RESUMEN

BACKGROUND: Our previous phase-3 study (TTCC 2503) failed to show overall survival advantage of 2 induction chemotherapy (IC) regimens followed by standard concurrent chemoradiotherapy (CRT) over CRT alone in patients with unresectable locally advanced head and neck squamous-cell carcinoma (LAHNSCC). This study described the long-term survival of those patients. MATERIALS AND METHODS: Long-term follow-up study of patients with untreated LAHNSCC assigned to IC (three cycles), with either docetaxel, cisplatin and 5-fluorouracil (TPF arm) or cisplatin and 5-fluorouracil (PF arm), followed by CRT, or CRT alone, included in the previous TTCC 2503 trial. RESULTS: In the intention-to-treat population (n = 439), the median OS times were 25.4 (95% CI, 16.8-34.4), 26.2 (95% CI, 18.2-36.6) and 25.4 months (95% CI, 17.4-36.0) in the TPF-CRT, PF-CRT and CRT arms, respectively (log-rank p = 0.51). In the per-protocol population (n = 355), patients with larynx-hypopharynx primary tumors treated with IC (TPF or PF) followed by CRT had a longer median PFS than those who received CRT alone. Moreover, patients with ECOG 0 treated with IC (TPF or PF) followed by CRT had a better TTF than those with CRT alone. There were no statistically significant differences in terms of OS, PFS or TTF, according to the tumor load or affected nodes. CONCLUSION: After a long follow-up, the TTCC 2503 trial failed to show the benefit of IC-CRT in unresectable LAHNSCC regarding the primary end point. However, fit patients with ECOG 0 and primary larynx-hypopharyngeal tumors may benefit from the use of IC if administered by an experienced team. ClinicalTrials.gov identifier NCT00261703.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioradioterapia , Neoplasias de Cabeza y Cuello/mortalidad , Quimioterapia de Inducción , Carcinoma de Células Escamosas de Cabeza y Cuello/mortalidad , Cisplatino/uso terapéutico , Ensayos Clínicos Fase III como Asunto , Intervalos de Confianza , Docetaxel/uso terapéutico , Fluorouracilo/uso terapéutico , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Humanos , Neoplasias Hipofaríngeas/tratamiento farmacológico , Neoplasias Hipofaríngeas/mortalidad , Neoplasias Hipofaríngeas/patología , Neoplasias Hipofaríngeas/terapia , Análisis de Intención de Tratar , Neoplasias Laríngeas/tratamiento farmacológico , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/terapia , Neoplasias de la Boca/tratamiento farmacológico , Neoplasias de la Boca/mortalidad , Neoplasias de la Boca/patología , Neoplasias de la Boca/terapia , Supervivencia sin Progresión , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Carcinoma de Células Escamosas de Cabeza y Cuello/tratamiento farmacológico , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/terapia , Taxoides/uso terapéutico , Resultado del Tratamiento , Carga Tumoral

RESUMEN

PURPOSE: Basaloid squamous cell carcinoma (BSCC) of the head and neck is an aggressive and highly malignant variant of squamous cell carcinoma that accounts for 2% of head and neck cancers. Previous studies have not analyzed the significance of adjuvant chemoradiation and anatomical site within BSCC subtype and its impact on survival. METHODS: A cohort of 1999 patients with BSCC of the head and neck was formed from the National Cancer Database and analyzed with descriptive studies, median survival and 5- and 10-year survival. A multivariable Cox hazard regression was performed to determine the prognostic significance of anatomical site and adjuvant therapy. RESULTS: The most common primary anatomical site was the oropharynx (71.9%) followed by oral cavity (11.5%), larynx (10.1%), hypopharynx (3.5%), esophagus (1.9%), and nasopharynx (1.1%). The presence of metastasis increased the risk of mortality (HR = 2.14; 95% CI 1.40-3.26). Tumors localized to the oropharynx demonstrated better survival compared to all sites except nasopharynx, including the oral cavity (HR = 2.45; 95% CI 1.83-3.29), hypopharynx (HR = 2.58; 95% CI:1.64-4.05), and larynx (HR = 2.89; 95% CI:2.25-3.73). Adjuvant chemoradiation (HR = 0.36; 95% CI 0.23-0.58) and adjuvant radiation (HR = 0.38; 95% CI 0.23-0.64) had better survival outcomes compared to adjuvant chemotherapy. Patients with microscopic margins had better survival outcomes when compared to no surgery (HR = 0.38, 98% Cl 0.23-0.64) while there were no better survival outcomes of patients with macroscopic margins compared to no surgery. CONCLUSION: This study illustrated that tumors in the oropharynx, lower age, adjuvant chemoradiation and radiation, and microscopic margins were associated with greater survival.

