Electroporation therapy of skin cancer in the head and neck area

BACKGROUND

Electroporation therapy is a new cancer treatment modality in which a locally applied electrical field enhances cell membrane permeability, allowing greater intracellular accumulation of a chemotherapeutic agent.

OBJECTIVE

To evaluate the efficacy of electroporation therapy in treating basal cell and squamous cell carcinomas of the skin.

MATERIALS AND METHODS

Six patients with skin cancer of the head and neck were treated using electroporation therapy with intratumorally injected bleomycin. Orbital growth, facial nerve proximity, or proximity to cartilage of the external meatus complicated four of these tumors. The intention was curative. The follow-up period was 24 months and included biopsies after 8 weeks.

RESULTS

In four of the six patients, one treatment was enough to eradicate the tumor. In one patient, the tumor persisted even after a second treatment with electroporation therapy. A septal cartilage perforation was the only major complication. The cosmetic results were very satisfactory. One additional recurrence was recorded 6 months after the follow-up period

CONCLUSION

Electroporation therapy is a promising new cancer treatment that should be further evaluated as an alternative to surgery, especially in complicated skin cancer.

Treatment of severe subglottic stenosis in children with the CO2 laser. A preliminary report on a few successful cases

Subglottic stenosis in children is difficult to resect even with the CO2 laser. The smallest laser bronchoscope is usually too large to pass through the glottis. In cases where it is possible, the precision may not suffice. A micromanipulator used together with a laryngoscope will permit a far better control of the laser beam. The commercially available instruments are not sufficiently small for use in a small stenotic larynx. As only small parts of the stenosis should be removed at one time, there has been a need for delicate instruments to protect parts of the laryngeal interior and at the same time permit access to the nether area of the subglottic region. Instruments designed by the author is described and the preliminary results of hitherto five consecutive cases are reported. Ages at the beginning of the treatment varies from 2 months to 4 years and 4 months. The most severe case has been treated six times. Three children are living without breathing problems. One child is about to be decannulated, and the treatment has just begun in the most recent case. The observation time after treatment is 2 years at most.

Reconstruction of the airway with a composite alloplastic and autogenous graft. An experimental study

A method by which an alloplast can be lined with mucosa and thereafter used as a composite pedicled graft is described and discussed. Autogenous buccal mucosa was transplanted to the pretracheal region in five beagles. Subsequently a cyst developed in which the graft constituted the main part of the cyst wall. After 5 to 6 weeks the cyst was explored and a Proplast sheet was sutured to its exterior. After another 3-9 weeks the area was explored again. A composite graft had then formed comprising buccal mucosa on the outside, stabilized by Proplast and supplied by blood vessels arising from the strap muscles and their fascia. After opening of the cyst, the composite graft was used to repair a tracheal defect in the same dog. All of the dogs survived and they did not lose any weight. The graft areas were removed 5 1/2-9 months after the tracheal window repair. Tracheoscopy was performed at least twice on each dog. The grafted areas were also studied by light microscopy, scanning electron microscopy and transmission electron microscopy. The grafts survived in all cases. There was no tendency towards graft extrusion. Connective tissue cells predominated in the pores of the Proplast framework, in which small foci of metaplastic bone formation were also seen.

The autogenous mucosal cyst procedure. Experimental reconstructive surgery of the airway with a new composite graft technique

Autogenous buccal mucosa was transplanted to the pretracheal region in five beagles. Subsequently a cyst developed in which the graft constituted the main part of the cyst wall. After 4 to 13 weeks the cyst was explored and a perforated autogenous cortical bone plate was sutured to its vertex. After a further 5 to 7 weeks the resulting composite graft was sutured to an anterior tracheal window defect. All dogs survived. They did not lose weight. One dog had moderate breathing difficulties during exertion. At bronchoscopy, which was performed in all dogs, no contractions or granulations were seen but the stability of the airway wall in the grafted areas was reduced. These areas were removed after 8 to 15 months and studied by light microscopy, scanning electron microscopy and transmission electron microscopy. The mucosa survived in all cases. Total resorption of the bone graft occurred in all but two cases, in which remnants were found.