• Korean Journal of Head & Neck Oncology
• /
• v.7 no.1
• /
• pp.40-44
• /
• 1991

Cystic metastasis in the neck from pharyngeal cancer has often been mistaken for either primary squamous cell carcinoma of branchiogenic origin or branchial cleft cyst. The distinctive histological and clinical features of cystic metastasis reviewed after its correct indentification can lead to the discovery of an unsuspected primary lesion and result in specific treatment options. Recendy, the authors experienced three cases of cystic metastasis in the neck from pharyngeal cancer ; one was from nasopharyngeal squamous cell carcinoma and the other two were from tonsillar squamous cell carcinomas. This report summarizes our experiences and review of the literatures.

• Korean Journal of Head & Neck Oncology
• /
• v.16 no.2
• /
• pp.172-176
• /
• 2000

Objectives: To improve local control and reduce toxicity, 3-D conformal radiotherapy was used as a boost the primary tumor site following fractionated radiotherapy in patients with nasopharyngeal carcinoma. Materials and Methods: Eight patients with previously untreated nasopharyngeal carcinomas were treated with 3-D conformal radiotherapy following fractionated radiotherapy from September 1998 to April 2000. All patients had biopsy confirmation of disease before radiation therapy. Stages were II in 1, III in 5, and IV in 2. Two patients received cisplatin based chemotherapy in addition to radiation therapy; induction chemotherapy in 1, concurrent chemoradiation in 1. 3-D conformal radiotherapy delivered using 6MV Linac as a boost(range 25.2-28.8Gy, median 25.7Gy) following conventionally fractionated radiotherapy(range 50.4Gy). Average total dose ranged from 75.6-79.2Gy(median 76Gy). Follow-up time was 4-21 months(median 9.6 months). Results: Seven of 8 patients were evaluated radiologically within 3 months after completion of radiation therapy. All 7 patients were seen complete remission. One of 7 patients had distant metastasis after 5 months and local failure after 7 months. The tree interval of local recurrence was ranged from 4 - 21 months(median 10.2 months). One patient without radiological evaluation got complete remission clinically. Treatment related toxicity was grade 1-3 xerostomia, dysphagia, and mucositis. During 3-D conformal radiotherapy, there was no aggravation of any toxicity. Conclusion: Although the number of patients was small and follow-up period was short, 3-D conformal radiotherapy following conventional radiotherapy improved tumor control and dose escalation without increased toxicity. Survival and late toxicity should be evaluated through long term follow-up. In addition, it is necessary to confirm the benefits of 3-D conformal radiotherapy in nasopharyngeal carcinoma with randomized trial.

• Korean Journal of Head & Neck Oncology
• /
• v.28 no.1
• /
• pp.3-7
• /
• 2012

Background and Objectives : Nasopharyngeal carcinoma(NPC) shows a distinct geographic and demographic distribution with high incidences in Chinese and Southeast Asians. Current WHO classification divides NPC into nonkeratinizing carcinoma(NKC)(differentiated and undifferentiated subtypes), keratinizing squamous cell carcinoma(KSCC), and basaloid squamous cell carcinoma(BSCC). Relative frequency of histologic subtypes of NPC is known to vary according to the incidence of NPC. Korea is one of the low-incidence countries according to the GLOBOCAN 2008 database by IARC. The aim of this study is to assess the histopathologic types and EBV status of NPC of Koreans. Materials and Methods : We reviewed and reclassified 168 cases of NPC(132 males and 36 females) diagnosed from January 1996 through July 2006. In situ hybridization for EBV-encoded early RNA(EBER) was performed on 146 cases and the results were compared among different histologic types, genders, and age and stage groups. Results : NKC, undifferentiated subtype(NKC-U) was identified in 106 cases(63.1%) and differentiated subtype(NKC-D) in 49 cases(29.2%). Remaining 13 cases(7.7%) were classified as KSCC. NKC and NKC-U were more common in females than in males. EBV prevalence was higher in NKC than in KSCC(NKC-U, 90% ;, NKC-D, 84.1% ; KSCC, 7.7%) and more common in younger age(${\leq}40$) than older age(>40) group. Conclusion : Histologic type distribution and EBV prevalence of NPC in Korean patients corresponded to that of intermediate incidence area. Pathogenesis of nasopharyngeal KSCC is assumed to be different from that of NKC.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.1
• /
• pp.245-252
• /
• 2014

