The clinical value of oral robotic surgery in the treatment of oropharyngeal squamous cell carcinoma / 中华肿瘤杂志

Objective: To explore the therapeutic effects of transoral robotic surgery (TORS) and traditional surgical modes in oropharyngeal squamous cell carcinoma (OPSCC). Methods: The clinicopathological data of patients with oropharyngeal squamous cell carcinoma treated at Sun Yat-sen University Cancer Center from 2010 to 2018 were retrospectively analyzed. 135 cases were treated with traditional surgery (non-TORS group), while 52 cases were treated with TORS (TORS group). The prognosis of the two groups of patients were analyzed by Kaplan-Meier method and Log rank test, the influencing factors were analyzed by Cox regression model. Results: The 2-year overall survival (OS, 94.2%) and 2-year progression-free survival (PFS, 93.8%) of patients in the TORS group were better than those in the non-TORS group (71.4% and 71.4%, respectively, P<0.05). The 2-year OS (93.3%) and 2-year PFS (92.8%) of TORS group patients in T1-2 stage were better than those of non-TORS group (73.1% and 72.8%, respectively, P<0.05). The 2-year OS (95.8%) and 2-year PFS (95.2%) of patients with stage Ⅰ to Ⅱ in the TORS group were not significantly different from those in the non-TORS group (84.1% and 83.9%, respectively, P>0.05). The 2-year OS (92.9%) and 2-year PFS rate (92.7%) of patients with stage Ⅲ to Ⅳ in the TORS group were better than those in the non-TORS group (64.7% and 63.9%, respectively, P<0.05). The 2-year OS (94.4%) of HPV-positive patients in the TORS group was not significantly different from that in the non-TORS group (83.3%, P=0.222). The 2-year OS of HPV-negative patients in the TORS group (94.1%) was significantly different from that in the non-TORS group (43.7%, P<0.001). HPV status was an independent prognostic factor (P=0.008). Conclusions: TORS has a better prognosis in the treatment of oropharyngeal squamous cell carcinoma compared with the traditional treatment methods. The patients with T1-T2 can achieve better survival benefits after TORS treatment. The HPV-positive OPSCC patients has a better prognosis than that of HPV-negative OPSCC patients, and regardless of HPV status, OPSCC patients in the TORS group could obtain a better survival prognosis.

Application value of indocyanine green fluorescence in sentinel lymph node biopsy for early-stage tongue cancer and oropharyngeal cancer / 中南大学学报(医学版)

OBJECTIVES@#Occult cervical lymph node metastasis is the most important reason for recurrence of early-stage tongue cancer and oropharyngeal cancer. Cervical sentinel lymph node (SLN) biopsy may help to identify them. Pigment dyes and radionuclide were used to label SLN. Both of them had shortage. This study aims to investigate the application and clinical value of indocyanine green fluorescence imaging in cervical SLN biopsy for patients with early-stage tongue cancer and oropharyngeal cancer.@*METHODS@#Retrospective analysis was conducted on 23 patients with early tongue cancer and oropharyngeal cancer, who received surgical treatment and used indocyanine green as a tracer to find SLN in Hunan Cancer Hospital from April to October 2021. The detection rate of SLN was calculated and the distribution of SLN in different regions of the neck was analyzed.@*RESULTS@#SLN was successfully identified in 22 of 23 patients, with a detection rate of 95.65%. Among these 22 patients, 3 patients were found to have cancer metastasis, and the rate of occult lymph node metastasis was 13.63%. No pathologically positive lymph nodes were detected in SLN-negative patients, and thus the positive predictive rate was 100%. For patients with primary lesions located in the anterior 2/3 of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 15.15%, 71.72%, 13.13%, and 0, respectively. For patients with primary lesions located in base of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 0, 44.44%, 44.44%, and 11.12%, respectively.@*CONCLUSIONS@#Indocyanine green fluorescence imaging has a high detection rate with accurate positive prediction in the anterior cervical SLN biopsy in patients with early-stage tongue cancer and oropharyngeal cancer. Meanwhile, it can also reflect the lymphatic drainage of tumors located at different primary sites, which has high clinical value.

