Comprehensive evaluation of medullary thyroid carcinoma before surgery / 中华医学杂志(英文版)

BACKGROUND@#Medullary thyroid carcinoma (MTC) is a rare disease, but it exhibits more aggressive behaviors. The aim of this study was to improve the diagnostic accuracy of MTC before surgery by analyzing the clinical and ultrasonic data of patients with MTC.@*METHODS@#The study included 71 patients (96 lesions) with histopathologically proven MTC between April 2011 and September 2016 in the Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College. The clinical characteristics and sonographic findings were retrospectively reviewed and compared between the ultrasonic correct diagnosis group and the ultrasonic misdiagnosis group with the t test or Mann-Whitney U test for quantitative parameters and the χ test or Fisher exact test for qualitative parameters.@*RESULTS@#Compared with the ultrasonic correct diagnosis group, the proportion of the cystic change in the ultrasonic misdiagnosed group was high (25.0% vs. 4.2%), the uncircumscribed margin and irregular shape proportions were low (20.8%, 58.3% vs. 74.7%, 87.3%), calcification was relatively rare (20.8% vs. 56.3%), and rich vascularity was relatively rare (25.0% vs. 78.9%).@*CONCLUSIONS@#In the case of atypical MTC, such as cystic change, circumscribed margin, regular shape, no calcification, no rich vascularity, and normal cervical lymph nodes, MTC is easily misdiagnosed as benign by ultrasound. Therefore, ultrasound, cytology and serum calcitonin should be comprehensively evaluated for a preoperative diagnosis of MTC.

Familial Nonmedullary Thyroid Carcinoma: A Retrospective Analysis of 117 Families / 中华医学杂志(英文版)

<p><b>Background</b>The first and most important step in characterizing familial nonmedullary thyroid carcinoma (NMTC) is to distinguish the true familial patients, which is the prerequisite for all accurate analyses. This study aimed to investigate whether patients from families with ≥3 first-degree relatives affected with NMTC have different characteristics than patients from families with only two affected members, and to compare these patients with those with sporadic disease.</p><p><b>Methods:</b>We analyzed the clinicopathological features and prognosis of 209 familial and 1120 sporadic cases of NMTC. Familial patients were further divided into two subgroups: families with two affected members and families with ≥3 affected members.</p><p><b>Results:</b>The familial group had a significantly higher risk of bilateral growth, multifocality, extrathyroidal extension, and lateral lymph node metastasis than the sporadic group (P < 0.05). These main features were also different between the group with ≥3 affected members and the sporadic group. The only difference between the two affected members' group and the sporadic group was incidence of multifocality (P < 0.05). The probability of disease recurrence in patients from families with ≥3 affected members was significantly higher than that in sporadic cases (14.46% vs. 5.27%; P = 0.001), while the probability in patients from families with two affected members was similar to that in sporadic patients (6.35% vs. 5.27%; P = 0.610). The Kaplan-Meier survival analysis showed a statistically significant difference in disease-free survival between the two subgroups (85.54% vs. 93.65%; P = 0.045).</p><p><b>Conclusions:</b>Patients from families with ≥3 members affected by NMTC have more aggressive features and a worse prognosis than those from families with only two affected members. Patients from families with ≥3 affected first-degree relatives may be considered to have true familial NMTC.</p>

Minimally invasive endoscopy-assisted neck dissection to treat lateral cervical metastasis of thyroid papillary carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Traditional open surgery for lateral neck dissection for patients with papillary thyroid carcinoma (PTC) leaves an unsightly scar. It is necessary to apply small incision to complete lateral neck dissection with endoscopy-technique for PTC and to evaluate its feasibility and safety.</p><p><b>METHODS</b>Between March 2010 and May 2011, 6 cases of PTC with no definite lymph node metastasis at level II-IV and 12 cases of PTC at T1-T4 with definite lymph node metastasis at level II-V received minimally invasive endoscopy-assisted lateral neck dissection. After accomplishing thyroidectomy and central compartment dissection, ipsilateral level II-IV,VI orII-VI dissection via small neck incision was performed.</p><p><b>RESULTS</b>This procedure was carried out successfully in all 18 patients. The incision was 5 cm every patient. Postoperative pT1 was 5 cases, pT2 5 cases, pT3 6 cases, pT4 2 cases, pN0 5 cases, N1b 13 cases. Mean operative time for lateral neck dissection was 3.6 hours (ranging 2.5-5.0 hours). No significant blood loss or complications occurred. Thirteen patients showed lymph node metastases in both central or lateral neck. The mean number of harvested nodes was 33.1 (ranging 16-61). No residual or recurrent disease was found in 2-3 years follow-up time.</p><p><b>CONCLUSION</b>Minimally invasive video-assisted comprehensive neck dissection for metastatic papillary thyroid carcinoma is feasible and safe with excellent cosmetic results.</p>