Asunto(s)

Quimioradioterapia Adyuvante , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Quimioradioterapia Adyuvante/mortalidad , Niño , Preescolar , Bases de Datos Factuales , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/terapia , Femenino , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Neoplasias Hipofaríngeas/mortalidad , Neoplasias Hipofaríngeas/patología , Neoplasias Hipofaríngeas/terapia , Lactante , Recién Nacido , Estimación de Kaplan-Meier , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/terapia , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/mortalidad , Neoplasias de la Boca/patología , Neoplasias de la Boca/terapia , Neoplasias Nasofaríngeas/mortalidad , Neoplasias Nasofaríngeas/patología , Neoplasias Nasofaríngeas/terapia , Neoplasias Orofaríngeas/mortalidad , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/terapia , Pronóstico , Modelos de Riesgos Proporcionales , Radioterapia Adyuvante/mortalidad , Carcinoma de Células Escamosas de Cabeza y Cuello/mortalidad , Adulto Joven

RESUMEN

Radiation-induced pharyngoesophageal stenosis is a frequent and unwanted consequence of nonsurgical treatment of hypopharyngeal carcinomas. Current treatment mainly includes endoscopic dilatations, but a poor response to this modality and/or a severe stenosis may lead to a radical resection (pharyngolaryngectomy) and reconstruction with tubed flaps, which allow oral feeding but fail to preserve speech. In this report, we present a case of radiation-induced hypopharyngeal stenosis treated with a pharyngoesophageal bypass using an anterolateral thigh (ALT) flap with the intention of preserving the larynx. We describe the case of a 59-year-old male with severe pharyngoesophageal stenosis after chemoradiotherapy due to a squamous cell carcinoma, where conventional dilatation treatment failed to restore pharyngoesophageal passage of solids or liquids. Since the patient rejected a pharyngolaryngectomy due the loss of speech entailed, a pharyngoesophageal bypass was performed using an ALT flap. The flap measured 13 × 20 cm, which ensured a 4-cm-diameter tube and enough length to communicate the lateral pharyngeal wall with the cervical esophagus. Endoscopy did not reveal flap failure, and during the immediate postoperative period, the patient had a small cervical leak detected only by imaging that did not affect the skin and resolved with antibiotic treatment. The patient also required a tracheostomy on day 4 and initially had no passage of saliva through the bypass; we attributed this to edema that resolved spontaneously after 1 month with complete liquid and solid passage and laryngeal competence that led to tracheal decannulation. Good functional results were achieved both for speech and swallowing at 5-year follow-up. We believe that this procedure may be considered before performing a pharyngolaryngectomy for the treatment of a persistent benign stenosis in patients with a functional larynx.

