This document provides information on nasal cavity and paranasal sinus cancers. It discusses the anatomy, etiology, pathology, natural history, clinical presentation, diagnostic workup, treatment recommendations including surgery, radiotherapy, reconstruction and complications of treatment. The most common tumor is squamous cell carcinoma of the maxillary sinus in males. Treatment involves surgical resection with clear margins combined with postoperative radiotherapy to improve outcomes. Advanced techniques like endoscopy, craniofacial resection and reconstruction with flaps are used to maximize tumor removal while preserving function.
Carcinoma Larynx; Evidence based management
Staging - Surgery - Adjuvant therapy - Organ Preservation - Altered fractionation, chemotherapy - Radiotherapy (RT) techniques, Role of IMRT
This is a Central presentation, presented at National Institute of Cancer Research & Hospital(NICRH), Mohakhali, Dhaka, Bangladesh on Metastatic neck node of unknown primary.
Neoplasms of the nose and paranasal sinus /certified fixed orthodontic course...Indian dental academy
Dental Courses by Indian Dental Academy
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Carcinoma Larynx; Evidence based management
Staging - Surgery - Adjuvant therapy - Organ Preservation - Altered fractionation, chemotherapy - Radiotherapy (RT) techniques, Role of IMRT
This is a Central presentation, presented at National Institute of Cancer Research & Hospital(NICRH), Mohakhali, Dhaka, Bangladesh on Metastatic neck node of unknown primary.
Neoplasms of the nose and paranasal sinus /certified fixed orthodontic course...Indian dental academy
Dental Courses by Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
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The Magnitude of Benefit from Adding Taxanes to Anthracyclines in the Adjuvan...Osama Elzaafarany, MD.
This presentation aims at providing the oncologists with a well-organized, inclusive and updated evidence of the benefit of adding taxanes in the adjuvant settings of breast cancer. It will answer some questions like, what are the indications of adding taxanes for those patients, and which regimen is best to chose.
It is directed mainly to clinical Oncologists, Medical Oncologists, Oncology residents and medical students who are interested in breast cancere.
This simple and short PPT will review three international Guidelines; NCCN, ESMO and ASCO guidelines for emesis prevention when using I.V chemotherapeutic agents which are highly or moderately emetogenic.
It is a PPT presentation talks about the magnitude of benefit from Adding Trastuzumab to Adjuvant Chemotherapy in Breast Cancer. It will discuss briefly the most important clinical evidence in this setting. The aim of such work is to know how worthy is to give your patient Trastuzumab with her adjuvant chemotherapy in your clinical practice as a medical oncologist.
This PPT presentation talks about osteosarcoma from the clinical point of view, summarizing the recent guidelines in diagnosis and treatment of osteosarcoma.
Aim of this ppt presentation:
To understand the standard of care for both GBM and anaplastic glioma.
To know what is the new advances and modifications to the standard of care?
Contents:
Introduction: 2 slides.
GBM:
Epidemiology: 1 slide.
Molecular biology & New trends: 5 slides
EORTC/NCIC trial: 10 slides.
MGMT: 1 slide.
Evidence-based medicine: 6 slides.
Avastin in GBM: 2 slides.
Novocure (TTF): 2 slides.
Gliadel (BCNU) wafers: 1 slide.
Anaplastic astrocytoma: 7 slides
Take home message.
This a ppt presentation which gives an introduction to Rb diagnosis and treatment in a simple, concise way.
This presentation was prepared by me to be presented for doctoral degree students, pediatric coarse at the Department of Clinical Oncology & Nuclear Medicine, Alexandria University, Egypt.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. Incidence:
3% of aerodigestive malignancies
1% of all malignancies
Males : females = 2 : 1.
Sixth to seventh decades
The maxillary sinus is most commonly involved with
tumor, followed by the nasal cavity, the ethmoids, and
then the frontal and sphenoid sinuses.
7. Lymphatic Drainage
The anterior nose has the
same lymphatic drainage as
the external nose. These tend
to spread to the submental or
level I area.
The posterior nose tends to
drain to the retropharyngeal
nodes as well as the lateral
pharyngeal nodes, which
eventually drain into the level II.
8. Etiological Factors:
Exposure:
Wood, nickel-refining processes
Industrial fumes, leather tanning
Specific asssociations found include squamous cell
carcinoma in nickel workers and adenocarcinoma in
workers exposed to hardwood dusts and leather
tanning.
