Am J Otolaryngol 2008l;29:63-5 原文作者姓名： Mohammed Iqbal Syed, Louise J

(1)

口腔病理科 On-Line KMU Student Bulletin

- 1 -

原文題目(出處)： Unintended benefits of immunosupression on autoimmune disease due to chemoradiation therapy for head and neck cancer. Am J Otolaryngol 2008l;29:63-5

原文作者姓名： Mohammed Iqbal Syed, Louise J. Clark, Roger D. Sturrock,

通訊作者學校： Royal Alexandra Hospital, Greater Glasgow & Clyde Hospitals NHS Trust, Glasgow, UK

Southern General Hospital, Greater Glasgow & Clyde Hospitals NHS Trust, Glasgow, UK

University Department of Medicine, Glasgow Royal Infirmary University Trust, Glasgow, UK

報告者姓名(組別)：實習E組曹博竣報告日期： 2008/9/22

內文：

Abstract:

Immunosupression by radiation and chemotherapy ÆCause

1. systemic complications 2. Hematologic complications 3. Opportunistic infection 4. Development malignancy ÆBut also beneficial incidentally

¾ Case I:

Ætonsil ca. with severe R.A.

ÆTreat with chemo-radiation Æresulted in remission of its R.A.

¾ Case II:

Æp’t with severe atopic eczema on long-term with psoralen and ultraviolet A radiation (PUVA)and azathioprine;

Ædeveloped metastatic carcinoma of the lip Ætreated with surgery and radiation

Æresulted in complete remission of his eczema.

CASE I

1. found enlarge tonsil on left side of neck on routine exam 2. excision biopsy: poorly differentiated SCC

fine needle aspiration cytology(FNAC): metastatic ca.

direct laryngoscopy: normal result 3. 14-year of erosive rheumatoid arthritis

Æaffecting his cervical spine, shoulders, wrists, knees, ankles, and distal interphalangeal joints.

Æmorning stiffness of 3 to4 hours

Æmobilized with 2 sticks and could barely walk 50 yards.

4. Tx of rheumatoid arthritis Æ gold injections Æ sulfasalzine

Æ nonsteroidal anti-inflammatory drugs, Æ long-term methotrexate (7.5 mg weekly) Æ folic acid

5. Tx for SCC

Æ Radiotherapy(5500 cGy given as 26 fractions) Æ concomitant chemotherapy

Æ methotrexate and folic acid were discontinued during chemoradiotherapy 6. result of chemotherapy (carboplatin, 5-fluorouracil[5-FU], and folinic acid) of SCC

(2)

- 2 -

Æ walk 200 yards unaided, without discomfort (50 yard with 2 sticks ) Æmorning stiffness now only lasted from30 to 40 minutes (3 to 4 hours ) Æreduction of myalgia

7. follow up Æ3 years

Æno signs of local or regional recurrence Ærheumatoid arthritis is well controlled

CASE II

1. 45-year-old patient, referred from Dermatology,

Æwith a painless, nonhealing ulcerated lesion of the lower lip 2. With severe atopic eczema

Ætreat by dermatologist for 6 years

Æinvolving the face and neck and the upper trunk 3. Tx of atopic eczema

Æpsoralen and ultraviolet A radiation (PUVA) (total of 268 cycles varying from 2 to 4 J for the past 2 years)

Æazathioprine (100–150 mg, bid) for the past 5 years, Æresult :only a temporary limited response to the treatment

4. On examination, he had a 1 x 0.5 cm ulcerated lesion on his left lower lip (near the vermilion border)

Æ full-thickness wedge excision of that lesion Æ Histolopathology report: poorly differentiated SCC Æmeta to neck over left neck

5. Tx for meta SCC

Æ left radical neck dissection.

Æpost-op: radiation (4500 cGy) to the neckand mediastinum.

Æ treatment with azathioprine and PUVA was stopped during surgery and radiation 6. result of the radiation tx

Æ eczema has been quiescent

ÆThe eruptions on his face, neck, and chest had dried up 7. follow up

Æ by dermatology and otolaryngology for the past 4 years Æno signs of local or regional recurrence of tumor Æeczema has remained well controlled on local emollients

Discussion CASE I

1. Disease-modifying antirheumatic drugs Æmethotrexate and azathioprine 2. Bunch et al (2002)

Æp’t with metastatic colorectal cancer + rheumatoid arthritis Ætreated with with 5-FU and leucovorin

Æimprovement in the patients’ symptoms of R.A.

3. Jensen and Mejer (2003)

Æ71-year-old patient who had a 12-year history of severe R.A.

Ætreated in the past with Salazopyrin and methotrexate for R.A

Ætreated with 2 cycles of chemotherapy (carboplatin, 5-FU, and folinic acid) for metastatic colonic cancer

Æ resulted in remission of his R.A

Æ his arthritis was methotrexate-resistant and responded to 5-FU 4. methotrexate

Æinhibit DHFR Æ interferes with the cell cycle Æbut drug-resistant condition: DHFR increase

DHFR convert folate to tertrahydrofolate(essential in purine and thymidine synthesis) 5. 5-Fu inhibits thymidylate synthase and the formation of thymidine

Æwhen DHFR presence, N5,N10-methylenetetrahydorfolate can be synthesized Æ cause irreversible binding

Discussion CASE II

(3)

- 3 - 1. PUVA (Psoralen and ultraviolet A radiation)

Æ treat skin disorders(psoriasis and eczema)

ÆBut increase in the risk of cutaneous SCC in patients treated with PUVA(Both European and US studies have demonstrated)

2. azathioprine

Ætreat Atopic eczema widely in UK

Æcausing effective immunosupression by interfering with lymphocyte proliferation Æby disrupts the synthesis of DNA and RNA

Æassociated with the development of SCC 3. Radiation therapy (Grenz rays)

ÆTreated benign dermatoses in the past

Æcarcinogenic effect of radiation for benign disease

Æbut in case II intention was not to treat eczema, however it also resulted in the remission of eczema

題號題目

1 下列有關放射線對口腔影響的敘述何者為非 (A) 味蕾對放射線並不敏感

(B) 放射線治療可能會造成radiation caries

(C) Candidia albicans的感染是放射線治療常見的併發症 (D) 放射線治療可能會造成牙齒發育上的問題

答案 (A )

出處：Oral Radiology - Principles and Interpretation, 5th Edition, 2000 p.32~35

題號題目

2 下列何種組織對於放射線誘發的癌症(radiation-induced cancer)最為敏感 (A) Lung

(B) Liver (C) Skin

(D) Salivary glands 答案

(A )

出處：Oral Radiology - Principles and Interpretation, 5th Edition, 2000 p.40