Preliminary experience of transoral robotic surgery for oropharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the oncological and functional efficacy and safety of transoral robotic surgery (TORS) in the treatment of oropharyngeal carcinoma. Methods: Twenty-six patients with oropharyngeal cancer were enrolled who underwent TORS at Beijing United Hospital from June 1, 2017 to December 31, 2020. Among them, 22 patients were males and 4 were females, aged 39 to 76 years old. T1-2 patients accounted for 88.5% (23/26). Clinicopathological data including the time of removal of gastric and endotracheal tube were collected. The SPSS software package was used for survival analysis, and the overall survival rate and disease-free survival rate were calculated. Results: All the 26 patients with oropharyngeal cancer received TORS without conversion to open surgery, and 20 of them underwent simultaneous cervical lymph node dissection. TORS operation time ranged from 65 to 360 minutes with an average of 215 minutes. Intraoperative blood loss ranged from 5 to 600 ml with an average of 70 ml. Four patients (15.4%) underwent tracheotomy, of whom 3 patients had the removals of tracheal tubes within 1 month after surgery and 1 case remained to wear a tube by the end of follow-up. Twelve patients (46.2%) underwent gastric tube implantation, among them, 11 patients had removals of gastric tubes within 1 month after surgery and 1 patient died of oropharyngeal hemorrhage 13 days after operation. One patient (3.8%) had a positive surgical margin and others had pathologically negative surgical margins. Sixteen patients (61.5%) received postoperative radiotherapy, of whom 11 patients (42.3%) received platinum-based concurrent chemotherapy. The median follow-up time was 21.5 months (0.4 to 45 months). The overall survival and the disease-free survival rates were 83.0% and 75.8%, respectively. Conclusion: The application of TORS in treatment of oropharyngeal cancer can achieve good oncological and functional outcomes in selected patients.

Application of transoral robotic surgery in treatment of oropharyngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the therapeutic and prognostic outcomes of transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OSCC). Methods: A retrospective study of 99 OSCC patients treated with TORS in Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center between April 2017 and May 2021 was conducted. There were 84 males and 15 females, with an age range of 35-85 years. Patients' clinical characteristics, including clinical staging, HPV infection status, perioperative management and postoperative adjuvant treatment, were recorded. The overall survival (OS) and progression-free survival (PFS) were analyzed. The survival outcomes were analyzed with Kaplan-Meier method and Log-rank test. Results: The hospital stay of OSCC patients with TORS was (5.3±2.9) days and the average time of postoperative nasal feeding tube indwelling was (15.2±10.8) days. Among the 99 patients, 21 (21.2%) received tracheotomy and the average time of tracheotomy tube indwelling was (11.9±11.4) days. The two-year OS and PFS in patients with follow-up over two years were 94.0% and 87.7%, respectively and the three-year OS and PFS of patients with follow-up over three years were 94.0% and 78.9%, respectively. The two-year OS and PFS were respectively 97.4% and 88.9%, for patients with stages I-II and 86.8% and 88.9% for patients with stages III-IV. HPV-negative and HPV-positive patients had respectively two-year OS (100.0% vs. 91.5%) and PFS (88.9% vs. 87.2%). There was no significantly statistical difference in survival between patients with and without adjuvant radiotherapy after TORS (82.6% vs. 90.5%, HR=0.52, 95%CI: 0.12-2.23, P=0.400). Conclusions: TORS is more suitable for the treatment of patients with early (Ⅰ-Ⅱ) or HPV-positive oropharyngeal squamous cell carcinoma, and the recovery after TORS treatment is good.