Cigarette and Alcohol consumption
No significant association has been shown
10. Natural History:
Squamous cell carcinoma:
Most common tumor (80%), Males, Sixth decade.
Location:
Maxillary sinus (70%)
• Nasal cavity (20%), lateral nasal wall is the most common site
88% present in advanced stages (T3/T4).
90% have eroded walls of sinuses.
Regional lymph node metastasis is about 10% to 20% of cases.
Local recurrence rate 30% to 40%.
•
11.
Adenocarcinoma:
2nd most common, 5-20%
Ethmoids.
Strong association with occupational exposures.
High grade subtype: 30% present with metastasis
12. Adenoid Cystic Carcinoma:
3rd most common (3-15%).
occurs most frequently in women, and in the fifth and sixth
decades.
Palate > major salivary glands > sinuses.
Neck metastasis is rare.
Multiple recurrences, distant mets.
Perineural spread
Resistant to tx.
Postoperative RTx is very important.
Long-term followup necessary
13. Olfactory Neuroblastoma
Esthesioneuroblastoma:
Originate from stem cells of neural crest origin that differentiate
into olfactory sensory cells.
Kadish staging system:
•
•
•
A: confined to nasal cavity
B: involving the paranasal cavity
C: extending beyond these limits
Aggressive behavior
Local failure: 50-75%
Metastatic disease develops in 20-30%
Treatment is en bloc surgical (craniofacial) resection with
postoperative RTx.
14. Sinonasal Undifferentiated Carcinoma:
• It is rare type, believed to arise from Schneiderian epithelium, the
•
•
•
•
•
•
•
•
Sionasal ectodermn.
Risk factors: Smoking and radiation.
The median age 6th decade, male predominance.
Aggressive locally destructive lesion.
Frequent orbital invasion and intracranial extension.
Greater tendency to metastasize than squamous carcinoma.
DD: melanoma, lymphoma, olfactory neuroblastoma,
rhabdomyosarcoma, neuroendocrine carcinoma, and poorly
differentiated squamous cell carcinoma.
Prognosis is usually poor, with a median survival of 18 months.
Overall survival is a bout 20% at 5 years.
Preoperative chemotherapy and radiation may offer improved
survival if combined with radical surgery.
18. Ohngren’s Line
a line that is drawn from
the angle of mandible to
the medial canthus.
Ohngren indicated that
tumors that presented
above this line
(suprastructure); both
superiorly and
posteriorly, tended to
have a worse prognosis
22. MRI
94% accuracy
Inflammatory tissue &
secretions: intense T2
Tumor: intermediate T1 & T2,
Enhancement with
Gadolinium
If there is a question of neural
involvement, MRI is excellent
for determining perineural
spread, involvement of the
dura, or involvement
intracranially.
25. Surgery:
• Surgical resection is the primary treatment modality for cancers
involving the maxillary or ethmoid sinuses.
• Resection is often limited by tumor involvement of the base of skull
which can result in damage to critical structures such as brain, and the
cranial nerves.
• In the past, contraindications to surgical resection included tumor
extension to the lateral skull base, intracranial contents, or cavernous
sinus. However, with advances in surgical technique and
reconstruction, the decision of more extensive surgery, such as a
craniofacial resection via craniotomy or transglabellar/subcranial
approach can be considered in ethmoid sinus tumors involving
cribriform plate for example.
27. Surgical procedures:
The goal of surgery for nasal cavity and paranasal sinus
tumors is to achieve en bloc resection of all involved
bone and soft tissue with clear margins while
maximizing the cosmetic and functional outcome.
Limited nasal cavity lesions may be resected with
medial maxillectomy.
Ethmoid lesions usually require medial maxillectomy
and en bloc ethmoidectomy.
combined craniofacial procedure for lesions involving
the inferior surface of the cribriform plate and the roof
of the ethmoid.
The bony defect in the anterior cranial floor is closed
with a vascularized pericranial or temporal muscle flap.
28.
maxillary antral cancers: radical maxillectomy that
removes en bloc the entire maxilla and ethmoid sinus.
Suprastructure lesions may involve the orbit,
necessitating orbital exenteration.