Asunto(s)

Carcinoma de Células Escamosas/cirugía , Quimioradioterapia/efectos adversos , Esófago/cirugía , Hipofaringe/cirugía , Faringe/cirugía , Traumatismos por Radiación/cirugía , Colgajos Quirúrgicos , Constricción Patológica , Deglución/fisiología , Estudios de Seguimiento , Humanos , Neoplasias Hipofaríngeas/terapia , Hipofaringe/efectos de los fármacos , Hipofaringe/efectos de la radiación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Habla/fisiología

RESUMEN

Most cancers occur in developing countries, and therefore, a discussion about cancer care would be incomplete without providing a developing world perspective. This chapter focuses on challenges and practices relating to hypopharyngeal cancer in limited-resource public healthcare systems in developing countries and specifically in Sub-Saharan Africa, India and South America and by extension, most patients in the developing world. Management of hypopharyngeal cancer must be adapted to the availability of specialised diagnostic and therapeutic services, radiotherapy and surgical expertise, and tailored to patient factors such as reliability of follow-up and social support. A particular challenge for physicians is to decide who can be denied the opportunity to be cured when the burden of cancer cases exceeds available resources. Public education campaigns about reducing risk factors for hypopharyngeal cancer are an important aspect of reducing the burden of cancer.

Asunto(s)

Países en Desarrollo , Neoplasias Hipofaríngeas/terapia , África del Sur del Sahara/epidemiología , Asia/epidemiología , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/terapia , Humanos , Neoplasias Hipofaríngeas/epidemiología , Asignación de Recursos , América del Sur/epidemiología

RESUMEN

UNLABELLED: Despite the low incidence, diagnostic and therapeutic advances, hypopharyngeal cancer still has high mortality. OBJECTIVE: To evaluate retrospectively the epidemiological profile and response to surgery and radiation/chemotherapy of patients with hypopharyngeal cancer. METHOD: We reviewed the medical records of 114 patients treated between 2002 and 2009 in a tertiary hospital with histopathological diagnosis of squamous cell carcinoma. RESULTS: The mean age of the patients was 57 years, 94.7% were males and 5.3% females, 98.2% were smokers and 92% consumed alcohol; 72% are illiterate or did not complete first grade schooling. The main complaints were: neck node (28%), pain and dysphagia (22%), odynophagia (12.2%), dysphonia (7.8%). The clinical staging was: I (1.7%), II (3.5%), III (18.4%), IV (76.3%). The treatment was carried out with radiotherapy and chemotherapy alone in 35%, with mean 2-year survival of 20% and 5-year survival of 18%; surgery followed by radiotherapy and chemotherapy in 22.8% with 2-year survival of 60.0% and 5 years of 55.0%; chemotherapy alone in 2.6%, and 39.4% without treatment. CONCLUSION: Most patients already had advanced clinical stages and independent of the treatment option, had a low survival rate, confirming the poor prognosis of this neoplasm.

Asunto(s)

Carcinoma de Células Escamosas/terapia , Neoplasias Hipofaríngeas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Terapia Combinada/métodos , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Hipofaríngeas/mortalidad , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento

RESUMEN

Apesar da baixa incidência, avanços diagnóstico e terapêutico, o câncer de hipofaringe ainda possui elevada mortalidade. OBJETIVO: Avaliar retrospectivamente o perfil epidemiológico e a resposta bà cirurgia e rádio/quimioterapia de pacientes portadores de câncer de hipofaringe. MÉTODO: Foram analisados prontuários de 114 pacientes atendidos entre 2002 e 2009 em um hospital terciário com o diagnóstico histopatológico de carcinoma epidermoide. RESULTADOS: A idade média dos pacientes foi 57 anos; 94,7% eram do sexo masculino e 5,3%, do feminino; 98,2% eram tabagistas e 92% etilistas; 72% analfabetos ou com 1º grau incompleto. As queixas principais foram: nódulo cervical (28%), dor e disfagia (22%), odinofagia (12,2%), disfonia (7,8%). O estádio clínico foi: I (1,7%), II (3,5%), III (18,4%), IV (76,3%). O tratamento foi realizado com rádio e quimioterapia exclusivas em 35%, com sobrevida média em 2 anos de 20% e 5 anos de 18%, cirurgia seguida de rádio e quimioterapia em 22,8% com sobrevida em 2 anos de 60,0% e 5 anos 55,0%, quimioterapia exclusiva em 2,6%, e 39,4% sem tratamento. CONCLUSÃO: A maioria dos pacientes já apresentava estádios clínicos avançados e, independentemente da opção terapêutica, apresentam baixa sobrevida, confirmando mau prognóstico desta neoplasia.

