1/13. Clinical delivery of intensity modulated conformal radiotherapy for relapsed or second-primary head and neck cancer using a multileaf collimator with dynamic control.BACKGROUND AND PURPOSE: Concave dose distributions generated by intensity modulated radiotherapy (IMRT) were applied to re-irradiate three patients with pharyngeal cancer. patients, MATERIALS AND methods: Conventional radiotherapy for oropharyngeal (patients 1 and 3) or nasopharyngeal (patient 2) cancers was followed by relapsing or new tumors in the nasopharynx (patients 1 and 2) and hypopharynx (patient 3). Six non-opposed coplanar intensity modulated beams were generated by combining non-modulated beamparts with intensities (weights) obtained by minimizing a biophysical objective function. Beamparts were delivered by a dynamic MLC (Elekta Oncology Systems, Crawley, UK) forced in step and shoot mode. RESULTS AND CONCLUSIONS: Median PTV-doses (and ranges) for the three patients were 73 (65-78), 67 (59-72) and 63 (48-68) Gy. Maximum point doses to brain stem and spinal cord were, respectively, 67 Gy (60% of volume below 30 Gy) and 32 Gy (97% below 10 Gy) for patient 1; 60 Gy (69% below 30 Gy) and 34 Gy (92% below 10 Gy) for patient 2 and 21 Gy (96% below 10 Gy) at spinal cord for patient 3. Maximum point doses to the mandible were 69 Gy for patient 1 and 64 Gy for patient 2 with, respectively, 66 and 92% of the volume below 20 Gy. A treatment session, using the dynamic MLC, was finished within a 15-min time slot.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/13. Lipomatous variant of nasopharyngeal angiofibroma: a case report.Nasopharyngeal angiofibroma is an uncommon benign vascular tumor that occurs in adolescent boys and young men. We describe an unusual histological variant of this entity characterized by a prominent adipose tissue component. The patient was a 35-year-old man with a 20-year history of nasal obstruction. Results of physical examination and angiography demonstrated a nasal mass consistent with a nasopharyngeal angiofibroma. We discuss the differential diagnoses pathologically for this lesion.- - - - - - - - - - ranking = 15.794198483952keywords = physical examination, physical (Clic here for more details about this article) |
3/13. The mediating role of optimism on post-radiation quality of life in nasopharyngeal carcinoma.Nasopharyngeal carcinoma (NPC) is prevalent in southern china. In non-welfare countries, eating difficulties after radiotherapy may hinder NPC patients' short-term quality of life (QoL) especially regarding work and finance. This study explored the positive mediating role of optimism on the relationship between eating ability and QoL of Chinese NPC patients who received radiotherapy in hong kong. A sample of 211 newly referred patients were recruited and followed-up face-to-face or by telephone at four (post-radiation 1) (FU 1) and eight (post-radiation 2) (FU 2) months from baseline. QoL was measured by the FACT-G (Chinese). Optimism and eating ability were measured by two 11-point self-rated items. Mediating effects were tested with a series of multiple regression models. After adjustment for pre-radiation QoL, socioeconomic status and cancer stage, optimism significantly mediated the relationship between eating ability at FU 1 and overall QoL at FU 2, in particular physical and social/family well-being. This study is the first to underpin the mediating role of optimism on QoL of NPC patients. Faced with aversive side-effects of radiotherapy, facilitating positive thinking in Chinese NPC patients may accelerate their short-term post-radiation adjustment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/13. Extranodal lymphoma originating from mucosa-associated lymphoid tissue of the nasopharynx.Non-Hodgkin's lymphoma originating from mucosa-associated lymphoid tissue has been connected with autoimmune disease. These tumours often arise in gastric mucosa and are extremely rare in airway mucosa. Three cases of mucosa-associated lymphoid tissue lymphoma in the cavum have been reported in the literature. A 52-year-old male with rheumatoid arthritis presented with an 8-month history of nasal obstruction and recurrent nasal blood discharge. On physical examination a bulky mass was observed in the nasopharynx. CT demonstrated a soft tissue lesion in the nasopharynx without bone destruction. MRI showed a contrast-enhanced mass with extension to the left pterygoid muscle. biopsy revealed a low-grade B-cell lymphoid tumour of the marginal zone. The patient received six cycles of cyclophosphamide, vincristine and prednisone with adriamycin treatment, together with intracranial methrotrexate as a prophylactic measure. After 48 months of follow-up there was no evidence of disease and a control MRI scan was normal. The prognosis of this type of tumour is unpredictable and there are too few cases to enable definitive conclusions to be drawn.- - - - - - - - - - ranking = 15.794198483952keywords = physical examination, physical (Clic here for more details about this article) |
