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A. Tfayli - Head and neck - Guidelines and clinical case presentation (2-3 cases)
1. Squamous cell carcinoma of the head and neck (SCCHN) General Features and Treatment Guidelines Arafat Tfayli, MD Associate Professor of Clinical Medicine American University of Beirut Medical Center [email_address]
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12. Lymph zones of the neck Level I: submental, submandibular Level II: upper jugular Level III: mid jugular Level IV: lower jugular Level V: posterior triangle (including spinal accessory or posterior cervical chain) Level VI: prelaryngeal (Delphian), pretracheal, paratracheal Other groups: sub-occipital retropharyngeal parapharyngeal buccinator (facial) preauricular periparotid intraparotid
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18. Figure 2. Human Papillomavirus (HPV) in Oropharyngeal Cancers. Recent studies confirm that oropharyngeal tumors are often HPV-positive and compose a distinct clinical and pathologic disease entity. In Panel A, a typical large tonsillar lesion (arrows) is shown. Panel B shows the typical basaloid appearance often seen in HPV-positive tumors. In Panel C, the same tissue section was subjected to in situ hybridization with an HPV-E7-specific probe. The dark brown spots indicate the presence of HPV DNA in virtually all the neoplastic cells. (Courtesy of Wayne M. Koch and William H. Westra.).
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29. Concurrent CRT Is Superior to Radiotherapy Alone in Both the Definitive and Adjuvant Setting Salama et al. JCO VOL 25 NUM 26 SEP 2007
39. Concurrent CRT Results in Superior Laryngeal Preservation Compared With Sequential CRT or RT Alone
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43. The VA Trial : Conclusion Induction chemotherapy and definitive radiation therapy are effective in preserving the larynx in a high percentage of patients, without compromising overall survival .
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47. Concurrent CRT Is Associated With Increased Toxicity compared With RT Alone
As you know concomitant chemoradiation has become the standard of care
Conclusion Severe late toxicity after CCRT is common. Older age, advanced T-stage, and larynx/hypopharynx primary site were strong independent risk factors. Neck dissection after CCRT was associated with an increased risk of these complications. These data suggest that the CCRT has reached the limits of acceptable long-term toxicity. Dose intensity can not be easily increased without some new and effective technique(s) of protection against late effects. In the future, these may include modern techniques in radiation therapy technology27,28 or biopharmacologic radioprotectors.29-31 Presently, however, these techniques have only succeeded in reducing xerostomia, not severe late dysphagia
(LOOK UP) But there is one thing we should never forget: Don’t focus on the disease - Focus on the human being !