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Despite the low incidence, diagnostic and therapeutic advances, hypopharyngeal cancer still has high mortality. OBJECTIVE: To evaluate retrospectively the epidemiological profile and response to surgery and radiation/chemotherapy of patients with hypopharyngeal cancer. METHOD: We reviewed the medical records of 114 patients treated between 2002 and 2009 in a tertiary hospital with histopathological diagnosis of squamous cell carcinoma. RESULTS: The mean age of the patients was 57 years, 94.7% were males and 5.3% females, 98.2% were smokers and 92% consumed alcohol; 72% are illiterate or did not complete first grade schooling. The main complaints were: neck node (28%), pain and dysphagia (22%), odynophagia (12.2%), dysphonia (7.8%). The clinical staging was: I (1.7%), II (3.5%), III (18.4%), IV (76.3%). The treatment was carried out with radiotherapy and chemotherapy alone in 35%, with mean 2-year survival of 20% and 5-year survival of 18%; surgery followed by radiotherapy and chemotherapy in 22.8% with 2-year survival of 60.0% and 5 years of 55.0%; chemotherapy alone in 2.6%, and 39.4% without treatment. CONCLUSION: Most patients already had advanced clinical stages and independent of the treatment option, had a low survival rate, confirming the poor prognosis of this neoplasm.

Asunto(s)

Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Carcinoma de Células Escamosas/terapia , Neoplasias Hipofaríngeas/terapia , Carcinoma de Células Escamosas/mortalidad , Terapia Combinada/métodos , Supervivencia sin Enfermedad , Neoplasias Hipofaríngeas/mortalidad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento

RESUMEN

OBJECTIVE/HYPOTHESIS: To evaluate and correlate voice-specific quality of life (QOL) and health-related QOL (HR-QOL) after treatment for advanced cancer of the larynx and/or hypopharynx. STUDY DESIGN: Cross-sectional study. METHODS: Patients submitted to partial laryngectomy (PL), salvage PL (sPL), concomitant radiotherapy and chemotherapy (RT+Chemo), total laryngectomy (TL), salvage TL (sTL), total pharyngolaryngectomy (TP) and salvage total pharyngolaryngectomy (sTP). The following questionnaires were used: (1) Voice Handicap Index (VHI) and (2) University of Washington Quality of Life Questionnaire (UW-QOL; version 4). RESULTS: Eighty-four patients participated in the study. All the patients PL (10), sPL (1), and RT+Chemo (24) communicated by laryngeal voice. Of the 49 patients submitted to total removal of the larynx, 30 communicated with alaryngeal phonation, the major part being tracheoesophageal prosthesis (17). The worst subscale of VHI for the total patient group was functional (mean=13.15), and the value of the total score was 31. Patients submitted to PL, RT+Chemo, and TL presented slight handicap (medians of 27, 14, and 21.5, respectively). Patients treated with sTL, TP, and sTP presented moderate handicap (medians of 45, 37.5, and 31.5, respectively). HR-QOL was considered between good and excellent for 78.6% of the patients, and poor for 21.4%. The correlation between voice-specific QOL and HR-QOL was significant (P=0.0001). CONCLUSION: Patients treated for advanced cancer of the larynx/hypopharynx present slight to moderate voice handicap and good/excellent HR-QOL. Stricter analysis of both the VHI and UW-QOL data suggests that more attention be given to the vocal handicap of the individual patient.