Significance of selective neck dissection in patients with cN0 thyroid carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the significance of selective neck dissection in patients with cN0 thyroid carcinoma who have a high-risk of lateral neck lymph node metastasis.</p><p><b>METHODS</b>Sixty three patients with cN0 thyroid carcinoma who have a high-risk of lateral neck lymph node metastasis were prospectively studied at the Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between August 2006 and June 2011. The patients with cN0 thyroid carcinoma easy to occur neck lymph node metastasis include: The maximum diameter of primary tumor is ≥ 2 cm; The primary tumor invaded the thyroid capsule; Lymph node metastasis in level VI is found; Lymph node enlargement in level III or/and IV were detected preoperatively by ultrasonography, but not considered as metastasis. The surgical procedure is that the selective neck dissection in level III and IV is performed depending on the collar incision of thyroid surgery. The lymph node chosen from the specimen has a frozen section. If lymph node metastasis is found in the frozen section, a functional neck dissection should be performed through prolonging the collar incision.</p><p><b>RESULTS</b>All cases were pathologically confirmed as thyroid papillary carcinoma. The occult metastasis rate of lateral neck lymph nodes was 39.7%. According to the univariate analysis, the patients with thyroid capsule invasion and lymph node metastasis in level VI were more likely to have lateral neck lymph node metastasis, and the occult metastasis rate was 46.9% and 54.3%, respectively (P = 0.028, P = 0.008), and there were statistically no significant difference in the primary tumor size and the preoperative neck lymph node status by ultrasonography with occult metastasis of lateral neck lymph nodes (P = 0.803 and P = 0.072). According to the multivariate analysis, there was a significant correlation only between the lymph node metastasis in level VI and occult metastasis of lateral neck lymph nodes (P = 0.017), but there was no significant correlation with the thyroid capsule invasion, primary tumor size and neck lymph node status by preoperative ultrasonography in prediction of occult metastasis of lateral neck lymph nodes (all P > 0.05).</p><p><b>CONCLUSIONS</b>Selective neck dissection is feasible for the patients with cN0 thyroid carcinoma who have a high-risk lateral neck lymph node metastasis and the lateral occult metastatic lymph node can be promptly found and removed. We suggest that the selective neck dissection for level III and IV should be routinely performed in cN0 thyroid carcinoma patients with thyroid capsule invasion and lymph node metastasis in level VI.</p>

Effects of sorafenib and liposome doxorubicin on human poorly differentiated thyroid carcinoma xenografts in nude mice / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of sorafenib and liposome doxorubicin on poorly differentiated thyroid carcinoma (PDTC) xenografts in nude mice.</p><p><b>METHODS</b>Sorafenib and liposome doxorubicin were applied to PDTC xenografts in nude mice. The mice were randomized into seven groups: blank control (A), vehicle control (B), single liposome doxorubicin (C), single sorafenib group (D), liposome doxorubicin combined with low dose sorafenib group (E), combined group with medium dosage of sorafenib (F), combined group with high-dose of sorafenib(G). The volume, weight and growth inhibition rate of tumours were measured to evaluate the therapeutic effects of drugs.</p><p><b>RESULTS</b>Sorafenib and liposome doxorubicin showed significant antitumor activity in the PDTC xenografts. The mean tumor volumes of seven groups were (1274.13 ± 393.76) mm(3), (1060.00 ± 469.05) mm(3), (726.76 ± 488.22) mm(3), (451.54 ± 97.75) mm(3), (518.37 ± 164.44) mm(3), (310.51 ± 210.53) mm(3), and (228.44 ± 129.21) mm(3), respectively. The mean tumor weights of the seven groups were (1.13 ± 0.42)g, (0.91 ± 0.39)g, (0.78 ± 0.45)g, (0.55 ± 0.17) g, (0.52 ± 0.19) g, (0.34 ± 0.21) g, and (0.19 ± 0.09) g separately. The tumor inhibition rates of group C to G were 30.8%, 40.8%, 42.3%, 62.9%, 72.6% separately.</p><p><b>CONCLUSIONS</b>Sorafenib and liposome doxorubicin, no matter for single agent or in combination, showed significant antitumor activity in the PDTC PDTC xenografts in vivo. The tumour-inhibited effect of single sorafenib is better than that of single liposome doxorubicin. Liposome doxorubicin combined with medium dosage of sorafenib had a better therapeutic effect and less side effects.</p>

