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Physiotherapy in dysphagic patients with head and neck cancer
Volfová, Michaela ; Nejezchleba, Josef (advisor) ; Bitnar, Petr (referee)
Oropharyngeal dysphagia is a frequent complication of oncological treatment of head and neck cancers. It develops in up to half of these patients. Physiotherapy can greatly contribute to the treatment of dysphagia, reduce its severity and improve the quality of life. It certainly has a place in the rehabilitation of dysphagia. Early diagnostics of dysphagia is essential for the proper setting of the therapy. The interdisciplinary cooperation of the dysphagia team is also important. The thesis deals with the benefits of physiotherapy in the treatment of dysphagia. It explores the use of manual medicine, exercises on a neurophysiological basis and analytical exercises. It evaluates the effect using an endoscopy evaluated by a penetration-aspiration scale, a standardized questionnaire and physiotherapy examination. Physiotherapy enables to increase and maintain the range of movement of the mouth and cervical spine, release the hypertone of the superficial neck muscles, modify the muscle dysbalances of the mouth floor, strengthen the muscles of the tongue, mouth floor and deep throat flexors, restore the mobility of the hyoid gland, modify the posture of the head improved coordination of swallowing movements, ensuring adequate hyolaryngeal elevation and adequate muscle strength of the swallowing...
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Detection and characterization of macrophages in the tumors of viral and non-viral etiology
Dalewská, Natálie ; Tachezy, Ruth (advisor) ; Krulová, Magdaléna (referee)
Head and neck cancers are etiologically associated with smoking and alcohol consumption. Part of these tumors is induced by HPV and their incidence is increasing in the last decade. Patients with virally induced tumors have better prognosis even though they are usually diagnosed with tumors in advanced stage. One of the possible explanations may be better stimulation of the immune system by viral antigens. Macrophages are cells of the innate immune system which belong to professional phagocytes. They are called TAM upon infiltration to the tumor where they represent heterogeneous group of cells. Two main phenotypes are antitumor M1 and protumor M2 macrophages. TAMs are a major component of tumor microenvironment of many types of tumors, one of them are also head and neck cancers. In my thesis I focused on the immunohistochemical detection of M1 and M2 macrophages in the head and neck tumors of viral and non-viral etiology and at the same time RT-qPCR analyses of gene expression of macrophage-associated and/or immunosuppressive genes IDO1, ARG1, CD163, NOS2 a PTGS2 was performed. My data showed that HPV- negative tumors had higher number of M2 macrophages with typical markers CD163, ARG1 and PTGS2. It is known that patients with these tumors have worse prognosis of the disease. Due to high...
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Impact of pattern and functional properties of tumor-infiltrating immune cells for clinical outcome of head and neck cancer
Hladíková, Kamila ; Špíšek, Radek (advisor) ; Plzák, Jan (referee) ; Reiniš, Milan (referee)
Head and neck squamous cell carcinoma encompasses a complex and heterogeneous group of malignant diseases. Originally, this tumor type was associated with tobacco and alcohol consumption. However, a significantly expanding subset of tumors associated with oncogenic human papillomavirus infection arising in deep tonsillar crypts was identified within the last decades. Due to the essential role of the immune system in antiviral and anticancer immune response, the prognosis of patients is significantly influenced by the volume, composition and functional capacity of the immune infiltrate. The immunosuppressive landscape of head and neck cancer leads to unfavorable outcome of patients and decreased efficacy of immunotherapy. The response rate to standard treatment is high, however, standard therapy is accompanied by considerable toxicity influencing the quality of life. In 2016, the first immunotherapeutics for the treatment of patients with recurrent squamous cell carcinoma of the head and neck were approved - the anti-PD-1 immune checkpoint inhibitors nivolumab and pembrolizumab. This type of therapy, based on mitigation of immunosuppression, shows strong efficacy and less toxicity in combination with other therapies. Therefore, anti-PD-1 immunotherapy was recently approved in the first-line...
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Detection and characterization of macrophages in the tumors of viral and non-viral etiology
Dalewská, Natálie ; Tachezy, Ruth (advisor) ; Krulová, Magdaléna (referee)
Head and neck cancers are etiologically associated with smoking and alcohol consumption. Part of these tumors is induced by HPV and their incidence is increasing in the last decade. Patients with virally induced tumors have better prognosis even though they are usually diagnosed with tumors in advanced stage. One of the possible explanations may be better stimulation of the immune system by viral antigens. Macrophages are cells of the innate immune system which belong to professional phagocytes. They are called TAM upon infiltration to the tumor where they represent heterogeneous group of cells. Two main phenotypes are antitumor M1 and protumor M2 macrophages. TAMs are a major component of tumor microenvironment of many types of tumors, one of them are also head and neck cancers. In my thesis I focused on the immunohistochemical detection of M1 and M2 macrophages in the head and neck tumors of viral and non-viral etiology and at the same time RT-qPCR analyses of gene expression of macrophage-associated and/or immunosuppressive genes IDO1, ARG1, CD163, NOS2 a PTGS2 was performed. My data showed that HPV- negative tumors had higher number of M2 macrophages with typical markers CD163, ARG1 and PTGS2. It is known that patients with these tumors have worse prognosis of the disease. Due to high...
