RESUMEN
This is a retrospective study of laryngeal preservation in endolaryngeal cancer with induction chemotherapy and radiotherapy for good responders. Between 1985 and 1995, 104 patients were treated in Institut Gustave Roussy (87 patients) and in Limoges (17 patients). The overall survival for the whole population was 76% and 69% at 3 and 5 years respectively, with a 36% rate of laryngeal preservation. In this retrospective series of patients, the single prognostic factor affecting survival was arytenoid mobility before treatment (66% and 55% at 3 years vs 85% and 82% at 5 years; p<0.004). Loco-regional failures were higher (33% vs 15%, p<0.03), and laryngeal preservation was lower (18% vs 51%) among patients with a fixed arytenoid (49 pts), compared with patients with a non fixed arytenoid (55 pts) ). The percentages of patients with a fixed arytenoid could explain the conflicting results of the two randomized studies of laryngeal preservation in laryngeal cancer.
Asunto(s)
Neoplasias Laríngeas/tratamiento farmacológico , Antibióticos Antineoplásicos/administración & dosificación , Antibióticos Antineoplásicos/uso terapéutico , Antimetabolitos Antineoplásicos/administración & dosificación , Antimetabolitos Antineoplásicos/uso terapéutico , Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cartílago Aritenoides , Bleomicina/administración & dosificación , Bleomicina/uso terapéutico , Cisplatino/administración & dosificación , Cisplatino/uso terapéutico , Terapia Combinada , Interpretación Estadística de Datos , Fluorouracilo/administración & dosificación , Fluorouracilo/uso terapéutico , Humanos , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirugía , Laringectomía , Leucovorina/administración & dosificación , Leucovorina/uso terapéutico , Metástasis Linfática , Metástasis de la Neoplasia , Pronóstico , Dosificación Radioterapéutica , Estudios Retrospectivos , Análisis de Supervivencia , Factores de TiempoRESUMEN
PATIENTS AND METHODS: Between 1974 and 1997, 297 patients underwent a subtotal laryngectomy at the Institut Gustave-Roussy; 146 of these patients underwent cricohyoidopexy (CHP) for a supraglottic primary as their first treatment. The majority of patients were men (137) aged from 33 to 78 years (median 54 years). The tumour stage at presentation was T1 in 2, T2 in 87, T3 in 53 (preepiglottic space involvement), and T4 (minimal thyroid cartilage invasion) in 4 patients. One hundred and twenty-five patients were N0 (86%) and 21 patients were Np (palpable); 98% had homolateral and 55% had bilateral neck dissections. RESULTS: One patient died postoperatively of a myocardial infarction and 68% patients had an uneventful course. Aspiration was the commonest complication (23 patients, 19%). The median time to removal of the tracheotomy cannula was 10 days and for the nasogastric tube 21 days during the past 10 years. Completion of subtotal laryngectomy into total laryngectomy was done in 21 cases (15%): eight times because of oncological events [five local failures, two second primary (hypopharynx), one positive margin] and 13 times because of aspiration (9%). There were six local failures (4%) and eight nodal failures (5%). The rates of distant metastases and second primaries were 6% and 16% respectively. Half of the local and nodal failures were subsequently sterilized. Findings at death were two local recurrences, four nodal recurrences, eight distant metastases, and 11 second primaries. The 3- and 5-year overall survival rates were 92% and 88% respectively, with an overall laryngeal preservation rate of 86%. CONCLUSION: When supraglottic laryngectomy is not feasible for supraglottic cancer, subtotal laryngectomy with CHP is a safe and effective oncological procedure, with preservation of satisfactory laryngeal function.
