INTRODUCTION
The Ear Nose and Throat Department of the Princess Alexandra
Hospital serves the community, not only on the south side of the Brisbane
River but also nationally and internationally. It is a recognised
Head and Neck Cancer Unit catering for patients from all over Queensland,
interstate and the Pacific Islands.
This
department has built its reputation on its ability to obtain good results
in patients with advanced head and neck cancer. It recently expanded
its clinical expertise in the development of skull base surgery through Dr
Ben Panizza, the development of the Voice Clinic
through Dr Scott Coman and its outreach into
Island and native communities through Dr Chris Perry.
Since the establishment of the Chair in
Otolaryngology, Head and Neck Surgery there has been an immense interest in
the research work being carried out with regards to the basic science of
head and neck cancer, chronic infection and nerve regeneration. At
the same time the clinic still sees over 4,223 outpatients and carries out
over 800 major surgical procedures each year (please see next page for
statistics and forecast).
STAFF
Professor
William B. Coman, Chairman ENT
Professor of
Otolaryngology, Head and Neck
Surgery
Visiting Medical Officers
Dr
Chris Perry, Visiting Medical Officer
Dr
Ben Panizza, Visiting Medical Officer
Dr
Scott Coman, Visiting Medical Officer
Dr
Bernard Whitfield, Senior ENT Consultant Surgeon
Registrars
Dr
Francis Vaz, Clinical Fellow
Dr
Simon Nasse, Senior Registrar
Dr
James Earnshaw, Registrar
Dr
David Chin, Plastics
Recent Visiting Overseas Medical Officers
Dr
Karin Annetz, Sweden
Research Officer (UQ)
Miss
Louise Edgeworth
Research
Secretary (PA/UQ)
Judy
Hawkins
CURRENT RESEARCH ACTIVITIES
THE ENT UNIT
Clinical
Service
Since the
establishment of the multi-disciplinary Head and Neck Clinic at the
Princess Alexandra Hospital in 1978, the main focus of the Department of
Otolaryngology, Head and Neck Surgery at this hospital has been in treating
patients who suffer with head and neck cancer.
This centre has
developed a national and international reputation for its
multi-disciplinary approach to the management of patients whose cancers
impact on their senses of smell, vision, hearing, taste and on vital
functions such as breathing, swallowing and speaking. This clinic now
sees over 300 new patients and many more continuing patients per year, who
are suffering with head and neck cancer.
Research
Last year a 10
year review was carried out with regards to parotidectomy surgery, which
has been accepted for publication in the Australian and New Zealand Journal
of Surgeons. A similar review was also carried out on total
glossectomy and this has been published in the March issue of the above
journal. Furthermore a review from 1977 to 2002 of pharyngolaryngectomys, using jejunal
conduits for reconstruction, has been
undertaken and the outcomes should be available for publication in the near
future.
Last year Dr
Boris Haxel carried out an objective at this
hospital with regards to the olfactory
function of patients suffering from head injury. Dr. Haxel is an ENT Resident from the University of Mainz
in Germany and the project was carried out in conjunction with Griffith
University, under the supervision of Professor Allan MacKay-Sim.
RESEARCH
ASSOCIATED WITH UQ
Molecular
Biology
Dr Nick
Saunders, who works in the Cancer Collaborative Group at this hospital, has
been working in conjunction with this department, using clinical material
from patients with head and neck cancer. He is studying the molecular
biology of head and neck cancer, in particular E2F, in the progression of
tumours. It is hoped that the outcome of this research may be a method
whereby the reversal of the cancer process may be achieved in tumours that
are susceptible.
Acoustic
Nerve Tumours
A study has started in
conjunction with Professor Jim Pickles which is looking at the gene arrays
of acoustic nerve tumours. One of our ENT research fellows, Dr Viv Shridar, is also
involved. It is hoped that the gene array will indicate which genes
are up-regulated and which genes are down-regulated so that a genetic
pattern for these tumours can be elucidated. Once this is known it may
be possible, using immuno-histochemistry, to halt
or cause tumour regression via the application of appropriate genetic
proteins.
A Clinical Prospective Randomised Control Study to
compare Laser Surgery with Radiotherapy for the treatment of T1, T2 Laryngeal
Cancer
This is a multi-national study
where patients enrolled in the study are treated with either laser surgery
or radiation. Several outcomes connected with vocal and swallowing
function, nutrition and quality of life are recorded at intervals of time
over two years. Survival outcomes will also be noted.
