Minimally invasive evaluation of head and neck squamous cell carcinoma

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Torchia, Mark G.
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Head and neck cancer represent about 7% of all malignancies in North America, the majority of these tumors being squamous cell carcinomas (SCC) which metastasize to local and regional lymph nodes. In Manitoba, they cause over 70 deaths each year. The goal of the present study was to investigate and develop novel minimally invasive techniques that could allow enhanced evaluation and treatment of patients with head and neck SCC. Human and animal experiments in this study included measurements of tumor microvascularization using dynamic contrast enhanced (DCE) and tumor oxygenation using blood oxygen level dependent (BOLD) and compared them to tumor histology. The detection and identification of sentinel lymph nodes was also investigated. VX-2 tumors in rabbits demonstrated applicability of the DCE and BOLD techniques to a model of SCC. VX-2 tumors showed reduced contrast uptake and decreased oxygenation during development of central necrosis. In patients with SCC, size distribution of microvasculature was shown to be related to tumor recurrence and survival. DCE functions were related to microvessel size distribution, tumor size, and nodal status while BOLD oxygenation studies correlated with tumor microvasculature. Positive nodal status was correlated with a widened oxygenation distribution in the tumors. An MRI based interstitial lymphangiography (MRII,) method using a USPIO contrast agent was developed and proved comparable to the isosulfan blue method. MRIL provides significantly improved anatomic information compared to current sentinel node techniques. Overall, these minimally invasive techniques showed significant promise for enhancing the treatment of patients with head and neck squamous cell carcinoma.* *This dissertation includes a CD that is multimedia (contains text and other applications that are not available in a printed format). The CD requires the following applications: Windows 95/98, Microsoft Office, Internet Access, Corel Draw, Photoshop, Microsoft Photo Editor, Paint.