Use of a linear stapler device in total laryngectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of using a linear stapler device for the closure of the pharynx during total laryngectomy.</p><p><b>METHODS</b>Sixteen total laryngectomies were performed between August 2010 and December 2011, during the operation, the TA 60 linear stapler was used for pharyngeal closure. Among these patients, two patients had the history of pre-operative radiotherapy, four patients recurred after radiotherapy, ten patients were treated for the first time. 100 ml methylene blue was injected into the newly closed laryngopharyngeal cavity through the nasopharyngeal breather pipe for checking up whether it was watertight or not.</p><p><b>RESULTS</b>Among the sixteen patients, methylene blue leakage from the mucosal joint of the gular cavity closed by the stapler were not found in fifteen patients, it was only found in one patient. The transudatory places were sutured with absorbable Vicryl sutures. This patient healed well without pharyngocutaneous fistula. Negative surgical margins were achieved in all patients. No patient needed to be transferred to open surgery. Using a linear stapler device in total laryngectomy, 45 minutes could be saved as compaired to manual suture. One patient developed a light pharyngocutaneous fistula. The incidence of pharyngocutaneous fistula was 6.25% (1/16).</p><p><b>CONCLUSIONS</b>This stapled closed technique for pharyngoplasty is efficient, eliminates the risk of wound contamination, saves operation time and decreases the incidence of pharyngocutaneous fistula. This technique can be recommended as alternative for repairing the pharynx in patients undergoing total laryngectomy.</p>

Application of SELDI-TOF-MS in establishing a model for predicting radiotherapy response of hypopharyngeal cancers / 南方医科大学学报

<p><b>OBJECTIVE</b>To detect the serum proteomic fingerprints in patients with hypopharyngeal squamous cell carcinoma (HPSCC) by surface enhanced laser desorption/ionization time of flight mass spectrometry (SELDI-TOF-MS) protein chip array technique.</p><p><b>METHODS</b>The serum samples were obtained from 58 HPSCC patients for protein expression analysis using SELDI-TOF Protein Chip technique and cation-exchange (CM10) protein array. All the spectra were compared and the qualified mass peaks with mass-to-charge ratios (m/z) between 1 and 70 kD were autotimatically detected. The tree analysis pattern was generated using Biomarker Patterns Software.</p><p><b>RESULTS</b>The protein profiles of HPSCC serum were analyzed according to the clinical and pathological features of the patients and their treatment response. No significant difference was noted in the serum proteins between HPSCC patients with different statuses of cervical lympha node metastasis (P>0.05), and the difference between well differentiated and poorly differentiated HPSCC was only minor. No significant difference was found in the serum proteins between chemotherapy-sensitive patients and the insensitive patients (P>0.05), but 5 proteins were identified to be overexpressed in the sensitive patients (P < / = 0.05). Radiotherapy-sensitive HPSCC patients were segregated from the insensitive group with a sensitivity of 86.67% and specificity of 100%.</p><p><b>CONCLUSION</b>The serum protein at the m/z value of 6115.74 is overexpressed in radiotherapy-sensitive HPSCC patients. Serum protein profiling allows the prediction of radiotherapy response in HPSCC patients, and the identified proteins may serve as candidate biomarkers for predicting the radiotherapy sensitivity of HPSCC.</p>

Use of en bloc principle in re-operation of thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The study is to explore the extent, main-point and use of en bloc principle in re-operation of thyroid carcinoma.</p><p><b>METHODS</b>Clinical data of 75 patients received re-operation from 2002 to 2006 because of nonstandard operation were reviewed, including 10 men, 65 women, age ranging from 21-56. Ipsilateral completing lobectomy, isthmectomy, ipsilateral anterior cervical muscle, and level VI dissection were done in all the patients by en bloc principle.</p><p><b>RESULTS</b>Residual tumor was found in 39 cases. There were, 10 in primary site, 8 in VI level, and 21 in both. Therefore tumor residual rate was 52.0%. The total metastatic lymph nodes in VI level were 63. Among the eight patients with recurrent laryngeal nerves paralyses which were hurt in the first operation, 4 were found been cut completely, 4 were ligated. The ligated locations were all near the place which the nerve enter the larynx. The ligated nerves were released, and the patients voice was improved greatly.</p><p><b>CONCLUSIONS</b>Ipsilateral completing lobectomy, isthmectomy, ipsilateral anterior cervical muscle and VI level dissection is adequate for thyroid carcinoma patients who received nonstandard operation. The principle of en bloc resection can be used in the reoperation of thyroid carcinoma.</p>

