Supervivencia de pacientes con metástasis cervical de primario desconocido en el Instituto Nacional de Oncología y Radiobiología. 2007-2012

Resumen Introducción: Las metástasis cervicales con primario oculto representan el 5% de los tumores de cabeza y cuello. Su diagnóstico y tratamiento han sufrido modificaciones con los años según las diferentes investigaciones, con vistas a mayores tasas de supervivencia. Objetivo: Determinar la supervivencia global y según diferentes variables. Material y Método: Investigación retrospectiva, descriptiva y longitudinal de 96 pacientes diagnosticados en el Instituto Nacional de Oncología y Radiobiología (INOR) en el periodo 2007-2012, manteniéndose el seguimiento hasta el 31 de diciembre de 2017. Resultados: De los pacientes estudiados, 65 eran hombres (67,7%) y 31 mujeres (32,3%), para una razón de 2,1:1, con una media de edad de 61,4 años. El tabaquismo estuvo presente en el 64,6% de la población. El nivel ganglionar más afectado fue el II y 41 pacientes (42,7%) presentaron una enfermedad N1 al diagnóstico. En 42 pacientes (43,8%) estuvo presente el grado histológico poco diferenciado. Al 70,9% se les practicó cirugía con adyuvancia o sin ella y el 86,5% tuvo respuesta completa. El tumor primario apareció en el 13,5% de los casos, más frecuente en amígdala. La supervivencia global a los 5 años fue del 74% y resultaron variables determinantes de supervivencia el estado ganglionar y la extensión extraganglionar. Los resultados coinciden con la literatura revisada. Conclusión: La supervivencia global a los 5 años de los pacientes con metástasis cervical de primario oculto es elevada, tiene tendencia a mejorar con el paso de los años y está determinada por el estado ganglionar y la extensión extracapsular de forma inversamente proporcional.

Abstract Introduction: Cervical metastases with occult primary represent 5% of head and neck tumors. Its diagnosis and treatment have been modified over the years according to different investigations, with a view to higher survival rates. Aim: To determine the overall survival and according to different variables. Material and Method: A retrospective, descriptive and longitudinal investigation of 96 patients diagnosed at INOR in the period 2007-2012 was carried out, with follow-up until December 31, 2017. Results: Of the patients studied, 65 were men (67.7%) and 31 women (32.3%), for a ratio of 2.1: 1, with a mean age of 61.4 years. Smoking was present in the 64.6% of the population. The most affected lymph node level was level II and 42 patients (43.8%) presented N1 disease at diagnosis. Poorly differentiated histological grade was present in 42 patients (43.8%). 70.9% underwent surgery with or without adjuvant surgery and 86.5% had a complete response. The primary tumor appeared in 13.5% of cases, more frequent in the amygdala. Overall survival at 5 years was 74%, and survival variables were lymph node status and extranodal extension. The results coincide with the reviewed literature. Conclusion: The overall 5-year survival of patients with occult primary cervical metastasis is high, tends to improve over the years, and is determined by lymph node status and extracapsular extension in an inversely proportional manner.

Hallazgo incidental de metástasis de carcinoma de tiroides en disección de cuello por carcinoma de laringe / Incidental finding of metastasis due to thyroid´s carcinoma in a neck dissection by larynx carcinoma

RESUMEN Introducción: El fenómeno de las neoplasias primarias múltiples se ha descrito en cabeza y cuello, de forma metacrónica y sincrónica. Caso clínico: Hombre de 54 años, piel negra y procedencia rural con carcinoma escamoso de laringe T3N1M0, etapa III, que en disección de cuello se encontró incidentalmente metástasis ganglionar de carcinoma papilar de tiroides, sin evidencia clínica de lesión tiroidea. Luego se realizó ecografía y gammagrafía de la glándula cuyos resultados no mostraron alteración alguna. Conclusiones: El carcinoma de tiroides es hallado incidentalmente en el espécimen resecado después de cirugía por cáncer de cabeza y cuello en 0,3 - 1,9 por ciento de los pacientes. Por este motivo debe evaluarse bien la glándula tiroides previa cirugía de cabeza y cuello(AU)

ABSTRACT Introduction: The phenomenon of multiple primary neoplasms has been described in the head and neck in a synchronous and metachronous way. Clinical case: A 54 years old man, black skin and rural origin with a T3N1M0 larynx squamous cell carcinoma, stage III that in a neck dissection was incidentally found a node metastasis of papillary thyroid carcinoma, without clinical evidence of thyroid lesion. This was followed by ultrasound and nuclear scan of the gland, whose results did not show any alteration. Conclusions: The thyroid carcinoma is found incidentally in the resected specimen after surgery by head and neck cancer in 0.3 - 1.9 percent of patients. The thyroid gland must be well assessed after head and neck surgery(AU)

Patterns of failure in head-and-neck cancer of unknown primary:a study of 92 patientshead-and-neck cancer of unknown primary / 中华放射肿瘤学杂志

Objective To retrospectively analyze the treatment outcomes and failure patterns in patients with head?and?neck cancer of unknown primary head?and?neck cancer of unknown primary, and to compare the efficacy between elective mucosal irradiation and ipsilateral neck treatment. Methods The clinical data of patients with head?and?neck cancer of unknown primary who were admitted from January 2007 to December 2013 were retrospectively collected. Thirty?one patients received elective pharyngeal mucosal irradiation and 61 patients only received ipsilateral neck treatment. The SPSS 19. 0 software was used for comparison of the survival and local control between the two groups. Results In the 92 patients, the median age was 57 years;79. 3% had metastasis to level Ⅱ lymph nodes;the median follow?up time was 36. 5 months;the 3?year overall survival, mucosal control, and neck control rates were 89. 0%, 86. 6%, and 82. 4%, respectively. Primary sites were found in 15 patients, containing nasopharynx in 4 patients, oropharynx in 3 patients, oral cavity in 3 patients, throat and hypopharyngeal part in 3 patients, maxillary sinus in 1 patient, and esophagus in 1 patient. The patients undergoing elective pharyngeal mucosal irradiation had significantly higher 3?year mucosal control and neck control rates than those undergoing ipsilateral neck treatment ( 100% vs. 74. 9%, P= 0. 040;87. 5% vs. 62. 2%, P= 0. 037 ) . There was no difference in the 3?year overall survival rate between the two groups ( 83. 5% vs. 88. 7%, P= 0. 910 ) . Conclusions For patients with head?and?neck cancer of unknown primary, elective pharyngeal mucosal irradiation can reduce the incidence of primary site and increase the neck control rate. A new standard for target volume delineation should be established as soon as possible for elective prophylactic pharyngeal mucosal irradiation.

Studies on microscopically diagnosed chorioepithelioma from twenty-seven cases admitted to the Philippine General Hospital from 1950-1954 (in three sections)

The study presented the histories of chorioepithelioma cases which were grouped into three sections namely: chorioepithelioma deaths due to neglect or to belated treatment, (2) chorioepithelioma deaths that were unavoidable, and (3) cases of chorioepithelioma that recoveredOf the 27 cases of microscopically diagnosed chorioepithelioma, 8 (30%) recovered because of early treatment while 18 (67%) died. One was a case of doubtful recovery because of the absence of follow up. The tumor occurred in women between 19-48 yrs of age. The gravidity and parity in the 27 cases are given. The antecedent pregnancy was hydatidiform mole in 63%, early abortion in 18%, full term labor in 4%, and ab initio in 15%It was noted that a great majority of the patients could have been saved if they were diagnosed and treated early specially when the chorionic malignancy was still confined in the uterus