Comparison of three kinds of free flaps used in patients with oral and oropharyngeal tumors / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the recovery and quality of life of patients with oral and oropharyngeal tumors treated with three kinds of free soft tissue flaps. Methods: The clinical data of 103 patients, including 66 males and 37 females, aged 26-74 years, who underwent primary repair of defects after resection of oral and oropharyngeal tumors in Sichuan Tumor Hospital from July 2014 to August 2020 were analyzed. Anterolateral thigh flap (ALTF) was used in 43 patients, radial forearm free flap (RFFF) in 45 patients, and lateral arm free flap (LAFF) in 15 patients. Postoperative qualities of life of patients were evaluated by the university of Washington quality of life questionnaire and oral health impact scale (HIP-14 Chinese edition). SPSS 23.0 software was used for statistical analysis. Results: The T staging of RFFF or LAFF group was significantly lower than that of ALTF group (P<0.05). There was no significant difference in mean flap areas between ALTF group ((55.87±27.38) cm2) and LAFF group ((49.93±19.44) cm2), while RFFF group had smaller mean flap area ((33.18±6.05) cm2) than ALTF group (t=5.311, P<0.001) and LAFF group (t=3.284, P=0.005). In terms of oral functions including swallowing, mastication, taste and spitmouth, there were no significant differences between LAFF group and RFFF group (P>0.05), but both groups had better oral functions than ALTF group (P<0.05). There was no significant difference in appearance scores between LAFF group (75(75, 75)) and ALTF group (75(75,75) vs.75(75,75),Z=-1.532, P=0.126), and both groups had higher scores than RFFF group (50(50, 75),Z values were -3.447 and -3.005 respectively, P<0.05). RFFF group had higher speech score (100(67, 100)) than LAFF group (67(50, 76),Z=-2.480, P<0.05) and ALTF group (67(33, 67),Z=-5.414, P<0.05). ALTF group had lower mean score of quality of life than RFFF group [72(56,77) vs.79(69, 89),Z=-3.070, P<0.05), but there was no statistical difference in the mean scores of qualities of life between ALTF group and LAFF group (Z=1.754, P=0.079). According to the evaluation of oral health impact scale (HIP-14 Chinese version) 1 year after surgery, individual item scores and the average score of all items in ALTF group were lower than those in RFFF and LAFF groups (P<0.05), with no significant difference between RFFF group and LAFF group (P>0.05). Conclusions: RFFF has unique advantages for small tissue defects, while ALTF is suitable for large tissue defects, such as buccal penetrating defect, whole tongue and near whole tongue defect, and LAFF is a compromise choice between ALTF and RFFF. ALTF is inferior to RFFF and LAFF in oral functional reconstruction, including swallowing, chewing, taste and spittle. ALTF and LAFF are superior to RFFF in postoperative appearance.

Complete pathologic response as a prognostic factor for squamous cell carcinoma of the oropharynx post-chemoradiotherapy / Resposta patológica completa como fator prognóstico no carcinoma espinocelular de orofaringe após quimiorradioterapia

ABSTRACT INTRODUCTION: Chemoradiotherapy for squamous cell carcinoma of the oropharynx (SCCO) provides good results for locoregional disease control, with high rates of complete clinical and pathologic responses, mainly in the neck. OBJECTIVE: To determine whether complete pathologic response after chemoradiotherapy is related to the prognosis of patients with SCCO. METHODS: Data were prospectively extracted from clinical records of N2 and N3 SCCO patients submitted to a planned neck dissection after chemoradiotherapy. RESULTS: A total of 19 patients were evaluated. Half of patients obtained complete pathologic response in the neck. Distant or locoregional recurrence occurred in approximately 42% of patients, and 26% died. Statistical analysis showed an association between complete pathologic response and lower disease recurrence rate (77.8% vs. 20.8%; p = 0.017) and greater overall survival (88.9% vs. 23.3%;p = 0.049). CONCLUSION: The presence of a complete pathologic response after chemoradiotherapy positively influences the prognosis of patients with SCCO.

RESUMO Introdução: O tratamento baseado em quimirradioterapia do Carcinoma Espinocelular de Orofaringe (CECOF) apresenta bons resultados no controle locorregional da doença com boas taxas de resposta clínica e patológica completas especialmente no pescoço. Objetivo: Determinar se a resposta patológica completa após quimiorradioterapia estárelacionada aos prognósticos dos pacientes com CECOF. Método: Os dados foram obtidos de maneira prospectiva da revisão de prontuários de pacientes com CECOF N2 e N3 submetidos a esvaziamento cervical planejado após quimiorradioterapia. Resultados: Um total de 19 pacientes foram avaliados. Metade dos indivíduos apresentou resposta patológica completa no pescoço. Recidiva à distância ou locorregional ocorreu em aproximadamente 42% dos pacientes e 26% deles morreram. A análise estatística demonstrou uma associação entre resposta patológica completa e menor taxa de recidiva (77,8% vs.20,8%; p = 0,017) e maior sobrevivência global (88,9% vs.23,3%; p = 0,049). Conclusão: A presença de resposta patológica completa após quimiorradioterapia influencia positivamente no prognóstico de pacientes com carcinoma espinocelular de orofaringe.

Cirugía trans-oral robótica para manejo de cáncer de orofaringe / Trans-oral robotic surgery for tongue cancer

Background: The traditional treatment of oropharyngeal cancer was based mainly in radio and chemotherapy, aiming to avoid organ excisions. However, the adverse effects of these therapies prompted the development of new therapies. Among these, trans-oral robotic surgery (TORS) has promising results. Case reports: We report two patients operated using this technique. An 82 years old woman treated for a tumor in the base of the tongue six years ago with radiotherapy. A new lesion in the tongue was found and excised by TORS uneventfully. The pathology report confirmed the complete excision of the malignant lesion. A 57 years old male with a history of palate cancer treated with radiotherapy in 1990. In 2013 a submandibular mass was biopsied confirming the presence of a squamous carcinoma metastasis. During a bilateral suprahyoid dissection, a tumor in the base of the tongue was found. In a second intervention the tumor was excised by TORS. The pathology reports tumor free borders but near the lesion. Postoperative radiotherapy was recommended.