Clinicopathological features and prognosis of nasopharyngeal adenocarcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical manifestations, EB virus serology and treatment outcome of nasopharyngeal adenocarcinoma (NPAC).</p><p><b>METHODS</b>Clinical records of NPAC patients between 1964 and 2000 in Cancer Center of Sun Yat-sen University were retrospectively reviewed.</p><p><b>RESULTS</b>Among 48 patients with NPAC, 45.2% (7 cases of N1, 8 cases of N2 and 4 cases of N3) of them presented with cervical metastasis. Pathologically, common type and salivary gland type of NPAC accounted for 58.3% (28 cases) and 41.7% (20 cases) respectively. The positive rate of the EB virus antibody VCA-IgA was 56.7% in the whole group and only 23.7% in the salivary gland type of NPAC. The overall local control rate and the 5-year disease free survival rate by Kaplan-Meier method were 87.0% (40/46) and 65.2% respectively. Baseline data analysis showed that age, gender, N stage and M stage were not the significant factors, never the less the T stage was not balanced between the two groups (surgery plus radiotherapy vs radiotherapy alone, chi2 = 4.801, P = 0.045). The patients treated by surgery plus radiotherapy had significantly higher 5-year disease free survival rate than by radiotherapy alone (88.9% vs 74.7%, Log Rank test: chi2 = 4.272, P = 0.039). Cox's multivariate analysis showed treatment modality and N stage were the significant factors influencing survival (RR were 15.276 and 6.529, P < 0.05).</p><p><b>CONCLUSIONS</b>NPAC is a distinct entity in all types of nasopharyngeal carcinoma. EB virus serology has limited value in its diagnosis. Surgery plus radiotherapy could be another choice of treatment for early lesions of NPAC.</p>

Prognostic factors of medullary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate prognostic factors of medullary thyroid carcinoma.</p><p><b>METHODS</b>By using univariate analysis and multivariate analysis, the prognostic factors were investigated in 102 patients with medullary thyroid carcinoma treated at this hospital.</p><p><b>RESULTS</b>Overall survival rates of 5-year, 10-year and 15-year were 87.4%, 74.6% and 54.2% respectively by Kaplan-Meier method analysis. In univariate analysis, gender, age, bilateral thyroid lobe tumors, tumor size > 4 cm, invasion of thyroid capsule, distant metastasis, and non-radical tumor resection were significant poor prognostic factors. In multivariate analysis, tumor size > 4 cm (chi(2) = 7.43, P = 0.0035), distant metastasis (chi(2) = 23.50, P = 0.0000), and non-radical tumor resection (chi(2) = 25.90, P = 0.0000) remained as independent prognostic factors.</p><p><b>CONCLUSIONS</b>Tumor size > 4 cm, distant metastasis, and non-radical tumor resection are the independent predictors of patients survival. Early diagnosis and early therapy can improve significantly the prognosis of medullary thyroid carcinoma.</p>

Concurrent chemoradiotherapy versus radiotherapy alone for locoregionally advanced nasopharyngeal carcinoma: a meta-analysis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To determine the value of concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma from the mainland of China.</p><p><b>METHODS</b>Data were extracted from randomized trials comparing chemotherapy plus radiotherapy with radiotherapy alone in locally advanced nasopharyngeal carcinoma. Actuarial rates of survival and distant metastases were calculated. The followed electronic databases were searched the Chinese Biomedicine database, Pubmed, Medline, Embase and Cochrane library; Data were extracted by tow reviewers and Review manager 4.1 software was applied for statistical analysis.</p><p><b>RESULTS</b>Eighteen trials with 1993 patients were include according to the including criterion. The 3-year overall survival rate of the chemoradiotherapy group and the radiotherapy group were 68.47% and 56.38% respectively, and the 5-year overall survival rate of the two groups above were 51.91% and 41.09% respectively, while the distant metastases rate of the chemoradiotherapy group and the radiotherapy group were 26.19% and 38.71% respectively. The result demonstrated that chemoradiotherapy increased overall survival by 12% at 3 years, and 11% at 5 years after treatment. After chemoradiotherapy, the rate of distant metastasis was reduce by 12%.</p><p><b>CONCLUSIONS</b>In patients with locoregionally advanced nasopharyngeal carcinoma, chemoradiotherapy significantly improves overall survival at 3 years, and 5 years compared with radiotherapy alone.</p>

