Protecting the oral mucosa in patients with oral tongue squamous cell carcinoma treated postoperatively with intensity-modulated radiotherapy: a randomized study.

Objectives/hypothesis: Is the severity of acute oral mucositis in patients who receive postoperative intensity-modulated radiotherapy (PO-IMRT) for oral tongue squamous cell carcinoma (SCC) reduced by sparing the oral mucosa outside of the planning target volume (PTV)?

Study Design: Prospective, randomized trial.

Methods: Forty-eight patients with oral tongue SCC who received PO-IMRT at our institution were randomized to two groups: the oral-sparing (OR-SP) group and oral-unsparing (OR-USP) group. For the OR-SP group (n = 24), the oral mucosa outside of the PTV was spared.

When is elective pelvic lymph node irradiation indicated in definitive radiotherapy for localized prostate cancer?

The objective is to define the role of elective pelvic node irradiation (EPNI) in patients treated with definitive radiotherapy for clinically localized prostate cancer. Review of the pertinent literature revealed few prospective randomized trials that evaluated the efficacy of EPNI. Although EPNI may reduce the risk of regional recurrence, its impact on biochemical progression-free survival and overall survival is unclear.

Adenoid cystic carcinoma of the head and neck.

Purpose: To report our experience using radiotherapy alone or combined with surgery to treat adenoid cystic carcinoma of the head and neck.

Materials And Methods: Radiotherapy alone or combined with surgery was used to treat 120 previously untreated patients with adenoid cystic carcinoma (ACC) of the head and neck from August 1966 to March 2008. Patients were treated with curative intent.

Skin carcinoma of the head and neck with perineural invasion.

Purpose: The aim of the study was to update the experience treating cutaneous squamous cell and basal cell carcinomas of the head and neck with incidental or clinical perineural invasion (PNI) with radiotherapy (RT).

Materials And Methods: From 1965 to 2007, 216 patients received RT alone or with surgery and/or chemotherapy.

Results: The 5-year overall, cause-specific, and disease-free survivals for incidental and clinical PNIs were 55% vs 54%, 73% vs 64%, and 67% vs 51%.

Contemporary management of lymph node metastases from an unknown primary to the neck: I. A review of diagnostic approaches.

In an era of advanced diagnostics, metastasis to cervical lymph nodes from an occult primary tumor is a rare clinical entity and accounts for approximately 3% of head and neck malignancies. Histologically, two thirds of cases are squamous cell carcinomas (SCCs), with other tissue types less common in the neck. With modern imaging and tissue examinations, a primary tumor initially undetected on physical examination is revealed in >50% of patients and the site of the index primary can be predicted with a high level of probability.

Radiotherapy for juvenile nasopharyngeal angiofibroma.

Purpose: To explain the concepts that radiation oncologists need to understand to manage patients with juvenile nasopharyngeal angiofibroma (JNA). To accomplish this goal we first describe our institution's experience with radiotherapy for JNA and then use this data set as a framework for explaining the role of radiotherapy in the treatment of this uncommon tumor.

Methods And Materials: We studied the outcomes of all 24 patients treated with radiotherapy for JNA at our institution.

Head and neck paragangliomas.

Background: The purpose of this study was to describe the natural history and optimal treatment for head and neck paragangliomas (PGs).

Methods: Our methods were the review of the pertinent literature.

Results: PGs are rare tumors seen most commonly in the head and neck.

Proton therapy for prostate cancer.

Proton therapy has been used in the treatment of cancer for over 50 years. Due to its unique dose distribution with its spread-out Bragg peak, proton therapy can deliver highly conformal radiation to cancers located adjacent to critical normal structures. One of the important applications of its use is in prostate cancer, since the prostate is located adjacent to the rectum and bladder.

Proton therapy for head and neck cancer: rationale, potential indications, practical considerations, and current clinical evidence.

There is a strong rationale for potential benefits from proton therapy (PT) for selected cancers of the head and neck because of the opportunity to improve the therapeutic ratio by improving radiation dose distributions and because of the significant differences in radiation dose distribution achievable with x-ray-based radiation therapy (RT) and PT. Comparisons of dose distributions between x-ray-based and PT plans in selected cases show specific benefits in dose distribution likely to translate into improved clinical outcomes. However, the use of PT in head and neck cancers requires special considerations in the simulation and treatment planning process, and currently available PT technology may not permit realization of the maximum potential benefits of PT.