Introducción: El cáncer de orofaringe representa una importante causa de morbimortalidad en la esfera de las patologías de cabeza y cuello en la actualidad. Su tratamiento tradicional por mucho tiempo consideró la conservación de órganos, utilizando mayoritariamente la radio y quimioterapia como herramientas terapéuticas. Los efectos no deseados tanto de las terapias médicas como las quirúrgicas han obligado a desarrollar técnicas nuevas para el manejo de estas enfermedades. Es así que a partir del año 2006 se ha ido desarrollando a nivel mundial la técnica de cirugía robótica transoral (TORS). La morbilidad y resultados oncológicos de este procedimiento hasta ahora se ven alentadores, por lo que se está transformando en una alternativa terapéutica que debemos manejar. Casos clínicos: Se presentan los dos primeros casos a nivel país realizados en esta institución de cánceres de orofaringe tratados con la técnica tradicional y después de largo tiempo recidivados. Se les realizó cirugía resectiva de sus tumores a través de TORS; se describen los resultados de estos procedimientos.

Modified Mandibulotomy Technique to Reduce Postoperative Complications: 5-Year Results

PURPOSE: To review the 5-year outcomes of our modified mandibulotomy technique. Retrospective review of a tertiary level oral cancer center. MATERIALS AND METHODS: During a 5-year period, 30 patients who had a uniform surgical technique consisting of a lower lip-splitting, modified stair-step osteotomy with thin saw blade and osteotome after plate-precontouring and combination fixation with monocortical osteosynthesis (miniplate) and bicortical osteosynthesis (maxiplate and bicortical screws), with at least 14 months postoperative follow-up, were selected and reviewed retrospectively. RESULTS: There were 8 women and 22 men with an average age of 56.5 years. All the patients involved malignancies were squamous cell carcinoma. The main primary sites of the those who underwent a mandibulotomy were the tonsil, the base of tongue, the oral tongue, the retromolar pad area, and others. Others included buccal cheek, floor of mouth, and soft palate. 23 patients received postoperative radiation therapy, and among whom 8 patients also received chemotherapy. Total four (13%) mandibulotomy-related complications occurred, only two (6.7%) requiring additional operation under general anesthesia. CONCLUSION: Our modified mandibulotomy meets the criteria for an ideal mandibulotomy technique relatively well because it requires no intermaxillary fixation, can precise preserve the occlusion in a precise way, allows early function, requires no secondary procedures, and has few complications.

Carcinoma epidermóide de orofaringe: análise de resultados do tratamento cirúrgico em 2 instituições / Oropharyngeal squamous cell carcinoma: outcomes of primary surgical treatment at two head and neck surgery departments

O objetivo deste estudo foi avaliar os resultados tardios do tratamento cirúrgico de pacientes com carcinoma epidermóide de orofaringe visando a identificação de fatores prognósticos nessa população. Os prontuários de 325 pacientes tratados nos Serviços de Cirurgia de Cabeça e Pescoço do Hospital A C Camargo e Hospital Heliópolis foram revisados. Todos os pacientes foram submetidos à cirurgia com ou sem radioterapia pós-operatória, de 1990 a 2005. Dois estudos foram realizados, o primeiro com 89 pacientes com lesões em estádios clínico I e II. Neste estudo incluímos 20 pacientes tratados no Hospital de Câncer de Barretos. Trinta e sete pacientes (41,6%) apresentavam tumores em estádio I e 52 (58,4%) em estádio II. Sessenta e dois pacientes (69,7%) foram tratados apenas com cirurgia e 27 pacientes foram tratados com cirurgia e radioterapia pós-operatória (30,3%). Durante o seguimento pós-operatório observamos que: 26,9% dos casos apresentaram recidiva local, 10,1% recidiva regional e 3,4% metástases à distancia. As taxas de sobrevida global e livre de doença aos 5 anos foram de 60,4% e 59,7% respectivamente. O modelo de Cox demonstrou que os fatores prognósticos independentes para sobrevida global foram grau histológico pouco diferenciado e pN2. No segundo estudo incluímos 256 pacientes com lesões ressecáveis em estádios III e IV. Noventa e cinco pacientes (37,1%) tinham tumores estádio III e 161 em estádio IV (62,9%). Cinquenta e cinco pacientes foram tratados apenas com cirurgia e 201 foram tratados com cirurgia e radioterapia pós-operatória (78,5%) Durante o seguimento pós-operatório observamos: 29% de recidiva local, 10,5% de recidiva regional e 7,4% de metástase à distancia. As taxas de sobrevida global e livre de doença aos 5 anos foram de 43% e 54,5%, respectivamente. O modelo de Cox demonstrou que os fatores prognósticos independentes para predição das taxas de sobrevida global foram: tamanho do tumor >3cm, pN+RC+ e presença de intenso infiltrado linfocitário peri-tumoral