Surgical treatment and prognosis analysis on medullary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics, the surgical treatments and the prognostic factors of medullary thyroid carcinoma.</p><p><b>METHODS</b>Eighty-two cases of medullary thyroid carcinoma undergoing surgeries between January 1999 and December 2004 were reviewed. There were 39 males and 43 females. Age ranged from 16 to 77 years old, with a median of 46 years old. The calcitonin, chromogranin A and neuron-specific enolase were analysed by immunohistochemistry in samples, and calcitonin was detected in 24 cases. Of them, 28 cases underwent lobectomy with isthmectomy, 24 for remained lobe dissection, 16 for total thyroidectomy, and 14 only for neck and upper mediastinal lymph node dissection. Of the 82 cases, 68 cases underwent trachea esophageal ditch dissection, 53 for unilateral neck dissection, 11 for bilateral neck dissection, 13 for upper mediastinal lymph node dissection through trans-cervical approach, and 5 for mediastinal lymph node dissection through inverted T-shaped incision.</p><p><b>RESULTS</b>Immunohistochemical examination revealed that the expression rates of calcitonin, chromogranin A and neuron-specific enolase were 95.8%, 88.9% and 80.0% respectively. Total metastasis rate of neck lymph nodes was 68.8%, and the rates in level II, III, IV, V and VI were 27.3%, 47.7%, 59.1%, 11.4% and 52.3% respectively. The overall five-year survival rate was 87.8%. The recurrent rate of contralateral lobes was 5.8% and local recurrent rate was 7.3% respectively. Univariate analysis showed that gender, age and TNM stage were significant prognostic factors. Multivariate analysis revealed that distant metastasis was an independent prognostic factor.</p><p><b>CONCLUSIONS</b>Standard radical surgery of the primary and metastatic lesion is key to the treatment of medullary thyroid carcinoma. Lobectomy with isthmectomy should be applied to sporadic medullary thyroid carcinoma, with regular postoperative follow-up, and total thyroidectomy to familial or bilateral medullary thyroid carcinoma. Therefore, detecting the calcitonin is very important for medullary thyroid carcinoma patients' prognosis.</p>

Functional reconstruction after total or near total glossectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the functional outcomes of patients who underwent total or near total glossectomy with pectoralis major myocutaneous flap (PMMF) or free flap (FF) reconstruction.</p><p><b>METHODS</b>Retrospective study of 38 consecutive patients undergoing total or near total glossectomy with PMMF or FF reconstruction. The outcomes of decannulation, feeding and speech function recovery were compared.</p><p><b>RESULTS</b>Near total glossectomy was performed in 33 patients and total glossectomy was performed in 5 patients. Twenty five patients underwent reconstruction with PMMF including 2 salvage reconstructions after free flaps failure. All PMMFs survived except one complete necrosis. The success rate of PMMF was 96.0% (24/25). Fifteen patients underwent reconstruction with FF. Two flaps developed complete necrosis and the success rate of FF was 86.7% (13/15). The difference in the rates between the two groups was not significant (P=0.545). In the PMMF and FF groups, the renewal of oral feeding were 65.2% (15/23) and 100% (13/13), P<0.05, and the tracheostomy decannulation were 52.2% (12/23) and 100% (12/12), P<0.05, respectively. Postoperative feeding function recovery was better in FF group than that in PMMF group (P=0.011). Single factor analysis showed that using FF and maintaining the continuity of the mandible were related to successful rate of renewal of oral feeding. Multivariate Logistic regression analysis showed that the continuity of the mandible was the only independent predictor for renewal of oral feeding. There was no significant difference in the postoperative speech functions between the two groups.</p><p><b>CONCLUSIONS</b>The continuity of the mandible is the major factor to restore the functional outcomes in feeding after total or near total glossectomy. Compared with PMMF, using FF is more beneficial to retain or rebuild the continuity of the mandible.</p>

