Craniofacial resections for paranasal malignancies

From 1984-1989, 18 patients underwent craniofacial resections for paranasal sinus malignancies involving the anterior skull base. Histologic types included 9 epidermoid cancer, 3 undifferentiated carcinoma, 3 adenoidcystic carcinoma, 2 adenocarcinoma and 1 esthesioneuroblastoma. A 44% complication rate included predominantly meningitis [22%], resulting from cerebrospinal fluid leaks [33%] and osteomyelitis [11%] An overall survival rate of 50% was recorded with follow up in all patients ranging from 26-38 months [mean 29 months]. Two surgery related deaths [11.1%] resulted from uncontrolled gram-negative meningitis. Disease free survival rate was notably better in those cases who underwent planned craniofacial surgery pre-post-operative radiation [58%] than in those in whom surgical salvage was carried for radio-recurrent tumors [33%]. Accurate pre-surgical assessment by high resolution computed tomography, satisfactory en bloc resection, meticulous repair of skull base defect and vigilant post-operative care seem to be critical factors enhancing local control sans overt morbidity

Radiorecurrent laryngeal cancers-role of salvage laryngectomy

Radiation therapy is a well established treatment for early laryngeal cancers. Recurrence after curative irradiation accounts for 15-30% of T1, T2 laryngeal cancers. Most recurrent lesions manifest in advanced stages despite close follow up and pose a challenge for surgical salvage. We recount our experience with 15 such lesions followed up over a period ranging from 18 months-4 years. Eight per cent of the lesions required upstaging with respect to clinical T stage after pathological examination. A surgical salvage rate of 86% was achieved by salvage total laryngectomy. Significant morbidity in the form of pharyngocutaneous fistula was seen in 20%. Our study re-emphasizes the utility of salvage laryngectomy even after cancericidal doses of irradiation

Treatment strategy for neck metastasis from an occult head and neck primary

This study highlights our treatment policy in 26 cases of epidemeroid metastatic carcinoma in the neck from a primary deemed occult, after exhaustive examination of the Upper Aerodigestive Tract. Planned Radical Neck Dessection and post-operative radiotherapy has been the favored approach in all neck nodes deemed resectable and a loco-regional control rate of 64% was obtained using this combined modality approach. Pre-operative Radiotherapy was utilized in three cases with nodal disease of borderline resectability and loco-regional control was achieved in one case. Three cases of massive neck matastasis initially unresectable became amenable to surgical salvage after RT with concurrently administered chemotherapy. Only one of these remained disease free. Overall loco-regional control rate of 55% could be achieved in 20 evaluable patients followed up for 2 years-3 years [mean 30.5 months]. Regional failure were noted in 25% of patients while distant spread occurred in 15%, thus accounting for an overall failure rate of 40%. Manifest primary were documented in 20%, half of which could be salvaged and successfully controlled

Rehabilitation after ablative laryngeal surgery, the kidwai experience

This study was conducted to assess the impact of total laryngectomy on the life style of thirty one [31] laryngectomized patients. Questionnaires were prepared in regional language [Kannada] which was designed to enquire about critical factors affecting successful acquisition of esophageal speech. We have observed that patients with excellent esophageal speech are motivated [100%], educated [100%], economically stable [100%] and had minimal organic defects. Seventy four percentage of patients went back to their original job though 58% of them complained of reduced income directly attributed to the loss of speech. This study emphatises that it is important to ensure regular speech therapy to facilitate satisfactory vocal rehabilitation. After two months of oncotherapy [viz., surgery and post operative RT] it is likely that patients will express their reluctance/inability to participate in such programmes owing to financial constraints and physical/mental exhaustion. Therefore it is of paramount importance to help these patients to overcome their difficulties and provide optional conditions to developed satisfactory esophageal voice

Epidermoid paranasal sinus cancer: Surgery and postoperative radiation therapy

Nineteen consecutive paranasal tumours, 12 maxillary and 7 ethmoidal were managed by primary surgery followed by post operative radiation. CT scan proved to be invaluable in determining the resectability.Compliance to complete oncotherapy was noted in 13/19 patients. Satisfactory local control was achieved in 52.9% of the evaluable cases. Failure at primary site [35.3%] was invariably associaed with incomplete resection. Failure with recurrenc in the neck occurred in 2 patients despite adequate local control. Enbloc excision with tumour free cutmargins when followed by postoperative radiation appeared to enhance local control