The purpose of this study was to review the late outcomes of primary surgical treatment of patients with squamous cell carcinoma of the oropharynx, aiming to identify prognostic factors in this population. The records of 325 patients treated at Hospital A C Camargo and Hospital Heliópolis were reviewed. All included patients were treated with surgery with or without postoperative radiotherapy from 1990 to 2005. Two different studies were conducted, the first one with 89 patients who had clinical stage I or II cases. For this study 20 patients treated at Hospital de Cancer de Barretos were included. Thirty-seven patients (41.6%) had tumors at stage I and 52 (58.4%) at stage II. Sixty-two patients (69.7%) had surgery only and 27 patients had surgery and postoperative radiotherapy (30.3%). During follow-up, there were 26.9% local recurrences, 10.1% regional recurrences and 3.4% distant metastasis. The 5-year overall survival rate was 60.4% and the 5-year disease free survival was 59.7%. The Cox model demonstrated poorly differentiated (histological grade) and pN2 as independent prognostic markers for decreased overall survival. For the second study 256 patients who had resectable clinical stage III and IV tumors were included. Ninety-five (37.1%) had tumors at stage III, 161 at stage IV (62.9%). Fifth-five patients had surgery only and 201 had surgery and postoperative radiotherapy (78.5%). During follow-up, there were 29% of local recurrences, 10.5% of regional recurrences and 7.4% of distant metastasis. The 5-year overall survival rate was 43.0% and the 5-year disease free survival was 54.5%. The Cox multivariate model demonstrated tumor size >3cm and pN+ECS+ as independent prognostic markers for decreased OS. The presence of intense lymphocytic infiltrate was associated with higher OS rates.

Survival and quality of life of patients with oral and oropharyngeal cancer at 1-year follow-up of tumor resection

OBJECTIVE: This study aimed to assess the survival and life quality evolution of patients subjected to surgical excision of oral and oropharyngeal squamous cell carcinoma. MATERIAL AND METHODS: Forty-seven patients treated at a Brazilian healthcare unit specialized in head and neck surgery between 2006 and 2007 were enrolled in the study. The gathering of data comprised reviewing hospital files and applying the University of Washington Quality of Life (UW-QOL) questionnaire previously and 1 year after the surgery. Comparative analysis used Poisson regression to assess factors associated with survival and a paired t-test to compare preoperative and 1-year postoperative QOL ratings. RESULTS: 1 year after surgery, 7 patients were not found (dropout of the cohort); 15 had died and 25 fulfilled the UW-QOL again. The risk of death was associated with having regional metastasis previously to surgery (relative risk=2.18; 95 percent confidence interval=1.09-5.17) and tumor size T3 or T4 (RR=2.30; 95 percentCI=1.05-5.04). Survivors presented significantly (p<0.05) poorer overall and domain-specific ratings of quality of life. Chewing presented the largest reduction: from 74.0 before surgery to 34.0 one year later. Anxiety was the only domain whose average rating increased (from 36.0 to 70.7). CONCLUSIONS: The prospective assessment of survival and quality of life may contribute to anticipate interventions aimed at reducing the incidence of functional limitations in patients with oral and oropharyngeal cancer.

Oropharyngeal True Teratoma.

Oropharyngeal teratoma in newborn is very rare. Here we report a case of oropharyngeal true teratoma where a 17-day-old female baby presented with a protruding mass from oropharynx with episodic respiratory distress and feeding difficulty complicated by aspiration pneumonia, and treated successfully with coordinated team approach.

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.