Resection of involved periosteum and frozen-section
control of adjacent orbital contents with preservation of
the eye may be possible in select lesions with
involvement of the periorbita without intraorbital
extension
Orbital preservation surgery in select patients with
involvement of the bony orbit but not soft tissue does
not appear to result in poorer survival or local control
than those undergoing exenteration.
30. Indications for orbital exenteration:
Involvement of the orbital apex
Involvement of the extraocular muscles
Involvement of the bulbar conjunctiva or sclera
Lid involvement beyond a reasonable hope for
reconstruction
Non-resectable full thickness invasion through the
periorbita into the retrobulbar fat
31. Reconstruction after surgery:
Surgery for sinonasal cancers
leaves major defects in the
skull and needs to be
reconstructed.
Advances in tissue transfer
techniques (particularly
microvascular free flaps)
provide reconstructive
options in addition to
maxillofacial prostheses.
32. Types (Stages) of obturator prostheses:
(I) Immediate (surgical) obturator prostheses:
•
•
•
•
initiated at the time of surgery
fabricated on a cast obtained from an impression made at the time of
the pretreatment dental examination.
fabricated using autopolymerizing acrylic resin (methyl methacrylate)
ligated into position following tumor resection but before flap closure.
(II) Transitional obturator prosthesis:
•
a minimum of 7 to 10 days after surgery.
(III) Definitive (permanent) obturator prosthesis:
•
begin once adequate healing has occurred, and radiation therapy is
completed (usually after three to four months).
33.
34.
35. Radiotherapy:
Addition of Rtx. to surgery improve 5-years survival (44%)
when compared to RTx. alone (23%) or surgery alone.
Indications:
•
•
Adjuvant (standard of care).
Definitive: medically inoperable or who refuse radical surgery
pre- and postoperative radiation may result in similar control
rates.
But post-operative RTx preffered:
•
•
Preoperative radiation increases the infection rate and the risk of postoperative
wound complications.
Preoperative radiation may obscure the initial extent of disease=surgery can not
remove the microscopic extensions of the tumor.
Postoperative radiation therapy is started 4 to 6 weeks after
surgery.
36. Indications of elective nodal irradiation:
Not routinely recommended in nasal cavity nor
ethmoid sinus tumors.
In maxillary tumors: include ipsilateral
submandibular and subdigasteric nodes in:
Squamous cell carc.
• Poor differ carc.
• T4 lesions.
ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
•
N.B. The neck is irradiated after neck dissection
for nodal involvement at presentation according
to the usual guidelines for postoperative neck
irradiation in other head & neck cancers.
37. Target & Dose for 3D-CRTx.
(I) Definitive RTx:
Recommend 3D-CRT or IMRT planning to
increase sparing of normal structures.
GTV = clinical and/or radiographic gross disease.
CTV1 = 1 cm margin on primary and/or nodal GTV= 66-70 Gy;
(1.8-2Gy/Fx.)
CTV2 = high-risk regions (depending on the presence or absence of
anatomic boundaries to microscopic spread)= 60-63 Gy.
CTV3 = elective neck= 54-57 Gy
38. (II) Post-operative RTx :
A typical target volume in a postoperative
setting encompasses: 60-66 Gy
• Both halves of the nasal cavity.
• Ipsilateral maxillary sinus.
• If the tumor extends superiorly into the ethmoid air cells:
Ethmoid sinuses and the ipsilateral medial orbital wall are
included
• bony orbit after orbital exenteration
39.
Field Margins:
a three-field technique for maxillary antrum: 1 anterior and 2 lateral fields.
Anterior field:
superior border: above the crista galli to encompass the ethmoids.
in the absence of orbital invasion, at the lower edge of the cornea to
cover the orbital floor.
inferior border: 1 cm below the floor of the sinus.
medial border: 1 to 2 cm (or more if necessary) across the midline to cover
contralateral ethmoidal extension.
lateral border: 1 cm beyond the apex of the sinus or falling off the skin.
Lateral fields:
superior border: follows the floor of the
anterior cranial fossa.
anterior border: behind the lateral bony
canthus parallel to the slope
of the face.
posterior border: covers the pterygoid plates.
40. Simulation films of wedged-pair setup for a limited lesion
involving the maxillary antrum only.
The treatment volume includes the ipsilateral maxillary
sinus and the nasal cavity.
A, Anterior portal. B, Lateral portal.