Asunto(s)

Carcinoma de Células Escamosas/terapia , Neoplasias Hipofaríngeas/terapia , Neoplasias Laríngeas/terapia , Complicaciones Posoperatorias/epidemiología , Trastornos de la Voz/epidemiología , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Encuestas y Cuestionarios

RESUMEN

OBJETIVO: Avaliar a sobrevida livre de doença nos tumores de hipofaringe submetidos ao tratamento operatório e à radioterapia pós-operatória. MÉTODOS: Estudo retrospectivo de 174 pacientes com distribuição, de acordo com o estádio clínico em: dois casos de estádio clínico I; quatro II; 46 III e 122 IV. Quanto ao gênero, 163 eram masculinos e 11 femininos, com idade média de 56 anos. Todos os casos foram submetidos à faringolaringectomia e realizados 206 esvaziamentos cervicais radicais e 16 seletivos. Cento seis pacientes foram submetidos à radioterapia pós-operatória, com dose média de 58,2 Gy. RESULTADOS: O exame histológico demonstrou dois casos de estádio clínico pT1, 15 pT2, 100 pT3 e 57 pT4. Quanto aos linfonodos, 25 pacientes apresentavam ausência de linfonodos comprometidos pela neoplasia (pN0) e 149 com linfonodos comprometidos pela neoplasia (pN+). A sobrevida livre de doença há cinco anos foi de 40% e a global de 28%. A sobrevida livre de doença há cinco anos foi de 75% no estádio clínico III versus 28% no IV, de acordo com o resultado do exame histológico. CONCLUSÃO: A manifestação inicial do carcinoma epidermóide de hipofaringe ocorre na fase avançada (estádios III e IV), com sobrevida livre de doença a cinco anos superior no estádio clínico III.

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OBJECTIVE: To evaluate the disease-free survival in hypopharyngeal tumors submitted to postoperative radiotherapy. METHODS: we retrospectively studied 174 patients with the following distribution: two cases of stage I, four stage II, 46 stage III and 122 stage IV. Regarding gender, 163 were male and 11 female; mean age was 56 years. All patients underwent pharyngolaryngectomy; neck dissections were radical in 206 and selective in 16. One hundred six patients underwent postoperative radiotherapy, with a mean dose of 58.2 Gy. RESULTS: Histological examination showed two cases of stage pT1, 15 stage pT2, 100 stage pT3 and 57 stage pT4. As for lymph nodes, 25 patients had no involvement (pN0); 149 presented with lymph node invasion (pN +). Five-year disease-free survival was 40% and the overall survival was 28%. According to the results of histological examination, five-year disease-free survival was 75% in clinical stage III versus 28% in IV. CONCLUSION: The initial manifestation of squamous cell carcinoma of the hypopharynx happens in advanced stages (III and IV), with superior five-year disease-free survival in clinical stage III.

Asunto(s)

Femenino , Humanos , Masculino , Persona de Mediana Edad , Carcinoma de Células Escamosas/terapia , Neoplasias Hipofaríngeas/terapia , Terapia Combinada , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Supervivencia sin Enfermedad , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Hipofaríngeas/cirugía , Estudios Retrospectivos

RESUMEN

OBJECTIVE: To evaluate the disease-free survival in hypopharyngeal tumors submitted to postoperative radiotherapy. METHODS: we retrospectively studied 174 patients with the following distribution: two cases of stage I, four stage II, 46 stage III and 122 stage IV. Regarding gender, 163 were male and 11 female; mean age was 56 years. All patients underwent pharyngolaryngectomy; neck dissections were radical in 206 and selective in 16. One hundred six patients underwent postoperative radiotherapy, with a mean dose of 58.2 Gy. RESULTS: Histological examination showed two cases of stage pT1, 15 stage pT2, 100 stage pT3 and 57 stage pT4. As for lymph nodes, 25 patients had no involvement (pN0); 149 presented with lymph node invasion (pN +). Five-year disease-free survival was 40% and the overall survival was 28%. According to the results of histological examination, five-year disease-free survival was 75% in clinical stage III versus 28% in IV. CONCLUSION: The initial manifestation of squamous cell carcinoma of the hypopharynx happens in advanced stages (III and IV), with superior five-year disease-free survival in clinical stage III.

