RESUMEN
BACKGROUND: To assess the feasibility of maximizing negative margins with minimal resection of healthy tissue, as confirmed by intraoperative assessment. This approach aims to be safe, effective, and to be considered a standard procedure. MATERIAL AND METHODS: A prospective pilot study. Peritumoral ink marking aided in identifying margins. Transtumoral incisions were made along the central line until healthy tissue was visible. If positive or close margins were identified, an extension was performed only in the involved area. The tumor bed and outer part of the tumor were inked to determine margins for intraoperative assessment of the specimen. RESULTS: Twelve patients with oral squamous cell carcinoma participated in the study, comprising 3 men and 9 women, with a mean age of 58 years. Four patients were diagnosed with clinical stage I (T1N0), while eight were classified as stage II (T2 N0). All patients underwent ipsilateral neck dissection (levels I-III). Intraoperative outcomes included negative, positive, or close margins. The number of tissue blocks varied based on the size of the tongue tumor and the segments that required expansion to ensure a tumor-free margin (>1 mm), which was necessary in 8 patients. All final pathological reports indicated negative margins of >1 mm. CONCLUSIONS: Piecemeal resection emerges as a feasible and oncologically sound procedure for achieving margins >1mm, which are deemed safe. Precisely identifying positive areas within the tumor proves significantly safer than en bloc resections. The prognoses observed in this series depended more on regional disease factors than on specific characteristics of the primary tumor.
Asunto(s)
Carcinoma de Células Escamosas , Estudios de Factibilidad , Estadificación de Neoplasias , Neoplasias de la Lengua , Humanos , Proyectos Piloto , Masculino , Persona de Mediana Edad , Femenino , Estudios Prospectivos , Neoplasias de la Lengua/cirugía , Neoplasias de la Lengua/patología , Anciano , Carcinoma de Células Escamosas/cirugía , Adulto , Márgenes de Escisión , Procedimientos Quirúrgicos Orales/métodosRESUMEN
BACKGROUND: Cancer of the oral cavity combined with oropharyngeal cancer is the sixth leading cause of death for cancer worldwide. Surgery remains the standard treatment for this disease in early clinical and locally advanced stages. Numerous studies have shown that laser management is useful for premalignant lesions in the oral cavity; however, there is no conclusive evidence that its use is appropriate in cancer of the oral cavity and that results are comparable with traditional surgery. The objective of this study is to determine cancer control after wide local resection with CO2 laser for oral malignant neoplasms. MATERIAL AND METHODS: Retrospective study in patients with tumors of the oral cavity who were considered for surgical resection with CO2 laser from January 2006-December 2015. Demographic data, treatment modalities, histopathological diagnosis and clinical stage variables were obtained. All resections were done with the use of the microspot. Patients with cancer of the tongue were not included because a specific protocol for these patients does exist in our institution. RESULTS: There were twenty patients, 10 male and 10 female with a average age of 58 years (range: 20-92 years). Mean age was 53.5 years for females and 63 years for males. Twelve (60%) patients are alive and disease free and four (20%) were lost free of disease. CONCLUSIONS: CO2 laser is an acceptable surgical method for the management of small lesions in the oral cavity. We cannot rule out that small lesions of the oral cavity with positive neck could be managed in this manner, adding treatment to the neck, producing an adequate local regional control. However, this hypothesis requires additional studies.
