Carcinoma epidermoide semidiferenciado de piso de boca y reborde residual: reporte de un caso / Semi-differentiated squamous cell carcinoma of the floor of the mouth and residual ridge: report of a case

El carcinoma epidermoide, es una neoplasia maligna de mayor incidencia de la cavidad bucal que representa el 55 por ciento de todos los tumores de esta región. El 68-72 por ciento de estos pacientes presenta etapas locorregionales avanzadas en el momento del diagnóstico. El objetivo de este trabajo es el de presentar un caso de un carcinoma epidermoide semidiferenciado de piso de boca y reborde residual mandibular anterior, tratado con submandibulectomía segmentaria y reconstrucción con osteosíntesis rígida...

Clinical experience on use of oral EGFR-TKIs as first-line treatment of advanced NSCLC from a tertiary care centre in North India and implications of skin rash.

Background. Limited data are available from India on treatment outcomes with oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in newly diagnosed non-small cell lung cancer (NSCLC). We studied the demographic profile and treatment outcomes of patients with NSCLC, receiving first-line treatment with oral EGFR-TKIs. Methods. Retrospective study of newly diagnosed NSCLC patients treated with oral EGFR-TKIs over a 4-year period at a tertiary care institute in North India. Results. Of 76 patients studied, females and non-smokers constituted 32.9% and 48.7%, respectively. Majority of patients had adenocarcinoma (59.2%), stage IV (64.5%) disease and Karnofsky performance status <70 (74.5%). Gefitinib was the most frequently used EGFR-TKI (92.1%). Most common indication for the use of EGFR-TKIs was poor performance status (65.8%). Among assessable patients, disease control and progressive disease were evident in 66% and 34%, respectively. Most common side effects were skin rash (17%) and diarrhoea (10.6%). Patients with and without skin rash differed significantly in relation to objective response to treatment (100% versus 23.1%) and overall survival (median not reached versus 178 days). On multivariate logistic regression analysis, malignant pleural effusion was associated with occurrence of rash (odds ratio=0.19; 95% confidence interval = 0.04-0.95; p=0.04). Conclusions. Oral EGFR-TKIs appear to be useful for the treatment of clinically selected patients with advanced NSCLC. Occurrence of skin rash was independently associated with treatment response and better survival in the current study.

Orofacial rehabilitation of patients with post-cancer treatment-An overview and report of three cases.

According to World Health Organisation statistics, individuals of the Indian subcontinent have the highest prevalence of orofacial cancer. Surgery, radiation, chemotherapy or combination therapies are commonly administered treatment modalities for treatment of oral cancer. Surgical resection can be mutilating, disfiguring and may deeply affect self-image of patients. Orofacial defects have unique limitations and challenges. A coordinated effort from the surgeon, oral physician and the maxillofacial prosthodontist to treat such patients is the need of the hour. This article presents an overview of the orofacial rehabilitation of postcancer treatments along with case reports.

Faringocoloplastia como reconstrução tardia pós-faringolaringectomia total por carcinoma espinocelular de hipofaringe: relato de caso e revisão da literatura / Pharyngocoloplasty as late reconstruction post-pharyngolaryngectomy by hypopharynx

Introdução: O carcinoma espinocelular de cabeça e pescoço representa cerca de 5% de todas as neoplasias malignas. A localização dessa neoplasia no trato aerodigestivo superior é um fator prognóstico importante, sendo que, na maioria dos casos de hipofaringe, apresentam-se já avançados no momento do diagnóstico. A ressecção cirúrgica, quimioterapia e radioterapia adjuvantes têm grande importância no seu tratamento. Muitos pacientes, com controle loco-regional da doença, beneficiam-se de procedimentos cirúrgicos reparadores e de reconstrução do trânsito intestinal. Relato de caso: Homem, 38 anos, ex-etilista e ex-tabagista, com queixa de disfagia e dispneia rapidamente progressivas, submetido à traqueostomia de urgência por insuficiência respiratória aguda. À investigação, foi diagnosticado um carcinoma espinocelular de supraglote, com extensão para a parede medial do recesso piriforme esquerdo. O paciente foi, então, submetido à faringolaringectomia total, seguida de quimiorradiação. Sem sinais de recidiva tumoral após 12 meses de acompanhamento, foi realizada faringocoloplastia como reconstrução do trânsito intestinal. Encontrase atualmente em acompanhamento ambulatorial sem evidência de recidiva tumoral e satisfeito com o resultado cirúrgico final. Discussão: A reconstrução do trânsito intestinal em pacientes submetidos à faringolaringectomias é indicada para pacientes com controle local da doença e que aceitem o procedimento cirúrgico. A técnica mais utilizada é a interposição de alça de delgado. Porém, o cólon também é utilizado como substituto do esôfago. A escolha da técnica depende fundamentalmente da acurácia técnica do cirurgião e da necessidade de uma longa alça para anastomose entre a faringe e o estômago, com resultados satisfatórios.