Asunto(s)

Carcinoma de Células Escamosas/terapia , Neoplasias Hipofaríngeas/terapia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Terapia Combinada , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Hipofaríngeas/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos

RESUMEN

El carcinoma sarcomatoide es una rara neoplasia maligna de alto grado, la cual, ha sido motivo de controversias en su diagnóstico y su tratamiento. Se observa con frecuencia en el tracto aerodigestivo superior, aunque su localización en la hipofaringe es rara, habiéndose reportado pocos casos a nivel mundial. Se presenta una paciente femenina de 42 años sin historia de consumo de tabaco ni alcohol, quien presentaba disfagia, pérdida de peso, disfonía y masa cervical bilateral, mediante laringoscopia de fibra óptica se evidenció un extenso tumor de hipofaringe a nivel del seno piriforme izquierdo que invalida la laringe supraglótica. La histología del tumor reportó un carcinoma sarcomatoide. La paciente fue intervenida quirúrgicamente realizándose una laringofaringoesofagectomía con reconstrucción con ascenso gástrico más disección cervical radical bilateral, Presentó complicaciones pulmonares y abdominales, falleciendo a los 2 meses del posoperatorio. El carcinoma sarcomatoide es una rara y agresiva neoplasia cuyo pronóstico depende de su localización, tamaño y presencia de metástasis cervicales; aunque por lo general el pronóstico es malo independientemente del tratamiento recibido

Asunto(s)

Femenino , Adulto , Carcinoma , Neoplasias Hipofaríngeas/cirugía , Neoplasias Hipofaríngeas/diagnóstico , Neoplasias Hipofaríngeas/terapia , Neoplasias de Cabeza y Cuello , Venezuela , Oncología Médica

RESUMEN

BACKGROUND: The main goals of larynx preservation protocols are preservation of a functional larynx with intact voice and maintenance of normal deglutition. However, few studies have addressed functional outcomes. OBJECTIVES: To evaluate voice and swallowing in patients enrolled in a larynx preservation protocol. DESIGN AND SETTING: Acoustic analysis of 15 patients and videofluoroscopic evaluation of 14 patients who underwent chemoradiotherapy in an attempt to preserve the larynx. PATIENTS: Forty-three patients with larynx or hypopharynx squamous cell carcinomas were treated with weekly paclitaxel (30 mg/m2) and cisplatin (20 mg/m2) concurrent to radiotherapy (180-rad/d fraction [1.8 Gy] to 7040 rad [70.4 Gy]). Voice was analyzed perceptually and acoustically in 15 patients. Videofluoroscopic evaluation of swallowing was performed in 14 patients, focusing on oropharyngeal motility disorders, stasis, laryngeal penetration, aspiration, and dysphagia severity. RESULTS: Vocal analysis produced normal results in 1 patient, mild dysphonia in 4, moderate dysphonia in 6, and severe dysphonia in 4. The mean fundamental frequency for acoustic analysis was 131.4 Hz for men and 109.8 Hz for women. Acoustic measures of perturbation and noise were above the reference limits, indicating changes in the voice signal. Swallowing analysis showed inefficient bolus preparation in 13 patients and changes in the bolus propulsion in 12. Stasis was observed in all areas of the oropharynx. Five patients had reduction in laryngeal elevation, and 12 had stasis in the hypopharynx. Five patients presented with silent aspiration. We detected functional swallowing in 3 patients, mild dysphagia in 7, mild or moderate dysphagia in 2, and severe dysphagia in 2. CONCLUSIONS: Laryngeal preservation resulted in voice and swallowing abnormalities, but they tend to be mild to moderate, allowing intelligible communication and efficient swallowing in most patients.