Clinical study of 36 cases with adenoid cystic carcinoma of the maxillary sinus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical characters, management and the prognosis of patients with adenoid cystic carcinoma of the maxillary sinus.</p><p><b>METHODS</b>The clinical data were analyzed retrospectively for 36 patients with adenoid cystic carcinoma of the maxillary sinus to evaluate the treatment results of different modalities. The contribution of every factors influencing on survival were also analyzed. Survival analysis was performed by life table method, comparison among/between groups was performed using log-rank test, and multivariate analysis was carried out using Cox proportional hazard model.</p><p><b>RESULTS</b>The 5-year survival rate was 58.33% in all patients, while they were only 75.0% and 42.9% in stage III and stage IV lesions respectively. The 5-year survival rate of 66.7% was obtained in patients who received surgery combined with radiotherapy,71.4% and 12.5% respectively in those treated by surgery and by radiotherapy alone. Multivariate analysis indicated that stage, treatment modality, and the tumour residues in the primary treatment were the predict factors for the prognosis.</p><p><b>CONCLUSIONS</b>Advanced adenoid cystic carcinoma should be treated by combined surgery and radiotherapy. Stage, treatment approach and short-term therapeutic response are the most important factors affecting the prognosis of the patients with adenoid cystic carcinoma of the maxillary sinus.</p>

Prognostic analysis of moderate tongue squamous cell carcinoma cases and the value of induction chemotherapy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of induction chemotherapy on the patients with moderate tongue squamous cell carcinoma and to investigate the factors that influence prognosis of these patients.</p><p><b>METHODS</b>One hundred and twenty two patients with moderate tongue squamous cell carcinoma (stage II-III, T2-3 N0/T1-3N1), treated from Jan. 1990 to Dec. 1999 were retrospectively reviewed. Among them, 69 and 53 patients were received operation alone and operation after induction chemotherapy respectively [cisplatin + 5-fluorouracil + bleomycin-A5 (PBF), 17 cases; bleomycin-A5, 36 cases]. Survival rate was estimated by Kaplan-Meier method. Multivariate analysis by the Cox proportional hazard model.</p><p><b>RESULTS</b>The mean follow-time of all patients were (79.9 +/- 49.8) (x +/- s) months (range: 7 to 177 months), and 45 patients died (including 5 lost to follow up) , 66 of 77 patients alive followed more than 5 years. The overall 3-year and 5-year survival rate were 79.4% and 69. 0% respectively. The overall 3-year and 5-year free-disease survival rate were 71.7% and 66. 3% respectively. The survival rate of 3-year and 5-year was 82.5% and 73.1% respectively for the group of operation alone; 82.4% and 70.1% respectively for the group of operation after induction chemotherapy with PBF, 72.2% and 61.1% respectively for the group of operation after induction chemotherapy with bleomycin-A5; and there were no significant difference between the above three groups (chi2 = 0.42, P = 0.8106). The locoregional recurrence rate were 30.4%, 41.2% and 38.9% for the operation alone group, operation after PBF induction chemotherapy group and operation after bleomycin-A5 induction chemotherapy group respectively. No significant benefit on decreasing locoregional recurrence (chi2 = 1.148, P = 0.563) or distant metastasis rate (chi2 = 2.305, P = 0.316) were found by induction chemotherapy by univariate analysis. Using multivariate analysis, risk factor that independently influence survival was the recurrence.</p><p><b>CONCLUSIONS</b>Risk factors that independently influence survival of moderate tongue squamous cell carcinoma was the locoregional recurrence. No significant benefit on improving survival rate or decreasing locoregional recurrence or metastasis rate were found by induction chemotherapy, there was no difference between the two induction chemotherapy schemes on the survival rate or locoregional recurrence or metastasis rate of these patients.</p>