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Láseres de Gas/uso terapéutico , Neoplasias de la Boca/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Orales/métodos , Estudios Retrospectivos , Adulto JovenAsunto(s)
Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/patología , Melanoma/mortalidad , Melanoma/patología , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Adulto , Anciano , Estudios Transversales , Supervivencia sin Enfermedad , Femenino , Neoplasias de Cabeza y Cuello/terapia , Humanos , Masculino , Melanoma/terapia , Persona de Mediana Edad , Membrana Mucosa , Estadificación de Neoplasias , Estudios Retrospectivos , Neoplasias Cutáneas/terapia , Tasa de Supervivencia , Melanoma Cutáneo MalignoAsunto(s)
Neoplasias Laríngeas/cirugía , Sarcoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/patología , Masculino , México , Persona de Mediana Edad , Sarcoma/mortalidad , Sarcoma/patología , Tasa de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Mucosal melanoma (MM) of head and neck (H&N) is a rare entity with a quite poor prognosis. Ballantyne's staging system has been commonly used since 1970. In the 7th edition of the AJCC Staging Manual a new chapter for the staging of TNM Classification system for mucosal melanoma (MM) of the head and neck (H&N) has been introduced to reflect the particularly aggressive biological behavior of this neoplasm. The aim of this study was to analyze and compare among Ballantyne's staging system vs TNM H&N in terms of overall survival (OS) and disease-free survival (DFS) in a consecutive population of patients with MM in a cancer centre. MATERIAL AND METHODS: Descriptive analysis of demographic, clinical and pathological variables of MM of the Head & Neck were performed. We compared the survival curves for both systems according to the Kaplan-Meier method using the Log-rank test. RESULTS: An up-staging migration effect from Ballantyne's localized disease to moderate-ly and very advanced disease according to AJCC staging system. The 5-year DFS and OS for Ballantyne's Localized Disease and AJCC Stage III were 31% and 36% vs. 47% and 50%, respectively. For locoregional disease the 5-year DFS / OS were 5% / 10% for Ballantyne's system vs. 13.8% / 17.8% and 0 / 0% for AJCC Stages IVA and IVB, respectively. CONCLUSIONS: In this series, the TNM staging system for MM of the H&N predicted the prognosis of the disease when comparing with Ballantyne's system.
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Neoplasias de Cabeza y Cuello/patología , Melanoma/patología , Estadificación de Neoplasias , Supervivencia sin Enfermedad , Humanos , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: This study was performed to define prognostic factors and management of minor salivary gland carcinoma of the oral cavity and oropharynx . METHODS: Retrospective analyses of patients with salivary gland carcinoma of the oral cavity or oropharynx, treated in 1989 to 2006. Statistics included univariate analyses to identify prognostic factors associated with disease-free survival (DFS) and disease-specific survival. A multivariate analysis model was constructed by the Cox method. RESULTS: Seventy-seven patients constituted our cohort. Significant prognostic factors regarding DFS and disease-specific survival in univariate analyses comprised tumor size, surgical margins, grade, lymph node status, and Karnofsky status and T classification. A multivariate model identified tumor size, grade, surgical margins, and lymph node status significant regarding DFS. CONCLUSIONS: Tumor size, grade, surgical margins, and lymph node status could be used for a rational design of treatment strategies in these rare tumors.
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Carcinoma/mortalidad , Neoplasias de la Boca/mortalidad , Neoplasias Orofaríngeas/mortalidad , Neoplasias de las Glándulas Salivales/mortalidad , Glándulas Salivales Menores/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/patología , Carcinoma/terapia , Supervivencia sin Enfermedad , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/patología , Neoplasias de la Boca/terapia , Análisis Multivariante , Clasificación del Tumor , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/terapia , Pronóstico , Radioterapia Adyuvante , Estudios Retrospectivos , Neoplasias de las Glándulas Salivales/patología , Neoplasias de las Glándulas Salivales/terapia , Glándulas Salivales Menores/cirugía , Adulto JovenRESUMEN
INTRODUCTION: Malignant sinonasal tumors are very rare in Mexico. They ussually present as advanced disease because it is extremely difficult to make an early diagnosis; in addition, its treatment is complicated by a variety of lesions. Surgical resection remains the mainstay of treatment, but its relative therapeutic value compared with alternative treatments is controversial. OBJECTIVE: We undertook a retrospective analysis in order to evaluate results of craniofacial resections for sinonasal tumors. MATERIALS AND METHODS: A total of 20 patients, 11 men and 9 women were considered, median age was 49 years (18-74). Eleven had received previous treatment elsewhere. In 13 patients tumor was limited to maxillo-ethmoid complex, but in 6 cases tumor involved anteroinferior aspect of sphenoid sinus, in 7 extended to the orbit, in 3 to dura and two to the brain. One had cervical metastases. Median tumoral size was 5.8 cm (1-10). RESULTS: Overall complication rate was 50%. Major surgical complications occurred in 4 patients (20%): one patient developed isolated cerebrospinal fluid leakage (CEFL), 1 developed deterioration of mental status, and two developed meningitis associated with CEFL. Late complications occurred in 30% of the patients. There was not any operative death. Eleven patients received postoperative radiotherapy. Fifteen patients recurred. There were 11 local relapses, although one associated with a regional relapse, and another with regional and distant relapse. There were four isolated regional fails and six isolated distant failures. Three year overall survival was 65%, and 3-year disease free survival was 50%. Patients without previous treatment median survival was 28.3 months, meanwhile with previous treatment was 18.2 months. CONCLUSIONS: Craniofacial resection is a safe and valuable tool in the treatment of advanced sinonasal tumors involving cranial base.