Introduction: Head and neck squamous cell carcinoma represents about 5% of all malignant tumors. Localization of this neoplasia at the upper aerodigestive tract is an important prognostic factor. In most cases, hypopharynx tumors are at an advanced stage when diagnosed. Surgical resection, as well as alongside chemotherapy and radiotherapy, are essential to the treatment. Many patients with locoregional control of the disease benefit from reparative and reconstructive surgeries of the intestinal transit. Case report: Man, 38 years old, former user of alcohol and tobaco, complaining of rapid progressive dysphagia and dyspnea, submitted to urgent tracheotomy due to acute respiratory failure. At examination, we diagnosed supraglottic squamous cell carcinoma, involving the left pyriform fossa medial wall. The patient underwent a pharyngolaryngectomy, followed by chemoradiation. Without signs of tumor recurrence after a 12-month follow-up, we performed a pharyngocoloplasty with reconstruction of the intestinal transit. At the moment, he is attending for an outpatient follow-up, with no evidences of tumor recurrence, and satisfied with the final surgical outcome. Discussion: The reconstruction of intestinal transit in pharyngolaryngectomy patients is indicated for those with local control of the disease and that accept this surgicalprocedure. The most used technique is the loop interposition of small intestine, but the colon is also used for esophageal replacement. Its choice depends mainly on the technical accuracy of the surgeon, but also on the requirement of a lengthy loop for the anastomosis between pharynx and the stomach, with suitable results.

Reconstrucción microquirúrgica del velo del paladar y pared lateral de orofaringe: una nueva propuesta de clasificación: resultados funcionales / Microsurgical velopharyngeal reconstruction: evaluation of 37 patients

Background: Velopharyngeal reconstruction after surgical excision of tumors is complex and must preserve swallowing and phonation Aim: To assess quality of life of patients subjected to velopharyngeal reconstruction after excision of a pharyngeal carcinoma. To propose a new classification velopharyngeal junction defects, based on tridimensional criteria, to allow a reconstruction using radial forearm flaps. Material and Methods: Prospective evaluation of 37 patients aged 25 to 78 years, with a carcinoma that involved the lateral wall of the oropharynx or soft palate, subjected to surgical excision with negative surgical margins. Four types of velopharyngeal effects were considered for reconstruction. In 25 of the patients quality of life and quality of swallowing and phonation was evaluated. Results: Eighty one percent of patients considered their quality of life as good or optimal. No patients had swallowing disturbances and 71, 21 and 8 percent had an excellent, good or acceptable phonetic results, respectively. Conclusions: The proposed classification allows a reconstruction without tension and with a good functional performance.

El propósito de esta serie clínica es la de proponer una clasificación de los defectos de la unión velofaríngea y/o pared lateral de la orofaringe basados en criterios tridimensionales que permita una reconstrucción con colgajos libres radiales de antebrazo. Se evalúa además la calidad de vida, lenguaje y deglución. Métodos: Estudio de tipo prospectivo, longitudinal que seleccionó 37 pacientes. La clasificación reconstructiva propuesta se basó en un criterio de tipo geométrico-espacial que distinguió 4 tipos de defectos. Los datos obtenidos se llevaron a tablas y se realizó análisis mediante frecuencias y promedios. Resultados: Al aplicar los criterios de inclusión sólo 37 (47,43 por ciento) de los 78 pacientes cumplieron con ellos. La calidad de vida aplicando la encuesta de Gliklich, se efectuó a 25 pacientes (67,56 por ciento) de un total de 28 vivos. El estudio reveló que el 81 por ciento (n = 20) refería tener una calidad de vida buena u óptima. El 100 por ciento (n = 25) de los pacientes no mostró dificultad en la deglución, sólo se observó prolongación en los tiempos de las fases oral y faríngea en cinco pacientes. El control fonoaudiológico mostró que un 71 por ciento de los pacientes presentó un resultado fonético excelente, 21 por ciento fue bueno y un 8 por ciento aceptable. Conclusiones: La clasificación propuesta permite establecer una correlación entre el defecto espacial y el modelo reconstructivo permitiendo de esta forma una reconstrucción sin tensiones y con un buen resultado deglutorio, fonético y de calidad de vida.