Cervical lymph node metastasis in clinical N0 papillary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the patterns of cervical lymph nodes metastasis and the surgical managements of cervical lymph nodes in clinical N0 (cN0) papillary thyroid carcinoma.</p><p><b>METHODS</b>Fifty-one consecutive patients with papillary carcinomas without clinical evidence of cervical lymph node involvement were included in the study between August 2007 and September 2010, in which 53 sides underwent neck lymph node dissection. Preoperative lymphoscintigraphy intra-operative hand-held gamma probe detecting and blue dye technique were used to detect the sentinel lymph node (SLN). SLNs were sent to frozen-section and the results were compared with specimen of routine selective neck dissection. All the pathologic specimens were reviewed by pathologists, counting the numbers of pathologic positive nodes and mapping the localization of positive nodes in level II, III, IV, V and VI respectively. The following criteria were used to study the predictive value of lateral neck compartment lymph node metastasis: age, multifocality of the tumor, extracapsular spread (ECS), tumor size, and the number of central compartment metastasis nodes. Univariate analysis with the χ2 test was used to analyze the statistical correlation between lateral neck compartment lymph node metastasis and the other clinical factors. Multiple logistic regression analysis was used to identify the multivariate correlates of lateral neck compartment metastasis.</p><p><b>RESULTS</b>The occult lymph node metastasis and lateral neck metastasis rates were 77.4% and 58.5% respectively, central compartment metastasis ≥3 nodes was the only independent predictive factor for the metastasis in lateral neck. Twelve sides were pN0 and other 41 sides were pN+ in all 53 side specimens. Of 41 sides with pN+, 17 sides (41.5%) involved single site and 24 sides (58.5%) involved multi-sites. The distribution of metastasis lymph nodes:level VI 62.3%, level III 52.8%, level IV 30.2%, level II 18.9%, and level V 0%.</p><p><b>CONCLUSIONS</b>Cervical occult lymph node metastasis in cN0 papillary thyroid carcinoma mainly localizes in level VI, level III, level IV and level II.Selective neck dissection including level VI, III, IV, II is enough for papillary carcinoma without clinical evidence of cervical lymph node involvement.</p>

Analysis of surgical treatment of papillary thyroid carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To present the treatment results and to analyze the causes of recurrence in patients with papillary thyroid carcinoma.</p><p><b>METHODS</b>A retrospective review of 600 patients with papillary thyroid carcinoma treated between 1994 and 1999 was conducted. The primary lesions were originated from the left lobe in 188 cases, the right lobe in 290 cases, the isthmus in 8 cases, and multicentric in 114 cases. From the 600 cases, 584 were well-differentiated and 16 poorly differentiated. TNM stage:385 cases of stage I, 37 cases of stage II, 17 cases of stage III, and 161 cases of stage IV. Three hundred and one patients was N1b stage. All patients received surgical treatment. Among them, 19 cases received radiotherapy, 71 received (131)I-therapy and one case received concomitant radiotherapy and (131)I-therapy.</p><p><b>RESULTS</b>There were 94 recurrent cases. Twenty-seven cases died of recurrence, metastasis and other diseases. The overall 10-year survival rate was 93.2%. The overall 10 year survival rates of stage I, II, III, and IV patients were 99.1%, 94.7%, 93.8%, and 78.5%, respectively (P < 0.01). The 10-year survival rate of lower-age group (< 45 years) was 99.4% and higher-age group (≥ 45 years) 82.1% (P < 0.01). The 10-year survival rate of patients with trachea invasion was 66.5%, significantly lower than the 95.1% in patients without trachea invasion (P < 0.01). The 10-year survival rate of well-differentiated cases was 94.9%, significantly higher than the 38.9% in the poorly differentiated cases (P < 0.01). Multivariate analysis showed that the TNM stage, differentiation degree and the thorough going surgical operation were independent risk factors for the prognosis of papillary thyroid carcinoma.</p><p><b>CONCLUSIONS</b>The TNM stage, differentiation degree and the thorough going surgical operation are independent risk factors for the prognosis of papillary thyroid carcinoma.</p>