Severe dry eye syndrome after radiotherapy for head-and-neck tumors.

Purpose: To investigate the incidence of severe dry eye syndrome (DES) after external beam radiotherapy for head-and-neck cancer and its dependence on the parameters relevant to external beam radiotherapy.

Methods And Materials: The present retrospective study included 78 patients treated for primary extracranial head-and-neck tumors between 1965 and 2000, whose lacrimal apparatus/entire globe was exposed to fractionated external beam radiotherapy. The dose received by the major lacrimal gland was used for analysis.

Cutaneous Merkel cell carcinoma.

Purpose: The aim of this study was to describe the treatment outcomes of patients with cutaneous Merkel cell carcinoma managed with curative intent.

Materials And Methods: Between December 1984 and November 2009, 40 patients with previously untreated Merkel cell carcinoma were managed with curative intent with radiotherapy alone (3 patients) or combined with surgery (37 patients). Adjuvant chemotherapy was administered to 11 patients.

Androgen deprivation therapy and definitive radiotherapy for prostate cancer.

Adjuvant androgen deprivation therapy (ADT) improves outcomes of patients receiving definitive radiotherapy (RT) for local-regionally advanced prostate cancer. However, patients in most randomized trials had more advanced disease than observed in many practices and were treated with suboptimal RT doses. Although data are conflicting, long-term ADT likely has adverse side-effects in patients with comorbidities.

Fractionated radiotherapy in the management of benign vascular tumors.

Purpose: To better characterize the long-term therapeutic ratio of fractionated radiotherapy for benign vascular and lymphatic tumors.

Methods: We retrospectively reviewed 19 medical records with 13 hemangiomas, 3 hemangioblastomas, and 3 benign lymphatic tumors treated with radiotherapy at the University of Florida from 1984 to 2007 to assess clinical presentation, treatment, and outcomes. The 10 men and 9 women had a median age of 43 years (range, 2 to 74 y).

Elective neck dissection for second primary after previous definitive radiotherapy.

Purpose: The aim of this study was to define the role of neck dissection during surgery for patients who have received elective nodal irradiation in the course of treatment for a prior squamous cell carcinoma of the head and neck (SCCHN) and are subsequently diagnosed with a second primary SCCHN.

Materials And Methods: We reviewed the medical records of 13 patients who received both definitive radiotherapy and elective nodal irradiation for T1-4 N0 M0 SCCHN of the oral cavity, oropharynx, hypopharynx, or larynx who then subsequently developed a metachronous T1-4 N0 M0 SCCHN primary at a new site. All second primary tumors were treated with surgery.

Proton radiotherapy for prostate cancer is not associated with post-treatment testosterone suppression.

Purpose: Three independent studies of photon (x-ray) radiotherapy (RT) for prostate cancer have demonstrated evidence of testosterone suppression after treatment. The present study was undertaken to determine whether this would also be the case with conformal protons.

Methods And Materials: Between August 2006 and October 2007, 171 patients with low- and intermediate-risk prostate cancer were enrolled and underwent treatment according to the University of Florida Proton Therapy Institute institutional review board-approved PR01 and PR02 protocols.

Human papillomavirus, smoking, and head and neck cancer.

Aims: Smoking and human papillomavirus (HPV) are both distinct risk factors for head and neck cancer, but the nature of interaction between these 2 risk factors in the development of head and neck cancer remains unclear. The purpose of this review is to determine the potential effect of smoking in causation of HPV-related head and neck carcinoma.

Method: A literature search was carried out using the keywords human papillomavirus, head and neck cancer, smoking, tobacco, and cervical cancer.

Evidence for treatment strategies in sinonasal adenocarcinoma.

Adenocarcinomas of various types account for 10% to 20% of all primary malignant neoplasms of the nasal cavity and paranasal sinuses. There is a general consensus that the optimal treatment of adenocarcinoma is surgery and postoperative radiotherapy. The purpose of this report was to review the results of this combined treatment as well as other treatment strategies and their outcome.