Resultados do tratamento cirúrgico versus quimioradioterápico em tumores iniciais da orofaringe / Results of surgical treatment versus chemoradiation therapy in oropharyngeal early tumors

Introdução: O carcinoma epidermoide na cabeça e pescoço é diagnosticado em aproximadamente 40% dos casos em estádios clínicos avançados. Objetivo: Avaliar a sobrevida livre de doença nos pacientes com carcinoma epidermoide de orofaringe de estádio clínico (EC) precoce (I e II), submetidos ao tratamento cirúrgico ou quimioradioterápico. Método: Estudo retrospectivo de 139 prontuários de pacientes portadores de carcinoma epidermoide de orofaringe submetidos a tratamento com intenção curativa, sendo elegíveis 38 casos de tumores de estádios clínicos precoces (I e II). Destes, 27 (71,1%) foram à cirurgia e 11 (28,9%) à quimioradioterapia, com idade média de 56,4 anos. Quanto ao gênero, 31 (81,6%) eram do masculino e sete (18,4%) do feminino. Resultados: Nos 11 pacientes submetidos à quimioradioterapia, 72,7% obtiveram controle loco-regional da doença e a sobrevida livre de doença há dois anos foram 42%. Dentre os 27 pacientes operados, 19 mantiveram-se em EC I e II no laudo histológico e seis foram à radioterapia pós-operatória. A sobrevida livre de doença há dois anos foi 70%. Conclusão: Os pacientes submetidos inicialmente à cirurgia tiveram melhor sobrevida livre de doença, quando comparados aos pacientes com tratamento quimioradioterápico.

Introduction: The epidermoid carcinoma of the upper aerodigestive tract is diagnosed in approximately 40% of the cases of advanced clinical stages. Objective: To evaluate the disease-free interval in patients with clinical stages I and II epidermoid carcinoma who were submitted to surgery or chemoradiation. Method: Retrospective study of the records of 139 patients treated for oropharyngeal epidermoid carcinoma submitted to treatment with curative intent. Among those patients, 38 were classified with early tumors clinical stages I and II. Twenty-seven (71.1%) underwent surgical treatment whereas eleven (28.9%) were treated with chemoradiation. The mean age was 56.4 years; 31 cases (81.6%) were in men and seven (18.4%) were in women. Results: Among the eleven patients who were submitted to chemoradiation, 72.7% obtained locoregional control of the disease and their disease-free survival was of 42%. Among the 27 patients operated, 19 remained in Clinical Stages I and II in the histological report and six underwent postoperative radiation therapy. The disease-free interval for two years was of 70%. Conclusion: The patients submitted to the surgery had a better disease-free interval as compared to those submitted to chemoradiation treatment.

Avaliação de fatores demográficos e estadiamento clínico nos pacientes submetidos a resgate cirúrgico por carcinomas epidermóides de orofaringe / Assessment of demographics factors and clinical staging in patients submitted to salvage surgery for oropharyngeal squamous cell carcinoma

O tratamento clássico do carcinoma epidermóide das vias aéreas digestivas superiores (VADS) é a cirurgia, associada ou não à radioterapia pós-operatória. As recidivas loco-regionais constituem a principal falha no tratamento inicial e o diagnóstico precoce favorece a indicação de cirurgia de resgate. OBJETIVO: Análise descritiva dos dados demográficos e de estadiamento no resgate cirúrgico dos tumores de orofaringe. CASUÍSTICO E MÉTODOS: Estudo retrospectivo de 78 pacientes, submetidos à cirurgia em todos os casos e a radioterapia complementar em 37 destes. RESULTADOS: Predomínio do gênero masculino em 70 casos, com idade média de 54,2 anos e etnia branca em 54 pacientes. O pacientes foram estadiados em T3 e T4 em 38 casos. Dos 78 pacientes, 40 eram pescoço N0. Trinta e cinco pacientes desenvolveram recidiva loco-regional e à distância. Das recidivas loco-regionais, 17 deles foram submetidos ao resgate cirúrgico, sendo que 12 pacientes foram reestadiados na recidiva em T1; 2 em T2 e quanto ao N, 2 eram N2a e 2 eram N2b. A idade média dos pacientes submetidos ao resgate foi de 52,8 anos, com predomínio na etnia branca e gênero masculino. CONCLUSÃO: O resgate predominou em estádios I e II com controle da doença em 58,8 por cento.