Value of elective neck dissection in patients with clinically stage I squamous cell carcinoma of the tongue / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To determine the value of elective neck dissection in patients with clinically stage I (cT1N0M0) squamous cell carcinoma of the tongue.</p><p><b>METHODS</b>This was a retrospective study of patients with surgical treatment between November 1984 and November 1999. A total of 130 patients were included in the study, all of whom received operation of the primary site, meanwhile, 99 of whom underwent elective neck dissection simultaneously including level I -III or level I -IV neck dissection in 20 patients and level I - V neck dissection in 79 patients. Results Among all these patients, the rate of occult metastasis to the neck were 12. 0%. Local failure rate in patients with only local treatment, level I II, II, III/IV neck dissection and level I - V neck dissection were 25. 8%, 15. 0% and 7. 6% respectively. There were significant difference in regional failure between patients with only local treatment and patients with elective neck dissection (P < 0.05). Also, no significant differences were noted in the survival rate between patients with only local treatment, elective neck dissection (level I -III or level I -IV) and level I -V neck dissection (P > 0.05).</p><p><b>CONCLUSIONS</b>Elective neck dissection significantly reduced regional control failure but was not able to reduce distant metastasis or increase the overall survival. A prospective randomized study is worthwhile to further evaluate the benefit of elective neck dissection in the treatment of clinically stage I squamous cell carcinoma of the tongue.</p>

Treatment and prognostic analysis of 92 cases with advanced mobile tongue squamous cell carcinoma / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To compare the results of different treatment modalities for the advanced tongue squamous cell carcinoma and investigate the factors that influence its prognosis.</p><p><b>METHODS</b>Ninety-two patients with advanced tongue squamous cell carcinoma without distant metastasis, treated in our hospital from Jan. 1990 to Dec. 1999 were retrospectively reviewed. Survival rate was estimated by Kaplan-Meier method, and multivariate analysis was performed by the Cox Proportional hazard model.</p><p><b>RESULTS</b>The overall 3-year and 5-year survival rates were 52.40% and 37.23% respectively. There was a significant difference in the overall between the two groups survival rate (chemotherapy only and radiotherapy after induced chemotherapy) and the three groups (operation only, operation after induced chemotherapy, radiotherapy after operation) cTNM stage, operation for the primary lesion and local recurrence were the independent factors that influenced the prognosis.</p><p><b>CONCLUSIONS</b>Risk factors that independently influence the survival of patients with advanced tongue squamous cell carcinoma were the local recurrence, cTNM and receiving operation or not for the primary lesion. Operation only or comprehensive therapy including operation could give a better prognosis, but the results of chemotherapy only or radiotherapy after chemotherapy were poor.</p>

Comparison of primary tongue carcinoma with second primary tongue carcinoma after radiotherapy for nasopharynx cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics and prognosis of second primary tumor of tongue (SPTr) after nasopharyngeal carcinoma (NPCR) treated with radiotherapy.</p><p><b>METHODS</b>Clinical data of 53 patients with SP7T after NPCR (group A) and 252 patients with primary tongue carcinoma (group B) were analyzed retrospectively with regard to clinical characteristics and survival rate (Kaplan-Meier); and multivariate analysis was performed using Cox proportional hazards model.</p><p><b>RESULTS</b>There was no significant difference between group A and group B ( P > 0. 05) in the presenting age, sex, tumor size, cTNM stage, tumor differentiation and the rate of distant metastasis. The overall 5-year survival rates were 41.6% in group A and 56.3% in group B (chi2 = 4.40, P = 0.0359) with a statistically significant difference between two groups. The differences of tumor location (chi2 = 61.18, P = 0.000) and rate of clinical (cN+, chi2 = 6.846, P = 0.009) or pathological lymph node metastasis (pN+, X2 = 3.993, P = 0.046) were also statistically significant between group A and group B, respectively. Multivariate analysis showed that age at presence, cTNM stage and with or without neck lymph node dissection were independent risk factors affecting survival.</p><p><b>CONCLUSION</b>Second primary tongue carcinoma after radiotherapy for nasopharyngeal carcinoma is likely to occur on the dorsal aspect of the tongue with worse prognosis but with a lower rate of lymph node metastasis than that of primary tongue carcinoma. However, radiotherapy history is not an independent influencing factor on prognosis. Surgical resection or combined modality therapy may give a better prognosis.</p>

