Head & Neck最新文献

Background: The purpose of this study was to analyze the pattern of occult cervical lymph node metastasis among patients with clinically N0 salivary gland carcinoma.

Methods: One hundred nineteen patients underwent primary surgery and ipsilateral neck dissection for clinically N0 carcinomas of the major and minor salivary glands. Eighty patients (67%) had parotid tumors. Distribution of T classification was: T1 (18%), T2 (28%), T3 (23%), and T4 (32%).

Results: Twenty-five patients (21%) had pathological cervical disease. The incidence was highest among patients with adenocarcinoma (35%) and high-grade mucoepidermoid carcinoma (35%). The most common site of cervical lymph node metastasis was level II (71%), followed by level III (15%), and level IB (8%). On multivariate analysis, histological subtype was independently predictive of occult pathological lymph node metastasis (p < .001).

Conclusion: The likelihood of occult cervical lymph node metastasis for patients with salivary gland carcinoma is driven predominantly by histological subtype. Implications for elective neck irradiation are discussed.

Background: Stomal recurrence in patients after laryngectomy has a poor prognosis. Studies performed using sternal resection with pectoralis flap reconstruction report <25% 2-year survival. The purpose of this study was to ascertain whether the use of larger resection with free flap reconstruction improves survival.

Methods: Thirteen cases of stomal recurrence that underwent extended sternal resection and free flap reconstruction were identified and classified according to Sisson criteria. Postoperative morbidity, mortality, and survival were assessed.

Results: Median survival was 10 months in patients with Sisson types I and II, with 37.5% 1-year and 25% 2-year survival. Median survival was 6 months in patients with Sisson types III and IV, with 40% 1-year and 0% 2-year survival. There were 2 perioperative deaths and a major morbidity rate of 45%.

Conclusion: Salvage surgery using free flap reconstruction did not show improved survival rates compared with previously described techniques.

Background: Surgical removal of large cervicofacial venous malformations might be hampered by massive intraoperative bleeding. Moreover, these lesions often insinuate within normal surrounding tissue, making complete resection impossible without causing significant morbidity.

Methods: Two patients affected by facial venous malformations nonresponsive to sclerotherapy underwent surgery. Bleeding and critical branching of the facial nerve within the lesion prevented the surgeons from proceeding with the removal. The unresectable malformation was decompressed by means of a number of nonresorbable stitches from the surface of the lesion to the periosteum, tailoring a permanent pressure dressing.

Results: Outcomes at 12-month follow-up were stable, with good cosmetic results and satisfaction reported by both patients. No long-term side effects related to the procedure were observed.

Conclusion: Decompression of large venous malformations by means of a strangling technique might represent a safe and effective procedure for those cases where a removal cannot be accomplished.

Background: Various studies have assessed the prognostic value of epidermal growth factor receptor (EGFR) overexpression in nasopharyngeal carcinoma (NPC), but their results remain controversial.

Methods: Studies published up to January 2013 were collected. A total of 16 studies involving 1179 patients were reviewed. A meta-analysis was performed to clarify the prognostic role of EGFR in patients with NPC. The combined hazard ratio (HR) and 95% confidence interval (CI) were estimated using fixed-effects or random-effects models.

Results: EGFR overexpression had significantly poor effect on overall survival (OS; HR, 1.86; 95% CI, 1.25-2.77), disease-free survival (DFS; HR, 2.25; 95% CI, 1.66-3.04) and locoregional control (HR, 2.93; 95% CI, 1.71-5.02). However, the association between EGFR overexpression and distant metastasis-free survival was not statistically significant (HR, 1.39; 95% CI, 0.72-2.67).

Conclusion: EGFR overexpression can be a prognostic factor for patients with NPC.

Background: Literature is scarce on the palliative care experiences of patients with head and neck cancer. We report our experience in this patient population after the establishment of our Expert Center.

Methods: We administered a questionnaire to 40 surviving relatives of patients with head and neck cancer after the establishment of our Expert Center and compared the results to a similar group of patients with head and neck cancer before the establishment of our Expert Center.

Results: Since the establishment of our Expert Center, we found: an improved evaluation of the psychosocial support offered; better contact between head and neck surgeons, the patients, and families; and improvement in the quantity of information in the palliative phase. Some relatives, however, reported that patients received treatment against their wishes and life was not made as comfortable as possible.

Conclusion: Important aspects of palliative care, such as psychosocial support and contact between patient and surgeon, have been improved since the establishment of our Expert Center.

Background: Determining the level of nodal metastases may help decrease the extent of neck dissections and reduce morbidity.

Methods: A prospective study of neck dissections in patients with oral cancer was conducted. Each nodal level was delineated, sent for histopathology, and reported level-wise. Incidence of overall and isolated metastatic nodes at different levels was calculated. Logistic regression was used to find factors predicting metastases to levels IIB and V.

Results: Five hundred eighty-three neck dissections were prospectively evaluated. A total of 95.7% metastases occurred at levels I to IV. Overall incidence of metastases to levels IIB and V was 3.8% and 3.3%, respectively. Multivariate analysis revealed IIA positivity as an independent predictive factor for metastases to both IIB and V.

Conclusion: This study of lymph node mapping in patients with oral cancer showed a predictable pattern of lymph node metastasis according to primary site. Selective neck dissection (levels I-IV) in patients with oral cancers may be adequate. Determining status of level IIA is important to guide dissection of levels IIB and V.

Background: The purpose of this study was to review the survival and toxicity in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT) and concurrent nedaplatin plus paclitaxel or fluorouracil (NP or NF).

Methods: A total of 155 patients with locoregionally advanced NPC seen at our institution between January 2008 and December 2010 were retrospectively reviewed. Seventy-nine cases (51%) were treated with IMRT and concurrent NP chemotherapy, and 76 cases (49%) were treated with IMRT and concurrent NF regimen. Survival and toxicity were reported.

Results: The 3-year locoregional relapse-free survival, distant metastasis-free survival, progression-free survival (PFS), and overall survival (OS) rates were 90.3% and 87.8%, 79.7% and 81.1%, 77.3% and 71.1%, and 81.6% and 83.7% for the NF and NP group, respectively. The results were comparable to that of the cisplatin-based regimens. Acute and late toxicities were acceptable.

Conclusion: IMRT with concurrent nedaplatin-based chemotherapy achieved comparable survival with acceptable toxicity to those of the cisplatin-based regimens in the treatment of locoregionally advanced NPC.

Background: The purpose of this study was to investigate the prognostic impact of comorbidity and of demographic and pathological factors on oral tongue squamous cell carcinoma (SCC) survival, and to compare the prognostic performance of a new clinicopathological model against the routinely used TNM staging.

Methods: We conducted a retrospective study of demographic, clinical, and pathological information of 166 patients with oral tongue SCC. Cox regression was used for multivariate analysis, model building, and model discriminatory analysis.

Results: Comorbidity had the most significant impact on overall survival (OS; log-rank test, chi-square  =  36.34; p  <  .0001). Comorbidity, tumor dimension >2 cm, and presence of extracapsular spread (ECS) or vascular invasion were independent predictors of survival. A clinicopathological model based on these 4 variables (chi-square  =  60.23; p  <  .0001) was better (c-statistic  =  0.736) at predicting survival compared to pathological TNM staging (c-statistic = 0.645).

Conclusion: Comorbidity combined with tumor dimension, ECS, and vascular invasion provide a better prediction of oral tongue SCC survival than TNM staging alone.