Revisiting unnecessary larynx irradiation with whole-neck IMRT.

Purpose: To determine if whole-neck intensity-modulated radiotherapy (IMRT) spares the larynx as well as techniques that match a conventional anterior-neck field to an IMRT plan superior to the larynx.

Methods And Materials: This is a dosimetric study using the treatment planning image sets from 5 consecutively treated patients with node-positive squamous cell carcinoma of the oropharynx, all with gross disease above the larynx. We compared 3 techniques for irradiating the mid- and low-neck lymphatics: whole-neck IMRT, conventional anterior-neck field with split-beam matching, and conventional anterior-neck field with gradient matching.

Radiotherapy with or without surgery for maxillary sinus squamous cell carcinoma: should the clinical N0 neck be treated?

Objectives: Maxillary sinus squamous cell carcinoma is commonly diagnosed at an advanced stage and treated using radiotherapy, with or without surgical resection.

Methods: Fifty-four patients with maxillary sinus squamous cell carcinoma were treated from 1969 to 2006, using radiotherapy, with or without surgical resection. Fifty-two (96%) patients had American Joint Committee on Cancer stages III to IV disease, and 45 (83%) patients had N0 neck disease.

Early outcomes from three prospective trials of image-guided proton therapy for prostate cancer.

Purpose: To report early outcomes with image-guided proton therapy for prostate cancer.

Methods And Materials: We accrued 211 prostate cancer patients on prospective Institutional Review Board-approved trials of 78 cobalt gray equivalent (CGE) in 39 fractions for low-risk disease, dose escalation from 78 to 82 CGE for intermediate-risk disease, and 78 CGE with concomitant docetaxel followed by androgen deprivation for high-risk disease. Minimum follow-up was 2 years.

Head and neck osteosarcoma.

Objective: The objective of the study was to discuss the optimal management and treatment outcomes for patients with head and neck osteosarcomas.

Study Design: Review article.

Methods: Review of the pertinent literature.

Intensity-modulated radiotherapy for oropharyngeal squamous cell carcinoma.

Objectives/hypothesis: To report the outcomes after intensity-modulated radiotherapy (IMRT) for patients with oropharyngeal squamous cell carcinoma.

Study Design: Retrospective review.

Methods: Between July 2001 and March 2007, a total of 130 patients were treated with definitive IMRT for squamous cell carcinoma of the oropharynx.

Impact of salivary gland dosimetry on post-IMRT recovery of saliva output and xerostomia grade for head-and-neck cancer patients treated with or without contralateral submandibular gland sparing: a longitudinal study.

Purpose: To observe the recovery of saliva output and effect on xerostomia grade after intensity-modulated radiotherapy (IMRT) with or without contralateral submandibular gland (cSMG) sparing and to assess the impact of salivary gland dosimetry on this recovery among patients with head-and-neck cancer.

Methods And Materials: Between May 2007 and May 2008, 52 patients with head-and-neck cancer received definitive (n=5 patients) and postoperative (n=47 patients) IMRT at our institution, with at least one parotid gland spared. Of these patients, 26 patients with a low risk of recurrence in the cSMG region underwent IMRT and had their cSMGs spared (cSMG-sparing group).

Squamous cell carcinoma of the anal margin: the university of Florida experience.

Objective: To update our experience in treating squamous cell carcinoma of the anal margin with definitive radiotherapy (RT).

Methods: A total of 26 patients treated curatively with RT between 1979 and 2008, with or without concurrent chemotherapy, were retrospectively reviewed. American Joint Committee on Cancer stage distribution was: T1, N = 1; T2, N = 16; T3, N = 9; N0, N = 25; and N1, N = 1.

Head and neck squamous cell carcinoma from an unknown primary site.

Background: The purpose of this study is to present our experience treating patients with squamous cell carcinoma (SCC) from an unknown head and neck primary site and to determine whether a policy change eliminating the larynx and hypopharynx from the radiotherapy (RT) portals has impacted outcome.

Methods: One hundred seventy-nine patients received definitive RT with or without a neck dissection for SCC from an unknown head and neck primary site. RT was delivered to the ipsilateral neck alone or both sides of the neck and, usually, the potential mucosal primary sites.