Clinical report of 81 cases of multiple primary cancers in laryngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the clinical characteristics and the survival status of the patients with laryngeal squamous cell carcinoma in the multiple primary cancers (MPC).</p><p><b>METHODS</b>Follow-up and clinical data were analyzed retrospectively in 81 laryngeal squamous cell cancer patients with MPC among 1101 patients with laryngeal carcinoma. Survival analysis and every influencing factor on survival rate were performed by Kaplan-Meier method.</p><p><b>RESULTS</b>The occurrence rate of MPC in the patients with laryngeal squamous cell cancer was 7.4% (81/1101) in this report. Oral cavity carcinoma and nasopharyngeal carcinoma were the most common MPC in 29 cases (35.8%) in head and neck regions. MPC in head and neck regions were more often seen among patients who had treated with radiotherapy (chi2 = 5.7, P = 0.017). Lung carcinoma (25.9%, 21/81) and esophageal carcinoma (22.2%, 18/81) were the most common MPC in remote organs in 52 cases (64.2%). Thirty seven MPC cases (45.7%) were occurred in aerodigestive tract and 32 cases(39.5%) in respiratory tract in this series. Fourteen cases (17.3%) were synchronous MPC, the median time interval was 2 months. Other 67 cases (82.7%) were metachronous MPC, the median time interval was 28 months. The squamous cell carcinoma (66.7%) was the most common pathologic type among all MPC in 81 cases, which was more often seen among patients who had smoked and drunk (P = 0.007). The MPC of esophageal carcinoma and oropharyngeal carcinoma were more often seen among patients of supraglottic index cancer presentation (P = 0.04). The MPC of oral cavity cancers and nasopharyngeal carcinoma and lung carcinoma were more often seen among patients of glottic index cancer presentation (P = 0.006). The total three-and five-year survival rates were 45.2% and 29.7% respectively of all MPC patients, the five-year survival rate for patients (53 cases) who received actively different therapies for their MPC was 45.5%, obviously higher than that of untreated patients (28 cases) whose three-year survival rate was zero (P = 0.000).</p><p><b>CONCLUSIONS</b>Lung carcinoma and esophageal carcinoma were the most common multiple primary cancers among MPC of the laryngeal cancer. MPC of the laryngeal cancer in head and neck regions were more often seen among patients who had treated with radiotherapy. The pathologic type of squamous carcinomas of MPC was more often seen among patients who had smoked and drunk. MPC affected the prognosis of patients in laryngeal cancer largely. Treating effectively and in time could help to improve the survival rate of patients with MPC in laryngeal squamous cell carcinomas.</p>

Research of modified rat laryngeal transplantation model / 南方医科大学学报

<p><b>OBJECTIVE</b>To study modified rat laryngeal transplantation model.</p><p><b>METHODS</b>Eighty isogeneic histocompatible F344 rats were randomized into control and experimental groups. Strome model of laryngeal transplantation was established in the the control group, and in the experimental group, the ascending pharyngeal artery was preserved and the base of the tongue, larynx and pharyngolarynx were harvested as a complex allograft followed by end-to-end anastomosis of the both allograft common carotid arteries with the recipient common carotid artery and the anterior jugular vein, respectively. The arterial and nenous patency rate and allograft viability rate were compared between the two groups.</p><p><b>RESULTS</b>The artery and vein patency rates and graft survival rate were 30%, 15%, and 30% in the control group, and 75%, 65%, and 80% in the experimental group, respectively, showing significant difference between the two groups (P<0.05).</p><p><b>CONCLUSION</b>In modified rat laryngeal transplantation model, the allograft viability rate and vessel patency rate are improved, which provides a good model for immunological study of larynx transplantation.</p>