The usual management of upper aero digestive tract squamous cell carcinoma is surgery associated or not to post surgical radiotherapy. Loco-regional relapses constitute the main failure of the initial treatment and early diagnosis justifies the indication of salvage surgery. AIM: Descriptive analysis of demographic data and staging for salvage surgery of oropharynx tumors. MATERIALS AND METHODS: We studied retrospectively 78 patients submitted to surgery in all cases; however, just 37 patients received post surgical radiotherapy. RESULTS: There was a predominance of males in 70 cases, with mean age of 54.2 years, and 54 patients were Caucasian. The patients were classified as T3 and T4 in 38 cases and 40 patients were classified as N0 neck. 35 patients developed loco-regional distant relapses. 17 patients were submitted to salvage surgery and 12 patients were reclassified as T1; 2 patients T2 and in relation to the clinical stage N, 2 patients were N2a and 2 patients N2b. The average age of the patients submitted to salvage surgery was 52.8 years, with predominance of male Caucasians. CONCLUSION: Clinical stage I and II were accorded salvage surgery.

Características clínico-epidemiológicas de pacientes portadores de carcinomas da cavidade oral e orofaringe em clínica privada no Sul do Brasil / Clinical-epidemiologic characteristics of patients with oral cavity and oropharynx cancer in a Private Ambulatory in South Brazil

Objetivo: Definir o perfil clínico e epidemiológico dos pacientes com diagnóstico de câncer de boca e orofaringe, atendidos em clínica de cirurgia de Cabeça e Pescoço. Métodos: Foram avaliados os prontuários dos pacientes com diagnóstico de carcinoma de boca e orofaringe atendidos no período de 2002 a 2006, em clínica decirurgia de Cabeça e Pescoço. Foram incluídos no estudo os prontuários de pacientes que foram submetidos, após o estadiamento da doença, a alguma modalidade de tratamento. Resultados: Entre os 28 casos incluídos no estudo,88,8% eram do gênero masculino, 85,7% eram caucasianos e a faixa etária mais acometida foi entre 51 e 60anos. A queixa de “ferida na boca” esteve presente em 88,8% dos casos de carcinoma de boca e odinofagia em80% dos casos de carcinoma de orofaringe. O tabagismo esteve presente em 92,8% e o etilismo em 85,7% dos pacientes. O sítio mais acometido na cavidade oral foi a língua (50%) e, na orofaringe, a amigdala e o palato mole (ambos com 40%). A maior parte dos pacientes foi submetida a tratamento cirúrgico radical (77,7%) com ou sem radioterapia adjuvante. O diagnóstico histopatológico, em aproximadamente 96% dos casos, indicou carcinoma espinocelular. Conclusões: Especial atenção dos profissionais de saúde, principalmente médicos e odontólogos, deve serdirecionada aos pacientes com idade maior que 50 anos, tabagistas e etilistas, com queixa de lesão na cavidade oral ou odinofagia persistente, com o objetivo de diagnósticosprecoces e maiores índices de tratamentos curativos, com menores taxas de morbidade e mortalidade.

Objective: It mains evaluate clinical and epidemiological factors of patients with oral cavity and oropharynx cancer that were trated in a head and neck surgeryclinic. Methods: The patients’ records that were taken care from 2002 to 2006 in head and neck surgery clinic andpatients with mouth and oropharynx carcinoma were evaluated. Results: Among 28 patients, 88,8% were men, 85,7% were caucasian, the average age was from 51 to 60, the complain about hurt in mouth was in 88,8% of the patients with oral cavity cancer and the odinofagia in 80% of the patients with oropharynx cancer.92,8% used tosmoke and 85,7% used to drink alcoholic drinks. The tongue was the most stricken part in oral cavity (50%), tonsil and soft palate (both 40%) in oropharynx. In the diagnose most of the patients were in advanced clinicalstaging cancer (III and IV) and infiltrating ulcer in both situations. Most of the patients were submitted to a radical the surgery treatment (77.7%) with or without adjuvant radiation therapy or chemotherapy. In almost 96% of the cases the histopathology diagnosis indicated squamous cell carcinoma. Conclusion: Special attention from the health professionals, mainly physicians and dentists, must be givento patients older than 50 years, smokers and alcoholic drunker, that complain about persistent oral hurt or odinofagiain an appointment to have a precocious diagnoses and higher ways of curative treatments, with lesser evidence of morbidity and mortality.