Human METCAM/MUC18, a cell adhesion molecule (CAM) in the immunoglobulin-like gene super family, plays a dual role in the progression of several epithelium cancers; however, its role in the nasopharyngeal carcinoma (NPC) remains unclear. To initiate the study we determined human METCAM/MUC18 expression in tissue samples of normal nasopharynx (NP), NPCs, and metastatic lesions, and in two established NPC cell lines. Immunoblotting analysis was used for the determination in lysates of frozen tissues, and immunohistochemistry (IHC) for expression in formalin-fixed, paraffin-embedded tissue sections of 7 normal nasopharynx specimens, 94 NPC tissue specimens, and 3 metastatic lesions. Human METCAM/MUC18 was expressed in 100% of the normal NP, not expressed in 73% of NPC specimens (or expressed at very low levels in only about 27% of NPC specimens), and expressed again in all of the metastatic lesions. The level of human METCAM/MUC18 expression in NPC tissues was about one fifth of that in the normal NP and metastatic lesions. The low level of human METCAM/MUC18 expression in NPC specimens was confirmed by a weak signal of RT-PCR amplification of the mRNA. Low expression levels of human METCAM/MUC18 in NPC tissues were also reflected in the seven established NPC cell lines. These findings provided the first evidence that diminished expression of human METCAM/MUC18 is an indicator for the emergence of NPC, but increased expression then occurs with metastatic progression, suggesting that huMETCAM/MUC18, perhaps similar to TGF-${\beta}$, may be a tumor suppressor, but a metastasis promoter for NPC.

• Korean Journal of Head & Neck Oncology
• /
• v.16 no.1
• /
• pp.14-19
• /
• 2000

Objectives: Epstein-Barr virus(EBV) is a B-lymphotrophic virus with a tumorigenic potential. EBV infection has been recognized as the main cause of nasopharyngeal carcinoma and Burkitt's lymphoma. Bcl-2 protein expression is known to be up-regulated by the EBV-latency associated antigen latent membrane protein(LMP). The aim of this study was to determine the incidence of EBV in squamous cell carcinomas of the larynx and the relationship between the presence of EBV and bcl-2 expression. Patients and Methods: From January 1994 to December 1977, 35 patients with primary squamous cell carcinoma of the larynx were studied. EBV genome DNA was surveyed by polymerase chain reaction(PCR) assay and then compared the results of in situ hybridization(ISH) for EBER1 using digoxigenin-tailed oligonucleotide probe. The expression of bcl-2 protein was studied by immunohistochemistry(IHC) using bcl-2 monoclonal antibody. Results: By PCR, EBV genome was detected in 22 of 35(62.9%) squamous cell carcinomas of the larynx. Nineteen of 35 cases(54.3%) showed a positive nuclear staining for EBER1 in tumor cells by ISH. Three cases showed positivity in inflammatory cells by ISH and one of them showed a positive staining of both tumor cells and inflammatory cells. Eighteen of 32 specimens(62.5%) were positive for bcl-2 protein. There was no significant correlations between the presence of EBV DNA and bcl-2 expression. Conclusions: It could be concluded that high incidence of EBV in the laryngeal cancer tissue may indicate a probable role of EBV in the development of laryngeal carcinoma.

• Radiation Oncology Journal
• /
• v.8 no.2
• /
• pp.177-182
• /
• 1990

From 1984 to 1988, fourty two patients with nasopharyngeal cancer were treated at the Department of Radiation Oncology in Kyungpook National University Hospital. Thirteen patients refused treatment and the median survival time was 7.8 months. Twenty nine patients received a full course of radiation at least 70 Gy to the primary site and 60 Gy to the nodal sites. These patients were all belonged to stage III or IV, The local control rate was $75\% in squamous cell carcinomas, and all the patients with lymphoepithelioma showed a complete response. Overall locoregional failure was $27.6\%. Distant metastasis was the predominant pattern of failures; 4/6 in lymphoepithelioma, 4/10 En squamous cell carcinoma. The Three-year-survival rate for squamous cell carcinoma was $40.5\%$, and for lymphoepithelioma $25.9\%, respectively. This may be due to the more frequent distant metastases in lymphoepithelioma and ineffective chemotherapy. No survival correlation was found with the level of neck node involvement. Though adjuvant chemotherapy was found to be of no benefit in overall survival, more prudent and aggressive chemotherapy would be necessary.