Treatment and prognosis of anaplastic thyroid carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment model and the factors that influence survival of the patients with anaplastic thyroid carcinoma (ATC).</p><p><b>METHODS</b>The clinical data of all patients with ATC in our hospital from May. 1970 to May. 2005 were analyzed retrospectively with regard to mortality and survival rate (Kaplan-Meier). Multivariate analysis was performed by the Cox proportional hazard model.</p><p><b>RESULTS</b>Fifty cases together were analyzed. The overall 1-year, 3-year, 5-year survival rate were 39.4%, 29.6% and 20.7% respectively. The median survival time was 6 months. Univariate analysis showed the patients with their age < 55 years old, without distant metastasis, white blood cell count < 10.0 x 10(9)/L at presentation, without receiving chemotherapy, receiving radiotherapy with the dose no less than 40 Gy, receiving multiple modality therapy had a better prognosis. White blood cell count at presentation, the model of therapy were the risk factors independently influencing prognosis by multivariate analysis.</p><p><b>CONCLUSIONS</b>White blood cell count at presentation, receiving surgery and postoperative radiotherapy or not were the risk factors independently influencing prognosis. The prognosis of anaplastic thyroid carcinoma was worse; the patients with ATC maybe get a better prognosis by receiving surgery and postoperative radiotherapy.</p>

Differentiated thyroid carcinoma in young people / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the factors that influence survival of the patients with differentiated thyroid carcinoma in young people and evaluate the efficiency of unilateral lobectomy plus isthmectomy with therapeutic cervical lymph node dissection and postoperative TSH (thyroid stimulating hormone) suppressive therapy.</p><p><b>METHODS</b>One hundred and thirty-one patients under 30 years old with differentiated thyroid carcinoma treated in this hospital (14 cases no more than and 117 cases more than 16 years) from Jan. 1st, 1985 to Dec. 31st, 1997 were retrospectively reviewed. One hundred and twenty-eight patients were received only surgery and TSH suppressive therapy, and 3 patients received chemotherapy or radiotherapy because of the progressive metastasis in necks or mediastina. A multivariate analysis was performed in these patients by the Cox proportional hazard model.</p><p><b>RESULTS</b>The mean follow-time (x +/- s) of all patients were (140.86 +/- 43.76) months, with range from 20 to 229 months; Ninety-eight patients followed more than 10 years. Ten patients died of thyroid cancer. The overall 10-year survival rate was 97.18%. The 10-year survival rate for patients < or = 16 years of age and > 16 years were 75.97% and 96.57% respectively (P = 0. 0006). The 10-year survival rate for women and men were 94.91% and 93.69% respectively (P = 0.5261). The 10-year survival rates of patients with papillary thyroid carcinoma and follicular thyroid carcinoma were 93.77% and 96. 55% respectively (P = 0.8137). For patients with tumor size of < or = 1 cm, 1-4 cm and >4 cm the survival rate was 100.0%, 96.40%, and 80.67% respectively (P = 0. 0589). The 10-year survival rates of patients with or without lymph node metastasis were 88.37% and 100. 0% respectively (P = 0.0313). For patients of with or without distant metastasis, The survival rate was 96.64% or 60.00% (P = 0.0000). The 10-year survival rates with or without recurrence were 86. 67% and 95.48% respectively (P = 0. 5681). Using multivariate analysis, risk factors that independently influence survival were distant metastasis, tumor size and age.</p><p><b>CONCLUSIONS</b>The distant metastasis, tumor size and age at diagnosis were the independent factors influencing survival significantly. The status of lymph node metastasis may have certain effect on the prognosis. Unilateral lobectomy plus isthmectomy with a therapeutic cervical lymph node dissection followed by postoperative TSH suppressive therapy is a favourable model to children and young adults with DTC without distant metastasis, but to the patients with distant metastasis, their prognosis of this therapy model is disappointing.</p>