Asunto(s)
Cartílago Cricoides/cirugía , Glotis/cirugía , Hueso Hioides/cirugía , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/cirugía , Laringectomía , Adulto , Anciano , Cartílago Cricoides/patología , Femenino , Estudios de Seguimiento , Francia , Glotis/patología , Humanos , Hueso Hioides/patología , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tasa de Supervivencia , Factores de Tiempo , Insuficiencia del TratamientoRESUMEN
Forty patients were treated or followed up for aesthesioneuroblastoma between 1980 and 1995 at Institut Gustave Roussy, France. There were three T1, seven T2, 15 T3 and 15 T4 lesions. The cervical metastatic rate at presentation was 18 per cent. Distant metastases were detected by bone marrow biopsy and bone scan in three patients at presentation. Treatment modalities included surgery alone in eight patients, radiotherapy alone in three patients, combined modality surgery plus radiotherapy in 11 patients, chemotherapy alone in two patients, chemotherapy plus radiotherapy in 10 patients, and multimodality therapy chemotherapy plus surgery plus radiotherapy in six patients. The five-year survival rate was 51 per cent. Multimodality treatment offered better survival (63 per cent at five years) and disease-free interval (54 months). Overall local, regional, and distant failure rates were 58 per cent, 15 per cent and 40 per cent respectively. Distant metastases commonly occurred in bone (82 per cent). Cervical metastasis was an unfavourable prognostic indicator (0 per cent survival at two years). In conclusion, aesthesioneuroblastoma is sensitive to chemotherapy and radiotherapy. Multimodality therapy should be used initially.
Asunto(s)
Estesioneuroblastoma Olfatorio/radioterapia , Cavidad Nasal , Neoplasias Nasales/radioterapia , Adolescente , Adulto , Anciano , Niño , Preescolar , Terapia Combinada , Supervivencia sin Enfermedad , Estesioneuroblastoma Olfatorio/tratamiento farmacológico , Estesioneuroblastoma Olfatorio/cirugía , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Persona de Mediana Edad , Neoplasias Nasales/tratamiento farmacológico , Neoplasias Nasales/cirugía , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoAsunto(s)
Adhesivo de Tejido de Fibrina/administración & dosificación , Enfermedades de las Parótidas/cirugía , Glándula Parótida/cirugía , Neoplasias de la Parótida/cirugía , Adhesivos Tisulares , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Técnicas de Sutura , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
BACKGROUND: Proximal esophageal cancer is usually diagnosed at an advanced stage, and the treatment is often limited to palliation. Surgery offers the best relief of dysphagia but it remains controversial, because a cure is unlikely even at the price of laryngeal mutilation. PATIENTS AND METHODS: We treated 40 patients with transhiatal esophagectomy for cancer of the proximal esophagus. The esophageal substitute was a stomach tube in 37 patients and colon in 3 patients. The larynx was preserved in 27 patients whose tumors did not extend to cricopharyngeus. Adjuvant treatment consisted of postoperative radiotherapy for 22 patients, chemotherapy for 1 patient, and a multimodality regimen for 4 patients. RESULTS: The postoperative complication and hospital mortality rates with gastric tube transpositions were 22% and 8%, respectively, with a 3% fistula rate. The 1- and 3-year overall survival rate was 53% and 21%, respectively. The unfavorable prognostic factors were tumor wall penetration, lymph nodal involvement, and cricopharyngeal involvement. Local recurrence of cancer was the major cause of failure. CONCLUSIONS: These results indicate that transhiatal esophagectomy with gastric tube transposition offers good palliation of dysphagia with low morbidity and mortality for proximal esophageal cancer. The laryngeal preservation can be attempted for tumors located close to, but not involving, the cricopharyngeus in order to retain speech in patients with a limited life expectancy.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica/efectos adversos , Carcinoma de Células Escamosas/patología , Quimioterapia Adyuvante , Colon/trasplante , Terapia Combinada , Fístula Esofágica/etiología , Neoplasias Esofágicas/patología , Esofagectomía/efectos adversos , Femenino , Humanos , Laringe/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia , Cuidados Paliativos , Pronóstico , Radioterapia Adyuvante , Estómago/trasplanteRESUMEN
A case of a low grade chondrosarcoma of the cricoid cartilage which had been diagnosed initially as a chondroma is presented. The tumour recurred twice after limited surgical resections. Total laryngectomy was inevitable due to near total involvement of the cricoid cartilage and subsequent histological examination revealed a low grade chondrosarcoma. We have discussed in brief, the diagnosis and treatment of chondrosarcomas of the larynx and support the view of conservative surgical management for low grade tumours as they are slow growing and metastases are infrequent. A total laryngectomy may be reserved for salvage or primarily when more than half of the cricoid cartilage needs to be resected. Histological grading reveals the biological behaviour of the tumour and CT scans help in planning the surgery. A regular follow-up is necessary for early detection of recurrences and metastases.