5/13. Nasopharyngeal carcinoma with axillary node involvement as a component of failure following chemoradiotherapy.We describe the treatment course and imaging correlations in a patient with a unique case of undifferentiated nasopharyngeal carcinoma with axillary lymph node involvement as a component of failure following chemoradiotherapy. To our knowledge, this is the only such case reported in the literature. A preliminary diagnosis ofaxillary node involvement was based on both positron-emission tomography and computed tomography; these findings were subsequently confirmed by pathologic review following dissection of the node. This case represents a rare presentation of a recurrent nasopharyngeal carcinoma and illustrates the importance of a comprehensive physical examination and correlation with imaging modalities when following these patients over time.- - - - - - - - - - ranking = 15.794198483952keywords = physical examination, physical (Clic here for more details about this article) |
6/13. Pitfalls in the radiographic diagnosis of angiofibroma.Radiographic findings previously thought pathognomonic for juvenile nasopharyngeal angiofibroma are anterior bowing of the posterior wall of the maxillary antrum on plain films or tomography, and a dense homogeneous blush on angiography. Two patients presented with nasopharyngeal masses which mimicked angiofibroma radiographically: one mass was a lymphoepithelioma and the other was a fibrous tumor. Constitutional symptoms and atypical physical findings should alert the physician to a diagnosis other than juvenile nasopharyngeal angiofibroma.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/13. Juvenile nasopharyngeal angiofibroma.JNA is a highly vascular, benign, yet locally invasive tumor that occurs in preadolescent males. diagnosis is based on history, physical examination, and radiographic findings. CT scanning is invaluable for evaluating tumor extent. angiography combined with embolization aids surgeons in identifying the main feeding vessels and decreasing intraoperative blood loss. Surgery is the mainstay of therapy with radiation therapy reserved for inoperable masses. For highly aggressive, recurrent angiofibroma, chemotherapy has shown some promise.- - - - - - - - - - ranking = 15.794198483952keywords = physical examination, physical (Clic here for more details about this article) |
8/13. Nasopharyngeal carcinoma: clinical and radiographic findings in children.Nasopharyngeal carcinoma (NPC) in childhood occurs so infrequently that it is not suspected in affected children until the disease has been present for a long time and local spreading has occurred. The survival rates are therefore quite poor. Six children with NPC are described. A massive local lymph node spread simulating lymphoma was present in half of the patients; in the other half the disease was more subtle, presenting with epistaxis and CNS involvement. If an evaluation of the nasopharynx were part of the initial physical examination in children, the diagnosis of NPC would be made earlier and survival rates would improve.- - - - - - - - - - ranking = 15.794198483952keywords = physical examination, physical (Clic here for more details about this article) |
9/13. Elusive head and neck carcinomas beneath intact mucosa.This study presents 19 patients who had mucosally inapparent carcinomas of the upper aerodigestive tract demonstrated by computed tomography (CT). This group contains subpopulations that were identified both retrospectively and prospectively. During the same period 40 nasopharyngeal, 20 oropharyngeal-tongue base, and over 100 laryngeal and hypopharyngeal carcinomas were studied; all had clinically obvious mucosal components. Nine of our 19 patients had strictly submucosal tumors and a variety of clinical presentations; 5 patients had strictly submucosal recurrence of treated carcinomas and 5 had mucosal lesions which were not identified on examinations by more than one practicing head and neck surgeon. Sixteen of the 19 tumors were confirmed histologically; in 3 others confirmation was by a combination of CT and clinical course. CT can demonstrate the deep extent of aerodigestive tract carcinomas more accurately than physical examination and it can show mucosally inapparent disease. CT should be part of the staging work-up in nearly all upper aerodigestive tract carcinomas and in patients suspected of harboring an unknown primary within this region.- - - - - - - - - - ranking = 15.794198483952keywords = physical examination, physical (Clic here for more details about this article) |
10/13. cerebrospinal fluid rhinorrhea as a complication of malignant lymphoma.A 53-year-old woman with a three-year history of recurrent stage IV diffuse aggressive lymphoma involving the nasopharynx presented with fever, chills, and the sudden onset of drainage of clear, colorless fluid from the left nostril. This woman had no history of trauma or physical activity that might increase intracranial pressure. Subarachnoid instillation of 111indium resulted in the accumulation of radioactivity in a cotton stint placed in the left nares, documenting cerebrospinal fluid rhinorrhea. Computed tomography of the head revealed bony erosion of the cribriform plate by lymphoma. Defervescence occurred in the patient 48 hours after treatment with antibiotics was begun, and systemic chemotherapy directed against the lymphoma resulted in resolution of the cerebrospinal fluid rhinorrhea within a month without surgical intervention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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