Furthermore, the costs of the clinical pathway for the two treatments will
be evaluated. At the present time there are several international
centres who are preparing to join the study. So far, over a one-year
period, we have accrued 20 consenting patients from our own Head and Neck
Clinic at the PAH. An enormous amount of work is required to prepare
and coordinate such a large clinical study. For example it took
almost a year to prepare the protocol and handbook,
copies of which are available for scrutiny.
COLLABORATION WITH QIMR
Nasopharyngeal
Cancer
This division
has collaborated with QIMR by providing important material regarding
tumours of the nasopharynx. This is a unique study regarding the
identification of the Epstein Barr virus in these tumours, with several
interesting outcomes. Firstly, it has lead to the possibility of the
development of an adoptive vaccine which may be useful in treating those
tumours which are recurrent following surgery or radiotherapy. At the
present time there are more than 12 patients enrolled in this study and a
test trial of a vaccine is currently being undertaken. Furthermore
these nasopharyngeal cancers have been studied by gene array analysis and
some very interesting protein markers have been discovered which may be
helpful in the future determination of prognosis and treatment. This study
is being undertaken at the QIMR in conjunction with Professor Dennis Moss,
Dr Joanne Davis, Dr Azgary, Dr Brent McMonagle, Dr David Chin Dr Michael Elliot (our
research masters student from last year) and Dr. Mark Smith (the Masters
student for this year).
Gene
Arrays in Head and Neck Cancer
This study is
being undertaken by Dr David Chin, Dr Glen Boyle and Professor Peter
Parsons of the QIMR. Tissue material from patients seen at the Head
and Neck Clinic in this hospital has been analysed using gene array
techniques. These techniques allow the discovery of those tumour proto-oncogenes
which are up-regulated and the identification of those tumour suppressor
genes which are down-regulated. Matched tissue taken from mucosa,
primary tumour and metastasis is being studied and an interesting genetic
pattern is emerging. Further work is being done to identify the
proteins by immuno-histochemical means and
hopefully this will lead to several conclusions. Firstly, it may lead
to the development of a serum or salivary test for tumours. Secondly,
it may be possible to use the gene array of tissue taken from a metastasis
to identify the primary site. Thirdly, it is hoped that eventually by
using either a virus or peptide, a genetic protein
reversal may be effected to halt tumour growth. These studies offer
great promise and the results so far are most encouraging.
COLLABORATION WITH GRIFFITH UNIVERSITY
Collaboration with Griffith University
is being undertaken in conjunction with Professor Allan MacKay-Sim and his
department.
Chronic
sinusitis
In a study of
chronic sinusitis with Dr Lennart Greiff and Dr Anders Cervin
of Lund University, Sweden, patients have had their tissue analysed, then
treated and followed up using the drug Klacid as
a therapeutic agent. Klacid acts on the
molecular cell biology to reduce the production of inflammatory
cytokines. In trials undertaken both in vitro and in vivo there has
been a 70% response to this treatment, after all other methods have failed,
for those patients regarded as having chronic sinusitis
Olfactory ensheathing cells and Spinal Cord Damage
Studies using Olfactory ensheathing
cells to penetrate glial scar in the spinal cord have been carried out on
the Wistar laboratory rat. After ethical
approval one such study has been carried out in a human paraplegic patient
at Princess Alexandra Hospital. This study is currently
ongoing.
Olfactory ensheathing cells and Nerve regeneration
Nerve
regeneration studies have been carried out by Dr Brent McMonagle,
where olfactory ensheathing material was used as
a healing promoter after resection of the sciatic nerve in the Wistar rat. The sciatic nerve regenerated in 70%
of those rats where olfactory ensheathing
material was used, compared to 0% in the controlled rats.
FUTURE RESEARCH
Current projects will be expanded,
updated and continued and we expect with anticipation some outstanding
results.
A new
project is being planned where muscle cells from the tongue will be used to
regenerate a vocal cord. This will first be carried out on a
laboratory animal, such as the rabbit. The research team will consist
of Dr Ann Tresize from the Department of
Anatomical Sciences at UQ, Dr Vivek Shridar, Dr Scott Coman and
Professor William B Coman. Dr Tresize has found that muscle stem cells in the tongue,
larynx and muscles of mastication rapidly repair and reconstruct damaged
muscle. It is hoped that this study will lead to the replacement of
resected laryngeal tumours with tongue muscle cells, the ultimate goal
being a new functioning vocal cord and larynx.
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