Asunto(s)

Deglución , Neoplasias Hipofaríngeas/fisiopatología , Neoplasias Hipofaríngeas/terapia , Neoplasias Laríngeas/fisiopatología , Neoplasias Laríngeas/terapia , Voz , Adulto , Anciano , Antineoplásicos/uso terapéutico , Antineoplásicos Fitogénicos/uso terapéutico , Carcinoma de Células Escamosas , Cisplatino/uso terapéutico , Femenino , Humanos , Neoplasias Hipofaríngeas/tratamiento farmacológico , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Laríngeas/tratamiento farmacológico , Neoplasias Laríngeas/radioterapia , Masculino , Persona de Mediana Edad , Paclitaxel/uso terapéutico , Resultado del Tratamiento , Trastornos de la Voz/etiología

Asunto(s)

Humanos , Masculino , Femenino , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Neoplasias de la Boca , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Neoplasias Hipofaríngeas/diagnóstico , Neoplasias Hipofaríngeas/terapia , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/terapia , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/terapia , Neoplasias Orofaríngeas/diagnóstico , Neoplasias Orofaríngeas/terapia , Conductas Terapéuticas Homeopáticas

RESUMEN

Se presenta la influencia de la desmoplasia (DP) en ganglios linfáticos metastatizados de pacientes con cáncer de laringe e hipofaringe. El estudio fue realizado en 122 enfermos operados de carcinomas epidermoides metástasis histológicamente comprobadas, tratados entre los años 1984 y 1992. Los resultados se evaluaron en función de la supervivencia y la recidiva cervical. Las tasas de supervivencia a los 3 años fueron las siguientes: sujetos sin DP 73,8 por ciento, y con DP 36,6 por ciento (p<0,03). Igualmente, los porcentajes de pacientes libres de recidiva cervical a los 3 años de la intervención mostraron diferencias estadísticamente significativas: pacientes sin DP 72,7 por ciento, y con DP 39,6 por ciento (p<0,03)- De acuerdo con los resultados obtenidos, la DP es un factor pronóstico ganglionar desfavorable en los enfermos con cáncer de laringe

Asunto(s)

Neoplasias Hipofaríngeas/diagnóstico , Neoplasias Hipofaríngeas/terapia , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/terapia , Metástasis Linfática/diagnóstico

RESUMEN

BACKGROUND: The extracapsular spread of disease in modal metastasis of head and neck tumors is an important prognostic factor. However, the implications of the degree of capsular involvement are rarely mentioned. This is a prospective study which intends to investigate the role of transcapsular spread in metastatic lymph nodes on the outcome of patients with laryngeal or hypopharyngeal carcinoma. METHODS: This is a prospective study of 170 consecutive cases of previously untreated patients with squamous cell carcinoma of the larynx or the hypopharynx treated from January 1981 through January 1988 at the Head and Neck Service of the Heliópolis Hospital Complex, São Paulo, Brazil. In an attempt to understand better the influence of the extension of capsular lymph node involvement on recurrence and actuarial survival rates, the Kaplan-Meier method and Mantel-Cox test were used. RESULTS: The nodal cervical relapse was associated only to a macroscopic transcapsular spread (confidence interval, 1.7-7.0). When the carcinoma was confined to the lymph node or only a microscopic transcapsular spread was present, no statistically significant differences were found in recurrence or in death rates. The 5-year global and disease-free actuarial survival rates were, respectively, 52.0% and 56.8% for cases without metastasis and 5.8% and 10.2% when macroscopic transcapsular spread was present (p < .0001). The capsular rupture was the most important independent prognostic factor associated with the N categories of the TNM clinical classification and with metastatic lymph node diameter. CONCLUSIONS: The risks of recurrence and death are higher when there is macroscopic extracapsular extension. When the tumor is confined to the lymph node or shows a microscopic invasion beyond the capsule, there are no statistically significant differences in risk rates. The risk of capsular rupture is related to the N category of the classification TNM and the diameter of the metastatic lymph node, from 3 cm and larger.