Prosthetic rehabilitation of edentulous mandibulectomy patient: a clinical report.

Segmental resection of the mandible commonly results in deviation of the mandible to the defective side. The amount of deviation depends on the amount of hard and soft tissue involvement, the method of surgical site closure, the degree of impaired tongue function, the number of remaining teeth and the extent of loss of sensory and motor innervations. Prosthodontic treatment along with physical therapy may be useful in reducing mandibular deviation and improving masticatory efficiency. This clinical report describes the use of two rows of nonanatomic teeth on the unresected side. This provided a broader occlusal table and improved masticatory efficiency in our edentulous madibulectomy patient.

Carcinoma escamoso basalóide mna mucosa bucal: comportamento clínico, prognóstico e análise da expressäo de PCNA, p53, BAX e BCL-X / Oral basaloid squamous cell carcinoma: analysis of the clinical behavior, prognosis, and expression of PCA, p53, BAX and BCL-X

O carcinoma escamoso basalóide (CEB) tem sido considerado uma das variantes mais agressivas do carcinoma espinocelular (CEC), acometendo preferencialmente a base da língua, a hipofaringe e a laringe. Um total de 776 carcinomas espinocelulares primários de boca, cirurgicamente excisados entre 1970 e 2000, foram revisados dos arquivos dos Departamentos de Patologia e de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia do Hospital do Câncer A.C. Camargo. Dezessete CEBs foram identificados e analisados comparativamente a 27 CECs pouco diferenciados com estadiamento e localizaçäo equivalentes, quanto ao gênero, idade, raça, tabagismo, etilismo, localizaçäo do tumor primário, classificaçäo pelo sistema TNM, tratamento, ocorrência de recidiva tumoral, metástases em linfonodos regionais, a distância e de segundo tumor primário. Analisaram-se a morfologia tumoral e a expressäo dos marcadores de proliferaçäo celular e apoptose: PCNA, p53, Bax e Bcl-X. As probabilidades de sobrevida, acumuladas nos períodos de 5 e 10 anos para ambos grupos tumorais, foram calculadas pelo método de Kaplan-Meier, sendo a influência das variáveis clínicas e microscópicas no prognóstico avaliada pelo modelo de regressäo de Cox. Morfologicamente, a maioria dos CEBs apresentou configuraçäo tumoral sólida/lobular, disposiçäo em paliçada das células periféricas, espaços císticos, comedonecrose, hialinizaçäo intra e peritumoral, disjunçäo epitélio tumoral/conjuntivo e associaçäo com o componente escamoso. Nenhuma diferença estatística foi detectada entre os grupos CEB e CEC quanto às características demográficas, clínicas e quanto à expressäo dos marcadores PCNA, p53 e Bcl-X. O CEB apresentou, comparativamente ao CEC, maior expressäo da proteína Bax (p=0,031). As probabilidades de sobrevida global, sobrevida específica e sobrevida livre de doença acumuladas em 5 e 10 anos para os pacientes com CEB e com CEC foram semelhantes. O estadiamento clínico N constituiu um fator prognóstico independente para os pacientes com carcinoma escamoso basalóide e carcinoma espinocelular pouco diferenciado na mucosa bucal. A morfologia tumoral, bem como a expressäo dos anticorpos PCNA, p53, Bax e Bcl-X, näo foram fatores prognósticos significativos. Estes resultados sugerem que, o CEB e o CEC pouco diferenciado com localizaçäo e estadiamento clínico equivalentes na boca, apresentam comportamento clínico e biológico similares...

Prosthetic rehabilitation of a patient following maxillectomy with orbital exenteration.

The maxillectomy patient despite the drastic nature of the procedure can often be restored to an acceptable aesthetic and functional condition. The treatment of maxillectomy patient presents an excellent opportunity for the surgeon and the prosthodontist to coordinate their efforts to enhance the patient's rehabilitation. This clinical report describes the prosthetic rehabilitation of a patient with squamous cell carcinoma of the right maxilla requiring maxillectomy with orbital exenteration.