Analysis of the efficacy and prognosis of radiotherapy in acute leukemia with extramedullary infiltration / 重庆医学

Objective To investigate the clinical characteristics,treatment methods,and prognosis of a-cute leukemia patients with extramedullary infiltration.Methods The clinical characteristics and treatment methods of 47 acute leukemia patients with extramedullary infiltration admitted to the Affiliated Hospital of Guizhou Medical University from April 2014 to April 2023 were retrospectively analyzed.Subgroup analysis was performed according to whether there was extramedullary infiltration before transplantation,and whether there was isolated extramedullary recurrence after transplantation.Based on this analysis,the patients were di-vided into the pre-transplantation radiotherapy group and pre-transplantation non-radiotherapy group,the post-transplantation radiotherapy group and post-transplantation non-radiotherapy group.According to the treatment methods of central nervous system leukemia(CNSL),the patients were divided into the intrathecal injection group(n=12)and combination of intrathecal injection and radiotherapy group(n=13).The local remission situation,survival duration,and toxic and side effects of radiotherapy and chemotherapy were com-pared.Results For acute leukemia patients with extramedullary infiltration,the overall survival time(OS)in the radiotherapy group was better than that in the non-radiotherapy group(median OS:706 d vs.151 d,P=0.015).Subgroup analysis showed that the OS of the pre-transplantation radiotherapy group was better than that of the pre-transplantation non-radiotherapy group(median OS:592 d vs.386 d,P=0.035).For CNSL,the combination of intrathecal injection and radiotherapy group had a better OS than the intrathecal injection group(median OS:547 d vs.388 d,P=0.045).The event-free survival time(EFS)of the radiotherapy group was better than that of the non-radiotherapy group(median EFS:175 d vs.50 d,P=0.005).The COX pro-portional-hazards model showed that treatment with or without radiotherapy had a significant impact on the OS of acute leukemia patients with extramedullary infiltration.The risk of death in the pre-transplantation non-radiotherapy group was 2.231 times higher than that in the pre-transplantation radiotherapy group(HR=3.231,95％CI:1.021-10.227,P=0.046).Compared with the non-radiotherapy group,the radiother-apy group had a higher local remission and a lower risk of haematological toxicity,infection,and haemorrhage.Conclusion Radiotherapy can rapidly alleviate the local symptoms of acute leukemia complicated with extr-amedullary infiltration,prolong the survival time of these patients,and reduce the risk of hematologic toxicity,infection,and haemorrhage.

Clinical application of supraclavicular flap for oncologic reconstruction of hypopharynx and upper esophagus / 中华耳鼻咽喉头颈外科杂志

Objective@#To assess the efficacy of supraclavicular artery island flap (SCAIF) for the reconstruction of hypopharynx and upper esophagus.@*Methods@#The SCAIF procedure on was used in 10 patients, including 8 with hypopharygeal carcinomas, 1 with esophageal carcinoma and neck skin invasion and 1 with hypopharyngeal leiomyosarcoma, at the Otorhinolaryngology Hospital, the First Affiliated Hospital, Sun Yatsen University between December 2015 and June 2017. The sizes of the flaps were measured in (4-8) cm×(5-12) cm. Clinical indexes such as harvesting time and survival were recorded.@*Results@#Harvesting time for SCAIF ranged from 20 to 30 minutes, averaging 26 minutes. Nine flaps survived, one flap had partially necrosis. Functional outcomes were excellent and the donor sites were direct closed without complications.@*Conclusions@#SCAIF is a versatile, reliable, and easily harvested flap, with good cosmetic and functional outcomes for reconstructing the defects of hypopharynx and upper esophagus.

Clinical outcome of conservative treatment for pharyngocutaneous fistula / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the conservative management and outcomes of pharyngocutaneous fistula after total laryngectomy.@*METHOD@#Twenty-one patients with postoperative fistulas were identified and treated by conservative therapy.@*RESULT@#Different treatment were given basing on the three stages of pharyngocutaneous fistula: drainage and cleaning stage, pressure bandaging stage and healing stage. Fourteen patients (66.7%) with the conservative therapy resumed oral feeding after closure of fistula, the other 7 patients had to be cured by further operation.@*CONCLUSION@#Management basing on the stages of pharyngocutaneous fistula can achieve satisfied outcome. It can provide important information for pharyngocutaneous fistula's treatment.

Diagnosis of small round cell tumor of nasal sinus and bases of skull (a report of 123 cases) / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the features and diagnosis way of small round cell tumor of nasal sinus and bases of skull.@*METHOD@#A retrospective analysis of 123 case with small round cell tumor of nasal sinus and bases of skull were carried out in our hospital in past ten year. Clinical, histological, radiological and immunohistochemical characters of these cases were studied.@*RESULT@#All cases usually complained of nasal obstruction, headache, diplopia, nasal mucus with bleeding, vision or weight loss. Expansible or infiltrative lumps were found in nasal sinus or bases of skull in radiological examination. A lot of small round cells were found in these tumors in histological pathology. At least 5-6 cell, tissue or tumor markers were examined immunohistochemically in most of cases before the final diagnosis were made. In some cases over 20 markers were examined. Five cases were carried out transmission electron microscope examination, special features such as desmosome and myofilament were found.@*CONCLUSION@#Clinical symptom, physical signs and radiological finding can supply malignant evidences of these tumors. Histological examination can make certain that they are small round cell tumors, but final diagnosis is still hard to make only by these. Immunohistochemical examination of various markers can tell the original characters of the specimen tissues, it is the key for final diagnosis. Transmission electron microscope examination is another helpful way for diagnosis.