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Background. Dysphagia is a common and debilitating side effect in head and neck radiotherapy (RT). Prognostic factors are numerous and their interrelationship not well understood. The aim of this study was to establish a multivariate prognostic model for acute and late dysphagia after RT, based on information from a prospective trial. Material and methods. The DAHANCA 6&7 randomized study included 1476 patients with head and neck cancer eligible for primary RT alone. Patients were randomized between 5 and 6 weekly fractions of conventional RT, and received 62-70 Gy in 31-35 fractions. Patients were scored for dysphagia weekly during treatment and at regular intervals until five years after treatment. Dysphagia scores were available from 1461 patients. Results. Acute dysphagia according to DAHANCA grades 1, 2, 3 and 4 occurred in 83%, 71%, 43% and 23%, respectively. Severe dysphagia occurred in 47% and 38% of patients receiving accelerated or conventional radiotherapy, respectively (p = 0.001). At one, two, three, four and five years the prevalence of chronic dysphagia above grade 0, was 46%, 32%, 29%, 24%, 23%, respectively with no difference between 5 and 6 fractions. In multivariate analysis, the following parameters were independent factors for severe acute dysphagia: T3-T4 tumors, N-positive disease, non-glottic cancer, age> median, baseline dysphagia > 1 and accelerated radiotherapy. The following factors were prognostic factors for late dysphagia: non-glottic cancer, T3-T4, N-positive disease and baseline dysphagia > 1. The data confirmed previously published predictive models, as it was possible to separate patients in groups with low, medium and high risk of dysphagia, respectively, based on pre-treatment risk scores. Conclusion. Prognostic models were established to characterize patients at risk of developing acute or late dysphagia in the DAHANCA 6&7 trial. The results may be useful to identify patients at risk of dysphagia and thus candidates for prophylactic measures against swallowing dysfunction. [ABSTRACT FROM AUTHOR]

The ECOSYS model is used to estimate ingestion dose in the ARGOS and RODOS decision support systems for nuclear emergency management. It is recommended that nation-specific values for several parameters are used in the model. However, this is generally overlooked when the systems are used in practice. We have estimated first year ingestion doses in two scenarios with wet and dry deposition of 137Cs, using the ECOSYS model. We calculated doses for each country using national dietary data while keeping all other parameters at their default values. These dose calculations were then used to estimate the variation in ingestion doses resulting from the variation in the diets only. The dietary data demonstrated that the average consumption of milk, meat and vegetables varied by a factor of 2–4 among the Nordic countries. For both scenarios, the ingestion doses varied by a factor of about 2, among the countries. For all countries, the model predictions were most sensitive to changes in milk, beef and wheat consumption. The results demonstrate that recent and reliable dietary data are required to reliably estimate ingestion doses. [ABSTRACT FROM PUBLISHER]

Objectives: To demonstrate the efficacy of whole-body 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG PET) in the detection of a carcinoma of unknown primary after conventional diagnostic workup in patients with a metastatic neck lesion and to demonstrate how the treatment policy of wide-field irradiation can be safely modified in relation to the findings from PET scanning. Study Design: Prospective cohort study of consecutive patients. Methods: Forty-two consecutive patients with squamous cell or undifferentiated metastatic disease in the neck from a carcinoma of unknown primary were enrolled after standard clinical workups. These patients underwent extensive clinical investigations including endoscopy under anesthesia with multiple mucosal biopsies and diagnostic imaging as well. If no primary site was indicated at this stage, a whole-body 18F-FDG PET scan was performed. Results: Potential focal pathological uptake indicated a primary tumor in 20 of 42 cases (48%). After PET, this was confirmed by additional investigations in 10 patients (24%). Of these, seven primaries were found in the head and neck region (hypopharynx [three], base of tongue/vallecula [two], nasopharynx [1], floor of mouth [1]), and three primaries were found below the clavicles (lung [1], esophagus [1], and abdomen [1]. Positron emission tomography resulted in significant modifications of radiation treatment fields or fractionation prescriptions in all the patients who were diagnosed with a primary tumor after PET. Conclusion: With our present strategy of wide-field irradiation in patients with neck node metastases from a carcinoma of unknown primary, whole-body 18F-FDG PET had treatment-related implications in 24% (10 of 42) of the patients. [ABSTRACT FROM AUTHOR]

Clinical data from 218 patients consecutively treated for nasopharyngeal carcinoma at the Finsen Institute in Copenhagen during the period 1965 through 1985 have been analyzed for factors of prognostic importance. Of the 218 patients, 47 were Greenland Inuit eskimos and 169 were white Danish. The 5-year crude survival for the entire group of patients was 30%. The two groups of patients differed with respect to the importance of different prognostic factors. Keratinizing tumors were only present in the Danish population. These patients had a highly significant worse outcome than the rest of the Danish (P<0.00001). Age, stage, and T classification were important prognostic factors in the Danish population, but not in the Inuit population. [ABSTRACT FROM AUTHOR]

A retrospective study of factors of prognostic significance for clinical course and survival was performed using uni- and multivariate analyses in 251 patients with primary salivary gland carcinoma admitted during the period 1958-1992. Univariate analyses indicated that site of primary tumour, histology, clinical stage, presence of node metastases at primary diagnosis, and status of surgical margins were important prognostic factors for cause-specific survival, locoregional control and distant metastases. Multivariate analyses confirmed that histology was important for both locoregional control and cause-specific survival, whereas primary site was only of importance for locoregional control. Presence of node metastases at diagnosis was more important for locoregional control than clinical stage, whereas clinical stage was the most important factor for cause-specific survival. Status of surgical margins was of major importance for both cause-specific survival and locoregional control. Radiotherapy in addition to surgery improved locoregional control only, whereas survival was not affected. [ABSTRACT FROM AUTHOR]