Sentinel lymph node biopsy in papillary thyroid cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the reliability and feasibility of sentinel lymph node biopsy (SLNB) of papillary thyroid carcinoma using combination of lymphoscintigraphy, the gamma probe and methylene blue staining techniques.</p><p><b>METHODS</b>Twenty-three consecutive patients with thyroid papillary carcinoma were entered in the study between August 2007 and August 2009. All cases were without clinical evidence of cervical lymph node involvement. The (99)Tc(m)-dextran of 74 MBq (2mCi) was injected intratumorally under ultrasound guidance about 2 h to 5 h prior to surgery. Methylene blue was injected around the tumor during surgery. Preoperative lymphoscintigraphy, intra-operative hand-held gamma probe detecting and methylene blue staining techniques were used to detect the sentinel lymph node (SLN). SLN biopsies were sent to prepare frozen sections and the results were compared with specimen of routine selective neck dissection.</p><p><b>RESULTS</b>The SLNs were identified in all cases with the combination techniques. The SLN identification rates were 87.0% and 100% with methylene blue staining and lymphoscintigraphy plus probe scanning, respectively. Metastases in SLNs were revealed by frozen-section histology in 12 patients. In one case, SLNs frozen-section were negative, but metastasis was detected in routine histology. In other case both SLN and routine histology were negative, but metastasis was detected in non-SLN (level VI) neck dissection. The overall accuracy of the SLN biopsy was 91.3%, positive predictive value 100% and negative predictive value 81.8%.</p><p><b>CONCLUSION</b>The results seem the SLN biopsy technique is a feasible and valuable method for detecting cervical lymph node metastasis and is helpful to decide performing neck dissection in patients with cN0 papillary thyroid carcinoma.</p>

Role of parathyroid hormone measurement in prediction for symptomatic hypocalcaemia after total thyroidectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the role of parathyroid hormone (PTH) and serum calcium in prediction for hypocalcaemia after total thyroidectomy.</p><p><b>METHODS</b>One hundred and sixty-five patients undergoing total or complete total thyroidectomy were reviewed retrospectively. The indications included bilateral carcinoma, undifferential carcinoma, surroundings invasion, distant metastasis and huge benign lesions. Preoperative and postoperative PTH, calcium concentrations and their decline levels were compared between Jan. 2005 and May 2009. The role of PTH value and decline level predicting for symptomatic hypocalcaemia were analyzed by receiver operator characteristics (ROC) curve.</p><p><b>RESULTS</b>After total thyroidectomy, 85 patients (51.5%) developed hypocalcemia. Symptoms were reported by 36 patients (21.8%). The mean concentration of PTH for normocalcaemia (80 cases), asymptomatic hypocalcaemia (49 cases) and symptomatic patients (36 cases) were 31.0 ng/L, 19.6 ng/L and 11.9 ng/L, respectively. The mean decline level for the three groups were 28.6%, 52.6% and 78.0%, respectively. PTH value and its decline level had a poor predicting value for symptomatic hypocalcaemia and high negative predicting value for asymptomatic patients. The serum calcium concentration more than 2.0 mmol/L, PTH level higher than 15 ng/L and PTH decline less than 50% had the good negative predicting value of 97.6%, 90.3% and 96.5%, respectively.</p><p><b>CONCLUSIONS</b>Postoperative PTH and its decline level were significantly correlated with postoperative serum calcium concentration but had a low accuracy for predicting symptomatic hypocalcaemia. The serum calcium concentration more than 2.0 mmol/L, PTH level higher than 15 ng/L and PTH decline less than 50% had the good predicting value for asymptomatic patients. Calcium should be routinely supplemented in the first 24 h after total thyroidectomy to reduce the rate of hypocalcemia and the severity of hypocalcemia symptoms.</p>

Clinical study of carotid artery rupture in head and neck cancer / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the efficacy and safety of carotid ligation in the treatment of the carotid artery rupture(CAR).</p><p><b>METHODS</b>A series of 30 patients who had CAR treated with carotid ligation were reviewed. There were 24 males and 6 females ranging in age from 32 to 76 years, with a mean of 53.9 years. The original sites of tumours were hypopharynx (n = 11), larynx (n = 5), thyroid (n = 6) and others (n = 8). Of the 30 patients, 24 patients had received radiotherapy from 40 - 126 Gy and 10 patients underwent one or more surgical treatments. CAR in all cases occurred after surgical operation. CAR occurred in 5 - 21 days after operation.</p><p><b>RESULTS</b>By pressing the carotid and keeping breathe of the patients immediately after CAR, 25 patients were conscious, 2 patients in coma, and 3 patients died before carotid ligation. Seven cases were applied with carotid ligation, 3 cases with the combined ligation of carotid and brachiocephalic arteries, and 17 cases with carotid ligation plus the repair by pectoralis major myocutaneous flap. The causes of CAR concluded fistula, wound dehiscence, wound infection and transferred flap necrosis. The mende hemorrhage occurred in 14 patients. Of 25 cases with the treatments of carotid ligation, 22 patients survived with no complication, 1 with brief muscle weakness and 2 with unconscious. Clinical follow-up period lasted more than 5 years at least in 6 patients.</p><p><b>CONCLUSIONS</b>CAR is the most dangerous complication in advanced carcinoma of the head and neck. The prompt hemostasis and carotid ligation are effective methods to rescue patients of CAR. It is important to keep patients conscious before carotid ligation surgery, with low rates of death and hemiplegia postoperatively.</p>