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Neoplasias Nasales/cirugía , Neoplasias de los Senos Paranasales/cirugía , Adolescente , Adulto , Anciano , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/cirugía , Terapia Combinada , Duramadre/cirugía , Senos Etmoidales/cirugía , Femenino , Humanos , Masculino , Neoplasias del Seno Maxilar/cirugía , Neoplasias Meníngeas/secundario , Neoplasias Meníngeas/cirugía , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia , Neoplasias Nasales/radioterapia , Neoplasias Orbitales/secundario , Neoplasias Orbitales/cirugía , Neoplasias de los Senos Paranasales/radioterapia , Radioterapia Adyuvante , Estudios Retrospectivos , Terapia Recuperativa , Seno Esfenoidal/cirugía , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Se presenta la frecuencia, características clínico-patológicas y evolución de los tumores odontogénicos malignos diagnosticados en tres servicios de patología de la Ciudad de México, de acuerdo a los criterios vigentes de la O.M.S. En total, se encontraron siete casos (5 en varones y 2 en mujeres), lo que representa menos del 4% de todos los tumores odontogénicos diagnosticados. Hubo seis carcinomas (dos ameloblastomas malignos, dos carcinomas odontogénicos de células claras, un carcinoma prima-rio intra-óseo y un carcinoma originado del revestimiento de quiste odontogénico) y un fibrosarcoma ameloblástico. El intervalo de edad fue de 25 a 72 años (media: 43.8). Los carcinomas odontogénicos de células claras se presentaron en la región canino premolar en maxilar y en mandíbula (un hombre y una mujer), mientras que el resto de lesiones se localizaron en la zona posterior de la mandíbula, con predominio por el sexo masculino (4:1), lo que concuerda con lo reportado en la literatura. El tratamiento en todos los carcinomas consistió en la resección quirúrgica, mientras que el fibrosarcoma fue tratado con quimioterapia debido a su gran extensión, sin respuestafavorable. El paciente con carcinoma primario intraóseo presentó metástasis submaxilar y cervical y la neoplasia fue causa de fallecimiento. A pesar de surareza, los tumores odontogénicos malignos constituyen una causa importante de intervenciones quirúrgicas extensas en la región maxilofacial.(AU)
Asunto(s)
Sarcoma , Tumores OdontogénicosRESUMEN
BACKGROUND: Concurrent chemoradiation is the current standard of treatment for patients with advanced unresectable head and neck squamous cell carcinoma (HNSCC). Due to the potent radiosensitizing properties of gemcitabine, we decided to assess its efficacy and toxicity with concurrent radiation in patients with advanced HNSCC. PATIENTS AND METHODS: From January 1997 to December 2001, 27 patients with locally advanced HNSCC (stage III, 37%; stage IV, 63%) were enrolled. All received a course of radiotherapy (70 Gy over 7 weeks) concurrent with weekly infusions of gemcitabine at 100 mg/m2 or 50 mg/m2. RESULTS: All patients were assessable for toxicity and 26 for response. Severe mucositis (grade 3-4) was observed in 74% of patients (grade 4, 41%). Severe hematological toxicity was uncommon. Mild and moderate xerostomy was the most common late toxicity in 23 patients (85%). The median radiation dose delivered was 70 Gy (40-80 Gy), 25 patients (93%) received > or = 80% of the intended dose. Gemcitabine dose intensity was > or = 80% in only 13 (48%) patients. The rate of complete and partial responses were 61% and 27%, respectively, for an overall response rate of 88%. At a median follow-up of 13 months (range 6-62), the actuarial 3-year progression-free survival (PFS) and overall survival (OS) were 37% and 33%, respectively. The only variable associated with prolonged survival (P = 0.0001) was the degree of response. No difference was observed in response or toxicity with either gemcitabine 50 or 100 mg/m2. CONCLUSIONS: The concurrent use of radiotherapy and gemcitabine is effective but produces manageable severe mucositis in a high percentage of patients.