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Impact of pattern and functional properties of tumor-infiltrating immune cells for clinical outcome of head and neck cancer
Hladíková, Kamila ; Špíšek, Radek (advisor) ; Plzák, Jan (referee) ; Reiniš, Milan (referee)
Head and neck squamous cell carcinoma encompasses a complex and heterogeneous group of malignant diseases. Originally, this tumor type was associated with tobacco and alcohol consumption. However, a significantly expanding subset of tumors associated with oncogenic human papillomavirus infection arising in deep tonsillar crypts was identified within the last decades. Due to the essential role of the immune system in antiviral and anticancer immune response, the prognosis of patients is significantly influenced by the volume, composition and functional capacity of the immune infiltrate. The immunosuppressive landscape of head and neck cancer leads to unfavorable outcome of patients and decreased efficacy of immunotherapy. The response rate to standard treatment is high, however, standard therapy is accompanied by considerable toxicity influencing the quality of life. In 2016, the first immunotherapeutics for the treatment of patients with recurrent squamous cell carcinoma of the head and neck were approved - the anti-PD-1 immune checkpoint inhibitors nivolumab and pembrolizumab. This type of therapy, based on mitigation of immunosuppression, shows strong efficacy and less toxicity in combination with other therapies. Therefore, anti-PD-1 immunotherapy was recently approved in the first-line...
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Head and neck carcinom irradiation off axis dose assessment
FIALOVÁ, Eliška
In the introduction of my bachelor thesis I am reviewing the problematics of head and neck tumors. This types of tumors belong under otorhinolaryngology - we are speaking about the tumors in the oral cavity, larynx, farynx, nasal cavity, paranasal sinuses and also salivary glands. Symptoms of tumors vary depending on their localization. Patients tend to consider early stage tumor to be something else and so the tumor has a chance to grow a long time unrecognized. Most prominent etiological risk include smoking and alcohol consumption. Other risk include low hygiene, social exclusion, weed smoking or ionizing radiation - in general, all of these can induce tumor growth. Tumor diagnosis often comes late. When choosing the appropriate treatment, all prognosis factors must be accounted for, in particular the stage of tumor (marked by TNM classification), its locality, histological type and patient's age and health condition and his wishes. Patients' wishes must be respected. The chapter "Methods of treatment" briefly summarizes characteristics of each method. As of next, I am looking at the modern radiation techniques. These techniques seem to have better results compared to their predecessors. The aim of conformal radiation technique (3DCRT) is to adjust the shape of the radiated volume to the irregular shape of the tumour. IMRT technique does this and also modifies the intensity (fluence) of the radiation beam. That enables the IMRT to affect more complex target shapes while sparing the surrounding tissue to a degree. IGRT method uses imaging of the targeted volume and its critical structures before the treatment itself. The field work was carried out at the oncological ward of the hospital in České Budějovice. Course of the treatment went standardly at the linear particle accelerator with patients being fixed with the radiation mask and equipped with personal electric dosimeter. I compared my measurements with those of Mgr. Renáta Chylíková who worked with the previous type of the accelarator machine. Patients undergoing oncological treatment receive higher doses than are the limits but since it is for the medical purposes, the doses are not subjected to limitation. Aim of the work was to test the manufacturer's claim that the mimoos dosage on the newest accelerator should be 60% lower compared to the older type. By comparing the results I found out the claim seems to be true.
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Clinical aspects of human papillomavirus infection in diagnosis and treatment in patients with squamous cell carcinoma of the oral cavity and oropharynx
Košľabová, Eva ; Klozar, Jan (advisor) ; Pellant, Arnošt (referee) ; Zámečník, Josef (referee)
A studies carries for the last twenty years accumulated data that show two different etiology of head and neck squamous cell carcinoma. Tumors located in the oral cavity are often independent of the viral infection and is associated with tobacco and alcohol use. Approximately 26 % of all HNC and more than 50 % of tonsillar cancers are associated with the presence of high risk human papillomavirus (HR HPV). The purpose of this study was to determine whether changes in HPV DNA prevalence in oral rinses and/ or HPV - specific antibody levels in sera of patients with head and neck carcinoma (HNC) have prognostic significance. Patients with HNC were enrolled (N=142). The presence of HPV DNA was assayed in tumor tissue and oral rinses, and HPV-specific antibodies were assessed in sera. Sera were drawn one month and one year after the end of treatment. One year after treatment, oral rinses were collected. Altogether, 59.2 % tumors were HPV positive. Initially, the presence of HPV DNA in the tumors strongly correlated with HPV DNA positivity in oral rinses as well as with the presence of HPV- specific antibodies in sera. Out of 66 patients with HPV positive oral rinses at enrollment, 84.8 % became negative at one-year follow up. The mean titres of HPV 16 E6 and E7 antibodies at follow- up were lower in...
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