41. OAR & possible complications of RTx.
Lens <10 Gy (cataracts).
Lacrimal gland <30–40 Gy. (dry eye syndrome)
Retina <45 Gy (blindness).
incidence of visual loss with Rtx. 12-20% unilateral, 0-8% bilateral.
Optic chiasm and nerves <54 Gy at standard
fractionation. (Optic neuropathy)
Brain <60 Gy (necrosis).
Mandible <60 Gy (osteoradionecrosis).
Parotid mean dose <26 Gy (xerostomia).
Pituitary and hypothalamus mean dose <40 Gy.
42. Measures to protect the eye during treatment
planning for RTx.
Using advanced techniques; 3D-CRT, IMRT.
can provide bilateral sparing of the globe for most patients, it may be more difficult to
spare optic nerves, especially on the ipsilateral side,
Good fixation by immobilization devices.
Using nonaxial and noncoplanar fields.
The contralateral eye is blocked, and greater than two
thirds of the ipsilateral eye are also blocked unless there
is intraorbital infiltration.
With the four-field technique (with interorbital electron
portal) the eyes are blocked from the anterior and
lateral photon portals.
With the three-field technique, the anterior border of
the lateral portal is placed at the bony canthus and the
anterior portal is weighted more heavily (2 : 1 to 3 : 1).
43. Role of IMRT in sinonasal cancers
The dose delivered to the optic pathways can be
selectively reduced by IMRT, which has the potential to
preserve binocular vision, particularly for patients who
have extensive and large-volume disease in the
paranasal sinuses.
In a longitudinal analysis of 127 patients treated with
radiation therapy from 1960 to 2005 at the University
of California, San Francisco, the incidence of grade 3 or
greater late ocular toxicity among patients treated with
3D-CRT=9% and in IMRT=0%.
44.
IMRT isodose plans of a patient with locally advanced
paranasal sinus undergoing definitive radiotherapy.
A: At the level of the maxillary sinuses/parotid glands;
B: at the level of the floor of the orbit/brainstem;
C: at the level of ethmoid sinuses/mid-orbit.
The bilateral eyes are nicely spared (<45 Gy isodose
region) as are the brainstem (<45 Gy isodose region)
and the parotid glands (<30 Gy isodose region).
45. Other RTx. Modalities:
Stereotactic Radiosurgery: could be ued for a
boost for gross residual disease in patients who
have small residual tumor volume at the skull
base
Proton Beam Radiation: for deep-seated
locations requiring high doses of radiation, but
no high level evidence for its use.
46. Role of Brachytherapy
For small lesions of nasal vestibule.
using a192 Ir wire implant or intracavitary192 Ir mold.
The recommended doses for low-dose-rate brachytherapy
range from 60 to 65 Gy delivered during 5 to 7 days.
In patients with T1 or T2 a boost of 20 to 25 Gy (LDR)
over 2 days or 18 Gy (HDR; 3 Gy twice daily), following
EBRTx. after 50 Gy, if there is good reduction of tumor
volume.
This technique has been reported as yielding a
2-year local control of 86%.
47. Role of chemotherapy
Neoadjuvant chemotherapy is sometimes offered in
order to reduce tumor volume, which may permit
removal of tumor with a less morbid resection or
facilitate radiotherapy planning if shrinkage pulls away
tumor from critical structures.
chemotherapy may be given concurrent with
radiotherapy in the management of inoperable tumors
on the basis of improved results in more frequent head
and neck carcinomas.
48. Follow-up
H&P, labs, and CXR:
•
•
•
•
every 3 months for frst year,
every 4 months for second year,
every 6 months for third year,
then annually.
Imaging of the H&N:
3 months post-treatment, then as indicated.
49. Inverted papillomas
47% of Schneiderian papillomas which derived from schneiderian
mucosa (squamous) are inverting papillomas.
men, 6th-7th decades, unilateral.
lateral nasal wall.
Recurrence up to 80%.
malignant potential; associated with SCC in 2-13%.
Management:
• The gold standard was lateral rhinotomy with medial
maxillectomy.
• Role of RTx.
absolute indication for radiation therapy is when an inverted papilloma is
associated with squamous cell carcinoma.
those who had advanced incompletely resected or unresectable lesions that
are biologically aggressive.
patients where morbidity in resection would be more pronounced that
morbidity of tumor radiation.