Asunto(s)
Antimetabolitos Antineoplásicos/farmacología , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Desoxicitidina/análogos & derivados , Desoxicitidina/farmacología , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/radioterapia , Adulto , Anciano , Antimetabolitos Antineoplásicos/administración & dosificación , Terapia Combinada , Desoxicitidina/administración & dosificación , Desoxicitidina/efectos adversos , Supervivencia sin Enfermedad , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Traumatismos por Radiación , Ribonucleótido Reductasas/antagonistas & inhibidores , Resultado del Tratamiento , GemcitabinaRESUMEN
Se presenta la frecuencia, características clínico-patológicas y evolución de los tumores odontogénicos malignos diagnosticados en tres servicios de patología de la Ciudad de México, de acuerdo a los criterios vigentes de la O.M.S. En total, se encontraron siete casos (5 en varones y 2 en mujeres), lo que representa menos del 4 por ciento de todos los tumores odontogénicos diagnosticados. Hubo seis carcinomas (dos ameloblastomas malignos, dos carcinomas odontogénicos de células claras, un carcinoma primario intra-óseo y un carcinoma originado del revestimiento de quiste odontogénico) y un fibrosarcoma ameloblástico. El intervalo de edad fue de 25 a 72 años (media: 43.8). Los carcinomas odontogénicos de células claras se presentaron en la región caninopremolar en maxilar y en mandíbula (un hombre y una mujer), mientras que el resto de lesiones se localizaron en la zona posterior de la mandíbula, con predominio por el sexo masculino (4:1), lo que concuerda con lo reportado en la literatura. El tratamiento en todos los carcinomas consistió en la resección quirúrgica, mientras que el fibrosarcoma fue tratado con quimioterapia debido a su gran extensión, sin respuesta favorable. El paciente con carcinoma primario intraóseo presentó metástasis submaxilar y cervical y la neoplasia fue causa de fallecimiento. A pesar de su rareza, los tumores odontogénicos malignos constituyen una causa importante de intervenciones quirúrgicas extensas en la región maxilofacial. (AU)
Asunto(s)
Persona de Mediana Edad , Adulto , Anciano , Masculino , Femenino , Humanos , Quistes Odontogénicos , Tumores Odontogénicos , Estudios Prospectivos , Estudios Retrospectivos , Ameloblastoma , Adenocarcinoma de Células Claras , Neoplasias MandibularesRESUMEN
The objective of this paper was to evaluate the potential utility of supracricoid partial laryngectomies (SCPLS) for non-squamous cell carcinoma of the larynx. To illustrate our management of such tumours we present a case series based on six patients. Local control was achieved in five patients, with the sixth being salvaged by total laryngectomy and post-operative radiation therapy. Three of the six patients died of distant metastases. We concluded that supracricoid partial laryngectomies should become part of the armamentarium of the otolaryngologist - head and neck surgeon for non-squamous cell carcinoma of the larynx.
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Adenocarcinoma/cirugía , Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Adulto , Anciano , Resultado Fatal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Previous reports suggest that morbidity and mortality post acute myocardial infarction (AMI) are increased in patients with non-insulin-dependent diabetes (NIDDM). To obtain information in our population related to the prognosis after an AMI in diabetic patients and its major determinants, we studied 96 NIDDM patients admitted consecutively with a diagnosis of AMI. We used a control group (CG) of age and sex matched non-diabetic individuals. Patients with NIDDM had more frequently a history of angina (40 vs 23%, p < 0.001) and previous MI (30 vs 15%, p < 0.05). The AMI localization and extension, and the presence of arrhythmias were similar for both groups. Early mortality after the AMI was 22% in the NIDDM group and 12% in the CG with Odds ratio of 1.9 (CI 95% 0.91-5.15), being higher in diabetic females [2.3 (CI 95% 0.77-14.6) vs female CG and 1.5 (CI 95% 0.8-7.6) vs male NIDDM]. Extended MIs predicted higher mortality rate, especially among NIDDM patients (p < 0.05). Stepwise logistic regression test supported diabetes mellitus, per se, as a major contributor for mortality (p < 0.02), followed by MI localization and extension. The worst outcome was in NIDDM female patients of advanced age and hypertensive (p < 0.00001).