Avaliação da sobrevida livre de doença de pacientes com recidiva loco-regional de carcinoma epidermóide de cavidade bucal e orofaringe submetidos a tratamento de resgate / Assessment of disease-free survival in patients with loco-regional recurrence of squamous cell carcinoma of the oral cavity and oropharynx submitted to salvage treatment

OBJETIVO: A cirurgia de resgate é primeira opção terapêutica, principalmente nas lesões de estadio clínico inicial. O objetivo do estudo é avaliação da sobrevida livre de doença após resgate cirúrgico de tumores de cavidade bucal e orofaringe. MÉTODOS: Estudo retrospectivo de 276 pacientes tratados com cirurgia, sendo que 127 desenvolveram recidiva loco-regional. Noventa e sete pacientes eram de estadiamento clínico inicial e 178 de estadiamento clínico avançado. Vinte e cinco casos de lábio, 173 cavidade bucal e 78 de orofaringe. A radioterapia pós-operatória foi realizada em 121 pacientes com dose média de 60,8 Gy. RESULTADOS: Oitenta e nove pacientes foram submetidos a tratamento de resgate, sendo que 76 destes foram à cirurgia. As recidivas loco-regionais de cavidade bucal foram submetidas ao resgate cirúrgico em 65 por cento casos. A sobrevida livre de doença pós-cirurgia de resgate foi de 13 por cento nas recidivas até seis meses e 48 por cento nas recidivas após 12 meses de seguimento (p=0,0009). O tipo de resgate e o intervalo livre de doença foram fatores independentes de sobrevida na análise multivariada. CONCLUSÃO: A sobrevida livre de doença pós-resgate nos estadios clínicos iniciais (I e II) foi de 70 por cento.

OBJECTIVE: Salvage surgery is the first therapeutic option for recurrent tumors of the mouth and oropharynx, mainly in early stage tumors. This study intends to evaluate the disease free survival interval after salvage treatment for recurrent tumors of the mouth and oropharynx. METHODS: Retrospective analysis of 276 patients with squamous cell carcinoma of the mouth and oropharynx treated with surgery. One hundred and twenty seven patients developed loco-regional recurrence. Ninety-seven were staged as early tumors and 178 as advanced ones. The tumor site was the lip in 25 cases, oral cavity in 173 and oropharynx in 78. Postoperative radiotherapy was indicated in 121 cases with a mean dose of 60.8Gy. RESULTS: Eighty-nine patients underwent salvage treatment (surgery in 76 patients). Loco-regional recurrences were treated with salvage surgery in 65 percent of cases. Disease free survival after salvage surgery was 13 percent in cases with recurrences diagnosed up to 6 months and 48 percent in those who recurred after 12 months of follow-up (p=0.0009). Modality of salvage treatment and the disease free interval were independent variables of survival in the multivariate analysis. CONCLUSION: In cases clinically staged as I and II, the disease free survival in five years after salvage treatment was 70 percent.

Salvage surgery for recurrent oral and oropharyngeal carcinoma

Local and regional recurrences are the main sites of treatment failure in patients with oral and oropharyngeal squamous cell carcinoma. Treatment failure depends fundamentally on tumor biologic behavior, previous treatment and the initial clinical stage. The rates of loco-regional recurrences range from 25 to 48%, and distant metastasis rarely occur in an isolated manner. When recurrent cancer is significant and there are no distant metastasis salvage surgery is the most widely used treatment approach. Most of these patients were previously treated with radiotherapy. Therefore, when recurrence occurs, salvage surgery is the only possible treatment option with curative intent. The aim of this study was to review the data in the literature regarding results of salvage surgical treatment for patients with recurrent oral and oropharyngeal carcinomas

Cáncer de orofaringe. INEN / Orophryngeal cancer. INEN

Se realizó una revisión de los aspectos anatómicos, fisiopatológicos, y cuadro clínico del Cáncer de Orofaringe, así como también un estudio retrospectivo de los casos de Cáncer de Orofaringe tratados en el INEN entre 1975 y 1994, analizando localizaciones más frecuentes, sintomatología, etapas clínicas, tipos histológicos, modalidades de tratamiento y resultados. En el período estudiado se trataron 174 pacientes con Cáncer de Orofaringe, las localizaciones más frecuentes, fueron las amígdalas y los pilares (66.7 por ciento) seguido de la base de la lengua (16.7 por ciento) y paladar blando (15.5 por ciento), el tipo histológico más frecuente fue el carcinoma Epidermoide (73 por ciento). La mayoría de los pacientes presentaban enfermedad neoplásica avanzada en etapas clínicos III y IV (37.9 por ciento) y (50.8 por ciento) respectivamente. La modalidad de tratamiento inicial fué radioterapia y cirugía radical para enfermedad persistente o recurrente. La sobrevida y el control local fueron calculados por el Método Actuarial, la sobrevida global libre de enfermedad a 5 años para todas las localizaciones fue 27.6 por ciento.