• Radiation Oncology Journal
• /
• v.17 no.2
• /
• pp.91-99
• /
• 1999

Propose : This study was performed to find out the prognostic factors affecting local control, survival and disease free survival rate in nasopharyngeal carcinomas treated with chemotherapy and radiation therapy. Materials and Methods : We analysed 47 patients of nasopharyngeal carcinomas, histologically confirmed and treated at Chonnam University Hospital between July 1986 and June 1996, retrospectively. Range of patients' age were from 16 to 80 years (median; 52 years). Thirty three (70$\%$) patients was male. Histological types were composed of 3 (6$\%$) keratinizing, 30 (64$\%$) nonkeratinizing squamous cell carcinoma and 13 (28$\%$) undifferentiated carcinoma. Histoiogicai type was not known in 1 patient (2$\%$). We restaged according to the staging system of 1997 American Joint Committee on Cancer Forty seven patients were recorded as follows: 71: 11 (23$\%$), T2a; 6 (13$\%$), T2b; 9 (19$\%$), 73; 7 (15$\%$), 74: 14 (30$\%$), and NO; 7 (15$\%$), Nl: 14 (30$\%$), N2; 21 (45%), N3: 5 (10%). Clinical staging was grouped as follows: Stage 1; 2 (4$\%$), IIA: 2 (4$\%$), IIB; 10 (21$\%$), III; 14 (30$\%$), IVA; 14 (30$\%$) and IVB; 5 (11$\%$). Radiation therapy was done using 6 MV and 10 MV X- ray of linear accelerator. Electron beam was used for the Iymph nodes of posterior neck after 4500 cGy. The range of total radiation dose delivered to the primary tumor was from 6120 to 7920 cGy (median; 7020 cGy). Neoadjuvant chemotherapy was performed with cisplatin +5-fluorouracil (25 patients) or cisplatin+pepleomycin (17 patients) with one to three cycles. Five patients did not received chemotherapy. Local control rate, survival and disease free suwival rate were calculated by Kaplan-Meier method. Generalized Wilcoxon test was used to evaluate the difference of survival rates between groups. multivariate analysis using Cox proportional hazard model was done for finding prognostic factors. Results: Local control rate was 81$\%$ in 5 year. Five year survival rate was 60$\%$ (median survival; 100 months). We included age, sex, cranial nerve deflicit, histologic type, stage group, chemotherapy, elapsed days between chemotherapy and radiotherapy, total radiation dose, period of radiotherapy as potential prognostic factors in multivariate analysis. As a result, cranial none deficit (P=0.004) had statistical significance in local control rate. Stage group and total radiation dose were significant prognostic factors in survival (P=0.000, P=0.012), and in disease free survival rates (P=0.003, P=0.008), respectively. Common complications were xerostomia, tooth and ear problems. Hypothyroidism was developed in 2 patients. Conclusion : In our study, cranial none deficit was a significant prognostic factor in local control rate, and stage group and total radiation dose were significant factors in both survival and disease free survival of nasopharyngeal carcinoma. We have concluded that chemotherapy and radiotherapy used in our patients were effective without any serious complication.

• Radiation Oncology Journal
• /
• v.23 no.1
• /
• pp.9-16
• /
• 2005

Purpose : To prospectively evaluate the use of positron emission tomography with the glucose analog fluoro-deoxyglucose (FDG-PET) to deoxyglucose (FDG-PET) to predict disease-free survival (DFS) after concurrent chemo-radiotherapy (CCRT) in patients with non-disseminated nasopharyngeal carcinoma (NPC). Materials and Methods : We studied 41 patients with non-disseminated NPC scheduled to undergo platinum-based CCRT were eligible for this study. Patients were studied by FDG-PET prior to the CCRT. FDG uptake of tumors were measured with the maximal standardized uptake value (SUV). Results : Complete response rate was $100\%$. In ten patients who presented with any component of treatment failure, the median $SUV_{max}$ was 8.55 (range: $2.49\~14.81$) in any component of failure and the median $SUV_{max}$ was 5.48 (range: $2.31\~26.07$) In the remaining patients without any such failure. Patients having tumors with high FDG uptake had a significantly lower 3-year DFS ($51\%\;{\nu}91\%$, p=0.0070) compared with patients having low uptake tumors. Conclusion : FDG uptake, as measured by the SUV, has potential value in predicting DFS in NPC treated by CCRT, High FDG uptake may be a useful parameter for Identifying patients requiring more aggressive treatment approaches.