into clinical practice. The possible routes of administration are systemic and transtympanic. An important condition when using such an agent systemically is that the compound may not affect the anti-tumor effect of cisplatin. The critical step at transtympanic administration is the diffusion of the compound through the round window membrane (RWM). This diffusion depends on the characteristics of the medication as on the properties of the RWM. Positive results of an otoprotector in clinical practice may increase the effectiveness of cisplatin therapy and can improve the quality of life for a large group of patients.
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Affiliation(s)
- J H van den Berg
- Department of Pharmacy and Pharmacology, Slotervaart Hospital/The Netherlands Cancer Institute, P.O. Box 90440, 1006 BK Amsterdam, The Netherlands.
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Balm AJM, Lohuis PJFM, Copper MP. Surgical technique—unwrapping the neck node levels around a sternocleidomastoid muscle bar: A systematic way of performing (modified) radical neck dissection. Eur J Surg Oncol 2005; 31:1216-21. [PMID: 16171967 DOI: 10.1016/j.ejso.2005.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Revised: 07/18/2005] [Accepted: 07/28/2005] [Indexed: 10/25/2022] Open
Abstract
AIM Description of a systematic approach to the neck for removal of lymph node bearing tissues in levels I-V. METHOD A (modified) radical neck dissection is divided in three steps: (1) Dissection of levels I-IV, (2) dissection of level V and (3) transection of SCM bar and finalisation of the dissection. The sternocleidomastoid muscle (SCM) is used as a "bar", around which the different neck levels can be systematically unwrapped, warranting permanent cranio-caudal tension of the neck specimen, while anatomical relations remain intact. RESULTS In a group of 115 (modified) radical en bloc neck dissections with or without post-operative radiotherapy 10% regional recurrences, 2% post-operative chylous fistulas and < 5% post-operative wound infections occurred. The overall 5 years survival was 45% (95% confidence interval: 36-54%). CONCLUSION A systematic unwrapping of lymph node levels around the sternocleidomastoid bar provides a reliable systematic method for performing (modified) radical neck dissections without a negative influence on clinical outcome.
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Affiliation(s)
- A J M Balm
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
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Balm AJM, Schornagel JH, Rasch CRN. [The role of simultaneous chemotherapy and radiotherapy in the treatment of locally metastasised tumours of the larynx, pharynx and oral cavity]. Ned Tijdschr Geneeskd 2005; 149:61-4. [PMID: 15688835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In The Netherlands each year there are 2300 new patients with a squamous-cell carcinoma of the larynx, pharynx and oral cavity, and of these, one-third has a locally regionally advanced tumour. An operation can then lead to an unacceptable loss of function, whilst radiotherapy alone has no effect on survival. Compared to radiotherapy alone, the combination of radiotherapy and chemotherapy containing cisplatin, when administered simultaneously, produces a higher percentage of patients with loco-regional control and a higher 3-year survival percentage. This improvement in treatment results is accompanied by an increased acute toxicity.
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Affiliation(s)
- A J M Balm
- Afd. Hoofd-halsoncologie en -chirurgie, Nederlands Kanker Instituut-Antoni van Leeuwenhoek Ziekenhuis, Plesmanlaan 121, 1066 CX Amsterdam
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Jol JAD, van Velthuysen MLF, Hilgers FJM, Keus RB, Neering H, Balm AJM. Treatment results of regional metastasis from cutaneous head and neck squamous cell carcinoma. Eur J Surg Oncol 2003; 29:81-6. [PMID: 12559082 DOI: 10.1053/ejso.2002.1330] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS To investigate the results of our treatment policy, we present our institutional experience in the management of regional neck node metastases of cutaneous head and neck squamous cell carcinoma (CHNSCC). METHODS Between 1977 and 1997, 343 patients presented with CHNSCC, of whom 41 were treated for regional metastases, with parotidectomy and/or (selective) neck dissection. Histological analysis was performed on all operation specimens. Patients with multiple nodes and/or extra capsular rupture, at risk for recurrence, received adjuvant radiotherapy. RESULTS Seventy-six percent of the regional metastases occurred within the first 2 years, but a delay of more than 5 years was also observed. Parotid gland (56%), neck levels II (39%) and V (22%) were most frequently involved. Twenty-four percent of patients treated with curative intent failed at the regional site. Five years overall survival was 46%, with a median survival of 49 months. No survival differences emerged between patients treated by surgery alone and patients receiving adjuvant radiotherapy (P=0.14). Five patients died of disease, of whom three with distant metastases. CONCLUSION Regionally metastasized CHNSCC is a serious disease with a high risk of regional recurrence, calling for combined surgery and adjuvant radiotherapy. A small subset of patients with a long interval between completion of primary treatment and presence of regional nodes justifies a long follow-up.
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Affiliation(s)
- J A D Jol
- Department of Otolaryngology/Head and Neck Oncology, Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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van den Brekel MWM, Balm AJM. Editorial comment on 'Frequent 3p allele loss and epigenetic inactivation of the RASSF1A tumour suppressor gene from region 3p21.3 in head and neck squamous cell carcinoma' by Hogg and colleagues. Eur J Cancer 2002; 38:1561-3. [PMID: 12142043 DOI: 10.1016/s0959-8049(02)00068-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Vander Poorten VLM, Balm AJM, Hilgers FJM, Tan IB, Loftus-Coll BM, Keus RB, Hart AAM. Prognostic factors for long term results of the treatment of patients with malignant submandibular gland tumors. Int J Oral Maxillofac Surg 2000. [DOI: 10.1034/j.1399-0020.2000.290519-2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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