Clinicopathological features and prognosis of postirradiation osteosarcoma in nasopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Post irradiation osteosarcoma (PIOS) in patients with nasopharyngeal carcinoma (NPC) is rare and a potential late complication of radiation. We investigate its clinicopathological features and prognosis.</p><p><b>METHODS</b>426 cases of bone sarcomas in Cancer Center of Sun Yat-sen University, China between 1964 and 2003 were reviewed retrospectively. Fifteen patients were determined to have PIOS after radiation of NPC. Its prevalence rate, onset time, site, image features, and treatment were described. Kaplan-Meier analysis was used to determine the relative prognostic factors.</p><p><b>RESULTS</b>In 12 patients undertaken radical surgery, one patient had residual tumor and six patients presented tumor recurrence five to 19 months (mean of nine months) after surgery. All patients survived seven to 41 months with a mean of 18 months. The one-year and two-year survival rates were 60% and 24% respectively. Female patients with large area of tumor bone formation in images had better survival than male patients without or few tumor bone formation. Age, radiation dosage, onset time of PIOS, tumor size, and treatment were probably not significant factors to prognosis.</p><p><b>CONCLUSIONS</b>PIOS in patients with NPC is a high malignant disease and often has poor prognosis. Surgery with pre-and post-operative chemotherapy might be a way to improve its survival.</p>

Second primary tumor of tongue after nasopharynx carcinoma radiotherapy: report of 53 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics of second primary tumor of tongue after nasopharyngeal carcinoma (NPC) radiotherapy and the prognostic factors of patients.</p><p><b>METHODS</b>Fifty-three cases with second primary tumor of tongue after NPC radiotherapy, presenting to Cancer Centre, Sun Yat-sen University from Jan. 1st 1975 to Dec. 31st 2000 were analyzed retrospectively with regard to mortality and survival rate (Kaplan-Meier method); A multivariate analysis was performed in these patients with Cox proportional hazard model.</p><p><b>RESULTS</b>Forty of 53 patients died. Among them,37 died of second primary tumor of tongue, 2 of recurrence of NPC, 1 of perioperative period. The overall 5-year and 10-year survival rate of 51 patients receiving therapy were 41.64% and 35.69% respectively. The subsites of tumor were: tip 0, margin 26 (49.06%), ventral lateral 8 (15.09%) and dorsal aspect 19 (35.85%). Eighteen cases had recurrence of second primary tumor of tongue (33.96%) ; Six (11.32%) cases had clinical lymph node metastasis from second primary tumor of tongue and 3 (5.66%) had pathological lymph node metastasis; The univariate analysis showed the major prognostic factors influencing survival of these patients were tumor size, clinical TNM stage at presentation; Using multivariate analysis, risk factors that independently influence survival were clinical and pathological stage and the interval between two tumors.</p><p><b>CONCLUSIONS</b>The clinical and pathological stage and the interval between two tumors are the prognostic factors for second primary tumor of tongue after NPC radiotherapy.</p>

Management option for cervical metastases in tongue squamous cell carcinoma with clinically N0 neck / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>This study was designed to explore the optimal management option for cervical metastases in tongue squamous cell carcinoma (SCC) with clinically N0 neck in order to avoid excessive or inadequate treatment in clinical practice.</p><p><b>METHODS</b>Clinical data of 327 cases of tongue SCC with cN0 neck were retrospectively analyzed. Neck control rates affected by different pathoclinical parameters were compared. Prognosis analysis and death analysis were also performed.</p><p><b>RESULTS</b>Overall 3-year survival was 69.7% (228/327), 3-year survival of neck recurrent group and non-recurrent group was 39.1% (25/64) and 77.2% (203/263), and 51.5% (51/99) of the death related to neck failure. Overall neck control rate was 80.4% (263/327); neck control rate of wait and watch group, level I neck dissection, level I + II neck dissection, supraomohyoid neck dissection, radical neck dissection, functional neck dissection, was 67.5% (27/40), 72.7% (24/33), 60.0% (15/25), 84.9% (45/55), 86.8% (131/151), 84.0% (21/25), respectively. Treatment modality and cervical lymph node involvement were independent factors for neck control.</p><p><b>CONCLUSIONS</b>Neck control is a key for prognosis of tongue SCC with cN0 neck. Supraomohyoid neck dissection is the first choice in management of cervical metastases in tongue SCC with cN0 neck, during which the suspected involved lymph nodes should be sent for frozen section to determine whether comprehensive neck dissection required. Multimodal metastasis and/or capsular spread are the indications for postoperative irradiation.</p>