Asunto(s)

Carcinoma de Células Escamosas/patología , Neoplasias Hipofaríngeas/patología , Neoplasias Laríngeas/patología , Recurrencia Local de Neoplasia/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/terapia , Intervalos de Confianza , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hipofaríngeas/mortalidad , Neoplasias Hipofaríngeas/terapia , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/terapia , Laringectomía , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/terapia , Estadificación de Neoplasias , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Medición de Riesgo , Rotura Espontánea , Tasa de Supervivencia

Asunto(s)

Neoplasias de Cabeza y Cuello/terapia , Escisión del Ganglio Linfático , Neoplasias Faríngeas/terapia , Neoplasias de Cabeza y Cuello/patología , Humanos , Neoplasias Hipofaríngeas/patología , Neoplasias Hipofaríngeas/terapia , Metástasis Linfática , Cuello , Neoplasias Faríngeas/patología , Pronóstico , Factores de Tiempo

RESUMEN

Säo analisados 56 casos de câncer de hipofaringe, do INCa., em um período de seis anos. Noventa e um por cento dos casos apresentaram antecedentes de tabagismo e 75 por cento de etilismo. Os estágios III e IV somados representaram quase 90 por cento dos casos e o seio piriforme foi o local mais frequentemente afetado. Vinte e sete por cento dos casos foram operados e receberam radioterapia complementar, e o restante recebeu radioterapia radical exclusiva. A sobrevida global atuarial foi de 22 por cento em 48 meses e a sobrevida livre de doença foi de 15 por cento no mesmo período. O grupo que foi operado e irradiado obteve melhor resposta e melhor controle que o grupo apenas irradiado. Conclui-se que, apesar dos maus resultados, a tentativa de somar benefícios da cirugia e da radioterapia ainda é a melhor política de tratamento para o câncer de hipofaringe. Dentro da discussäo, os autores discorrem brevemente sobre os prós e contras da radioterapia pré e pós-operatórias.

Asunto(s)

Humanos , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Hipofaríngeas/terapia

RESUMEN

O autor revisa os avanços no tratamento do carcinoma ado recesso piriforme nos últimos 20 anos. No que diz respeito a cirurgia, dois pontos principais säo assinalados: 1) hemilaringofaringectomia supraglótica para tumores da parede medial da porçäo membranácea do seio piriforme com mobilidade preservada de cordas vocais; 2) várias opçöes de reconstruçäo do trânsito faringoesofágico, entre elas a transposiçäo gástrica e os enxertos microcirúrgicos. Devido a alta freqüência de metástases linfonodais (80-87%), além do grande número de casos com ruptura capsular de linfonodos (mais de 50%), o esvaziamento cervical é obrigatório no tratamento destes casos. Em referência aos tumores externos que ultrapassam a linha média, deve ser considerado o tratamento do lado oposto do pescoço (esvaziamento cervical radical ou funcional). A radioterapia exclusiva só é atualmente indicada para tumores inoperáveis, tendo em vista o insucesso desta modalidade terapêutica. Radioterapia pré-operatória aumenta a freqüencia de complicaçöes cirúrgicas. Radioterapia pós-operatória melhora as taxas de controle loco-regional da doença. A quimioterapia neoadjuvante, incluindo cisplatina e 5FU, com ou sem bleomicina, melhorou o controle local de casos submetidos a faringectomias parciais com radioterapia pós-operatória (33 para 63%). Conclusöes definitivas com respeito ao real papel da quimioterapia requerem estudos prospectivos randomizados

Asunto(s)

Humanos , Carcinoma/terapia , Neoplasias Hipofaríngeas/terapia , Carcinoma/tratamiento farmacológico , Carcinoma/radioterapia , Carcinoma/cirugía , Neoplasias Hipofaríngeas/cirugía , Neoplasias Hipofaríngeas/tratamiento farmacológico , Neoplasias Hipofaríngeas/radioterapia

RESUMEN

El autor presenta la casuística de 22 casos de cáncer de hipofaringe tratados en los últimos 4 años, presentando un estudio detallado de los factores etiopatogénicos, presentación clínica, resultados del tratamiento, sus complicaciones y sus conclusiones

Asunto(s)

Humanos , Carcinoma de Células Escamosas , Neoplasias Hipofaríngeas , Carcinoma de Células Escamosas/etiología , Carcinoma de Células Escamosas/terapia , Neoplasias Hipofaríngeas/etiología , Neoplasias Hipofaríngeas/terapia , Pronóstico