Squamous cell carcinoma of naso-ethmoid sinus: Analysis of 146 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the treatment outcome of different therapeutic modalities for squamous cell carcinoma of the nose and ethmoid sinus and prognostic factors.</p><p><b>METHODS</b>One hundred and forty-six cases of squamous cell carcinoma of the nose and ethmoid sinus treated from 1990 to 2007 were reviewed. Of the 146 cases, 28 were at stage I or II; 46 stage III; 72 stage IV. Forty-one patients were treated with preoperative radiation plus surgery (R + S), 22 patients with surgery plus postoperative radiation (S + R), 5 patients with surgery alone (SA), 78 patients with radiotherapy alone (RA).</p><p><b>RESULTS</b>The overall 5 year survival rate of 146 patients with squamous cell carcinoma of the nose and ethmoid sinus was 49.1%. The 5 year survival rate of the patients at stage I and II was 95.7%, while the rate was 59.8% in the patients at stage III and 28.2% in the patients at stage IV (χ(2) = 24.15, P < 0.05). The 5 year survival rate was 57.7% in R + S group, 60.4% in S + R group, 100% in SA group, and 38.8% in RA group, respectively (P > 0.05). The 5 years survival rate of N+ patients was lower than that of N0 (χ(2) = 12.326, P < 0.05). Local recurrence and distant metastasis were main causes of death. Cox analysis showed TNM stage and differentiation of tumor were independent significant prognostic factors.</p><p><b>CONCLUSIONS</b>The higher survival rate of patients with squamous cell carcinoma of the nose and ethmoid sinus was obtained from combined therapy R + S or S + R. SA gave ideal results for early lesions (stage I and II).</p>

Clinical analysis of 60 cases with maxillary squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical characters, treatment modalities and prognosis of patients with maxillary squamous cell carcinoma.</p><p><b>METHODS</b>The clinical data of 60 patients with maxillary squamous cell carcinoma treatment between January 1994 and December 2004 were analyzed retrospectively. The patients were treated with three therapy modalities including radiotherapy alone (22 cases), radiotherapy and surgery (R + S, 29 cases) and concurrent chemo-radio-therapy adjuvant surgery (CCR + S, 9 cases).</p><p><b>RESULTS</b>The five year survival rate were 18.2%, 51.7% and 33.3% for patients in the radiotherapy alone group, the R + S group and the CCR + S group, respectively. Patients receiving R + S combined modality therapy had a significantly higher five year survival rate than the patients who were treated radiotherapy alone (χ(2) = 15.62, P < 0.01). The five year survival rate (51.7%) of patients in R + S group was significantly higher than that (33.3%) of patients in CCR + S group (χ(2) = 4.28, P < 0.05), and also higher than that (18.2%) of patients in radiotherapy group (χ(2) = 9.49, P < 0.01).</p><p><b>CONCLUSIONS</b>The combined therapy of radiation and surgery was a good choice of treatment for the patients with maxillary sinus squamous cell carcinoma. The role of concurrent chemo-radiotherapy adjuvant surgery in the treatment of maxillary sinus squamous cell carcinoma needs further to research.</p>