Surgery for the recurrent and persistent lymph node of nasopharyngeal carcinoma after radiotherapy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVES</b>To investigate the effect of four types of neck dissections for the recurrent and persistent lymph nodes of NPC after radiotherapy.</p><p><b>METHODS</b>The clinical data of 88 cases of nasopharyngeal carcinoma with recurrent and persistent lymph nodes after radiotherapy were analyzed retrospectively, the 5-year survival rate, recurrent rate, distant metastatic rate and surgical complications were analyzed. The survival rate and recurrent rate of the radical neck dissection (RND), modified radical neck dissection (MRND), selective neck dissection (SND) and lymph node resection (LNR) were compared. The survival and recurrent rate between those with and without postoperative radiotherapy were investigated as well.</p><p><b>RESULTS</b>The 5-year survival rate and recurrent rate of whole group were 42.8% and 22.7%, respectively. As for the patients with disease staged II, III, IV, the 5-year survival rates were 56.7%, 36.1% and 32.4%, respectively. The 5-year survival rate of groups of RND, MRND, SND and LMR were 39.8%, 60.0%, 37.9% and 44.1%, respectively, the differences were insignificant (Log Rank = 1.0, P = 0.8011), the recurrent rate of the lymph node among the 4 groups were insignificant either (chi2 = 0.470, P = 0.493). The 5-year survival rates of those with and without postoperative radiotherapy were 39.1% and 45.3%, respectively, the differences were insignificant (Log Rank = 0.06, P = 0.8138), the recurrent rate of the two groups were insignificant (chi2 = 0.593, P = 0.441).</p><p><b>CONCLUSIONS</b>The four types of neck dissection were effective and safe to control the recurrent and persistent lymph nodes in the neck after radiotherapy, as long as choosing patients rationally and gave postoperative radiotherapy if necessary.</p>

Clinical research of sentinel node biopsy in oral tongue carcinoma / 中华口腔医学杂志

<p><b>OBJECTIVE</b>This study was designed to evaluate whether sentinel node (SN) biopsy can accurately assess the cervical lymph node status of oral tongue carcinoma, as well to research the best method and indications of SN biopsy.</p><p><b>METHODS</b>Preoperative lymphoscintigraphy with (99m)Tc-SC and intraoperative sentinel node mapping with methylene blue dye were administered on 20 cases of oral tongue carcinoma with cN(0) neck and 5 cases with cN(+) neck; routine pathological examination was used to assess the status of SNs. The results of routine pathological examination of cervical specimen were set as golden standard to assess the efficacy of SN biopsy in evaluating the cervical lymph node status.</p><p><b>RESULTS</b>53 SNs were detected in 24 cases out of the total 25 cases (96%), averaging 2.2 SNs per case. SNs were detected in all 20 cases with cN(0) neck, in which 4 cases with occult cervical metastasis were detected by SN diopsy, without false negative case found in the procedure. In 5 cases with cN(+) neck, SNs were detected in 4 cases. In 4 cases whose SNs were detected, there were 5 cN(+) necks, out of which SNs were detected in 4 cN(+) necks but failed to predicted the cervical lymph node status in 2 necks. However, SNs were detected in 2 out of the other 3 cN(0) necks, both of which were diagnosed as SN(+)pN(+).</p><p><b>CONCLUSIONS</b>Nuclear lymphoscintigraphy and blue dye mapping can be used to trace the SNs in cases with oral tongue carcinoma, with satisfactory detective rate. SN biopsy can accurately evaluate the cervical lymph node status in cases of oral tongue carcinoma with cN(0) neck. Whether it can be used to evaluate the lymph node status of the cN(0) neck in case with a contralateral cN(+) neck is worthy of further research.</p>