Asunto(s)
Condrosarcoma/patología , Cartílago Cricoides , Neoplasias Laríngeas/patología , Recurrencia Local de Neoplasia/patología , Condrosarcoma/cirugía , Humanos , Neoplasias Laríngeas/cirugía , Laringectomía , Masculino , Persona de Mediana Edad , TiroidectomíaRESUMEN
A study of 20 cases of gastric tube transposition following total laryngopharyngoesophagectomy during an eight-year period is presented. The site of the tumour was: hypopharynx in 13 cases (12 pyriform sinus, 1 post-cricoid); and cervical oesophagus in seven cases. There were nine (45 per cent) Stage III lesions and 11 (55 per cent) Stage IV lesions (UICC, 1987). Post-operative morbidity rate was 15 per cent. Hospital mortality rate was 10 per cent (cause of death was myocardial infarction). Anastomotic fistula rate was five per cent. Excluding hospital mortality, the three year actuarial survival rate was 35 per cent for the whole series and 53 percent for patients with hypopharyngeal cancer. The actuarial survival rate for patients with oesophageal cancer at one and two years was 41 and zero per cent respectively. The transposition of a tubed stomach provided successful swallowing in two-thirds of the patients for a period of more than a year and these patients developed good neoesophageal speech.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Neoplasias Hipofaríngeas/cirugía , Estómago/trasplante , Adulto , Anciano , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Esofagectomía , Femenino , Humanos , Neoplasias Hipofaríngeas/mortalidad , Neoplasias Hipofaríngeas/patología , Laringectomía , Masculino , Persona de Mediana Edad , Faringectomía , Complicaciones PosoperatoriasRESUMEN
One hundred and four cases of osteoradionecrosis (ORN) of the mandible following irradiation of head and neck cancer are reported. Conservative management for ORN failed in all cases. Indications of hemimandibulectomy included intractable pain, severe trismus, pathological fracture, oro-cutaneous fistula and persistent exposure of bone. Surgical approach was intra-oral in 100 cases and extra-oral in four. Immediate soft tissue reconstructions were carried out in 20 per cent cases. Post-operative complications included minor sepsis (8.6 per cent), major sepsis (2.9 per cent), haemorrhage (2.9 per cent) and fistula (3.8 per cent). Major complications occurred only in patients treated exclusively by external irradiation at doses equal to or higher than 65 Gy. Relief from pain and trismus was obtained and normal swallowing was established following radical surgery.
Asunto(s)
Mandíbula/cirugía , Enfermedades Mandibulares/cirugía , Osteorradionecrosis/cirugía , Traumatismos por Radiación/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Enfermedades Mandibulares/etiología , Persona de Mediana Edad , Osteorradionecrosis/etiología , Complicaciones Posoperatorias/etiología , Colgajos QuirúrgicosRESUMEN
A clinicopathological study of 51 cases of adenoid cystic carcinoma in the head and neck region seen over a period of 20 years is presented. The correlation between various histological features and their impact on the results is attempted. Longterm results with respect to loco-regional recurrences, distant metastases and survival with various modalities of therapy are presented. Although this is a small series, radical surgery in keeping with the aim of avoiding undue mutilation, thus preserving the quality of life, followed by a full course of radiotherapy has been the mainstay of treatment and the results here presented justify this approach.