Sonographically guided percutaneous ethanol injection for therapy of thyroid benign lesion / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To develop the microtrauma therapy for thyroid benign lesion, to evaluate efficacy of sonographically guided percutaneous ethanol injection for therapy of thyroid benign lesion.</p><p><b>METHODS</b>Thirty-two patients with thyroid benign lesion were treated in Cancer Hospital, the patients had thyroid disease with cystic or cystic and solid nodule without heart and lung disease, and no allergy to ethanol, but the most diameter was below 3 cm for the solid disease. These patients were divided into two groups, the first group were 14 patients (from June 2002 to August 2003), the second group was 18 patients (from September 2003 to March 2006). The mean injection times was four (1-6) in the first group, the volume of each ethanol injection made the absolute ethanol well-distributed and kept slight compression intralesional for five minutes for solid disease. Partial liquid was extracted for cystic disease first, and 2-10 ml ethanol was injected into cyst, the internal time between two punctures was one week. Each patient received six times ethanol injection in the second group, ethanol injection was same with the first group. The mean follow-up was 29 (12-57) months.</p><p><b>RESULTS</b>The efficacy rate was 100.0%, the cure rate was 69.2% in the first group. The efficacy rate was 100.0%, the cure rate was 77.8% in the second group. There was no significant difference in the cure rate between the groups (chi2 = 0.0258, P > 0.05). During follow-up, ultrasound revealed no recurrence for the cured patients and no growth for the remnant lesion. Its complications were transient after the procedure, no severe complications occurred.</p><p><b>CONCLUSIONS</b>Sonographically guided percutaneous ethanol injection should be simple, effective, and safe for the thyroid benign lesion, it is easy popularized and may has the effect of cosmetology and microtrauma.</p>

Prospective cohort study on prevention of Frey syndrome in parotid surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the prevention of Frey syndrome after parotidectomy.</p><p><b>METHODS</b>A prospective cohort study of 100 patients with parotid cancer who received parotid surgery was underwent in our hospital from 2001 to 2004. These patients were assigned to two groups, study group (50 cases) and control group (50 cases). The patients in the study group received parotidectomy and intraoperative placement of collagen pieces within the parotid bed, between the skin flap and the facial nerve. The patients in the control group received a conventional parotidectomy and no collagen pieces was implanted. All of the patients were followed-up and were evaluated for Frey syndrome with identical questionnaires.</p><p><b>RESULTS</b>Compared with control group, the incidence rate of Frey syndrome was significantly decreased in the study group (20% vs 60%, chi(2) = 15.04, P < 0.001). Postoperative incidence of facial contour apparent deformity was 80% (40/50) in control group and 44% (22/50) in study group (chi(2) = 12.26, P < 0.001).</p><p><b>CONCLUSIONS</b>Use of collagen pieces as an interposition fill barrier improves parotidectomy outcome by reducing the incidence of Frey syndrome, and it improves cosmetic results concurrently.</p>

Experience of diagnosis and treatment for primary cervical tracheal tumors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To review the experience of diagnosis and treatment of primary cervical tracheal tumor.</p><p><b>METHODS</b>Medical history records of 38 patients with primary cervical tracheal tumor who were treated at department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences between January 1981 and December 2002 were retrospectively analyzed. Twenty six patients underwent surgical resection, twelve patients received only radiotherapy. Eleven patients underwent sleeve tracheal resection, thirteen patients with partial tracheal wall resection and 6 of them with tracheal reconstruction immediately, two patients with total laryngectomy and resection of partial trachea and thyroid lobectomy.</p><p><b>RESULTS</b>Thirty four patients had malignant tumors, among which 19 cases were adenoid cystic carcinoma and 10 cases squamous cell carcinoma. The 3-year and 5-year survival rate were 79. 80% and 48. 36% respectively for the patients with adenoid cystic carcinoma, 80.00% and 20. 00% respectively for the patients with squamous cell carcinoma. The rate of complication was 18.4% (7/38), among which tracheal stenosis was 11.5% (3/26).</p><p><b>CONCLUSIONS</b>Most of primary cervical tracheal tumors were malignant, adenoid cystic carcinoma and squamous cell carcinoma were the common malignant cervical tracheal tumors. Surgery is the first choice for cervical tracheal tumors, and the sleeve trachea resection is one of the optimal surgical modality.</p>

