Head & neck
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Randomized Controlled Trial Multicenter Study Comparative Study
Phase III randomized study: oral pilocarpine versus submandibular salivary gland transfer protocol for the management of radiation-induced xerostomia.
Xerostomia is a serious morbidity of radiation treatment in head and neck cancer. ⋯ Submandibular SGT procedure is superior to pilocarpine in management of radiation-induced xerostomia.
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Controlled Clinical Trial
Prospective study of early detection of pharyngeal superficial carcinoma with the narrowband imaging laryngoscope.
The newly developed narrowband imaging (NBI) gastrointestinal endoscope makes possible the detection of superficial carcinoma in the oropharynx and hypopharynx, which is difficult with the conventional laryngoscope. Here, we investigated whether the combined use of laryngoscope with NBI allows the detection of superficial carcinoma in this region. ⋯ The NBI laryngoscope may play an important role in the diagnosis and treatment of superficial carcinoma in the oropharynx and hypopharynx.
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Radiation therapy (RT) is commonly used in the management of patients with advanced (T3-T4) oropharyngeal squamous cell carcinomas. In recent years, based upon the meta-analyses of randomized trials, chemotherapy administered concurrently with RT (chemoradiotherapy) has become the standard of care. Twice-a-day hyperfractionated or accelerated-fractionated RT regimens have been shown in a number of randomized trials to significantly improve the rate of local control compared with conventional once-a-day fractionation. Concurrent chemotherapy administered along with hyperfractionated or accelerated RT has been shown to add significant additional benefit over hyperfractionated or accelerated RT alone. Neoadjuvant chemotherapy (usually consisting of cisplatin and fluorouracil) also produces favorable responses in most patients (approximately 75% partial or complete response rates) with advanced head and neck cancer, but its role remains controversial. ⋯ This study is noteworthy in that it uses both neoadjuvant and concurrent sensitizing chemotherapy along with hyperfractionated RT. There is little information in the literature on this approach. Although the regimen is somewhat toxic, it is less so than many other regimens, which combined full-dose multiagent chemotherapy during the course of RT. The latter regimens also have a significant incidence of permanent dysphagia, gastrostomy dependence, and/or aspiration, complications that were not encountered in this group. The local control rate was high (89%). We continue to recommend this regimen for patients with locally advanced head and neck squamous cell carcinomas.