Therapeutic modalities of nasopharyngeal adenoid cystic carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To grasp clinical characteristics, therapeutic methods and prognosis of the patients with nasopharyngeal adenoid cystic carcinoma, and explore the optimal therapeutic modalities.</p><p><b>METHODS</b>Twenty one cases with nasopharyngeal adenoid cystic carcinoma were retrospectively reviewed. The treatment results were compared between radiotherapy alone and combined therapy.</p><p><b>RESULTS</b>The cases with nasopharyngeal adenoid cystic carcinoma in T1, T2 phases was 28.6%, the cases in T3, T4 phases was 71.4%. The lymphatic node metastasis rate was 14.3%. The present symptoms were nasal discharge with blood, headache, nasal obstruction, deafness, double vision, facial insensibility, etc. One of 21 cases was lost follow up. Five years free-disease survival rates of the patients with nasopharyngeal adenoid cystic carcinoma was 42.9% (9/21). Five years free-disease survival rate of the patients with radiotherapy alone (RA) and the patients with radiotherapy combining surgery (R + S) were respectively 38.5% (5/12) and 50.0% (4/8), P = 0.472. Ten years free-disease survival rates of the patients was 16.7% (3/18). Ten years free-disease survival rates of the patients with RA and the patients with R + S were respectively 0/12 and 3/6, P = 0.025. The local recurrent rate was 50.0% (10/20). The local recurrent rates of the patients with RA and the patients with R + S were respectively 66.7% (8/12) and 25.0% (2/8), P = 0.085. The distant metastasis rate was 30. 0% (6/20). The distant metastasis rates of the patients with RA and the patients with R + S were respectively 25.0% (3/12) and 37.5% (3/8), P = 0.455.</p><p><b>CONCLUSIONS</b>The course of nasopharyngeal adenoid cystic carcinoma is long, and it is prone to the local recurrence and the distant metastasis in advanced stage. Comparing with the radiotherapy alone, the radiotherapy combining surgery has better 10 years free-disease survival rate.</p>

Surgical management of upper mediastinal lymph nodes metastases from thyroid carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the significance of upper mediastinal lymph nodes dissection for thyroid carcinoma patients.</p><p><b>METHODS</b>The clinical data of 79 thyroid carcinoma patients who underwent the upper mediastinal lymph node dissection (between January 1984 and December 1998) were retrospectively analysed. There were 45 male and 34 female with a median age of 47 years (range 10 to 74 years). Follow-up was ended on December 31, 2003.</p><p><b>RESULTS</b>Histopathologically, there were 58 (73.4%) papillary carcinoma, 14 (17.7%) medullary carcinoma, and 7 (8.9%) follicular carcinomas. Four of them had poorly-differentiated carcinoma. Upper mediastinal lymph node dissection was carried out in 62 patients through trans-cervical approach, in 10 through an inverted T-shaped incision, and in 7 through a midline sternotomy. Seventy-six patients had 93 neck lymph node dissection procedures, and 47 patients developed paratracheal lymph node metastasis. The overall 5- and 10-year cumulative survival rate was 64.6% and 63.1%, respectively. Mediastinal lymph node recurrence developed only in 10 patients after initial upper mediastinal lymph node dissection. Nine patients died of upper mediastinal lymph node metastasis. Postoperative complications were observed in 11 patients without perioperative death.</p><p><b>CONCLUSION</b>Upper mediastinal lymph node metastasis is most frequently found in papillary thyroid carcinoma. Surgical dissection of upper mediastinal metastatic lymph nodes through either cervical incision or mediastinotomy is safe and effective with low rate of perioperative complications. It may improve the life quality and survival of thyroid carcinoma patients.</p>

Diagnosis, treatment and prognostic factors of adenoid cystic carcinoma of the palate / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the clinical characteristics, diagnosis, treatment and prognosis of adenoid cystic carcinoma of the palate.</p><p><b>METHODS</b>A retrospective review was conducted in 42 patients with adenoid cystic carcinoma of the palate treated in our hospital from 1967 to 1998. Statistical analysis was performed using the Kaplan-Meier method. Prognostic factors were analyzed by Log Rank test.</p><p><b>RESULTS</b>The overall 5-, 10-, 15-year accumulative survival rates were 85.0%, 61.8% and 28.1%, and the 5-, 10-, 15-year accumulative disease-free survival rates were 52.4%, 32.7% and 22.4%, respectively. The 5-, 10-, 15-year accumulative local recurrence rates were 25.2%, 50.9% and 73.1%, and the 5-, 10-, 15-year accumulative distant metastasis rates were 28.5%, 50.4% and 66.0% respectively. T stage, bone invasion, extent of tumor, local recurrence and distant metastasis were significant prognostic factors. Treatment method, dose and area covered by radiotherapy were related to the prognosis.</p><p><b>CONCLUSION</b>Surgery alone can be done for early lesions, and combination of surgery with radiotherapy should be adopted for advanced lesions in adenoid cystic carcinoma of the palate. Radiotherapic salvage could prolong the survival of the locally recurrent patients.</p>